- 學位論文
健康促進醫院認證對護理人員健康相關指標 及工作績效之影響
Impact of the Health Promoting Hospital Accreditation on nurses’ health-related indicators and job performance
摘要
目的 健康促進醫院旨在營造「健康促進」的支持性環境，不但能提供有品質的健康照護服務給有需要的病患及社區居民，也希望能提供有利健康的支持性環境給院內員工。在這過程中，擔任核心服務的醫護人員不但是「健康促進醫院」概念的推行者，也應是此一概念活動的受惠者，但未有實證資料顯示取得認證醫院之護理人員的健康行為、健康狀態及工作績效是否與未取得認證者有明顯差異。 方法 本研究以立意抽樣方式，選取14家（有取得認證、未取得認證者各7家）署立醫院之護理人員為研究對象。資料收集採郵寄問卷方式，於2009年5月至2009年8月間，郵寄420份，回收389份有效問卷（回收率92.6%）。問卷內容除個人基本屬性，主要包括健康行為、健康狀態與工作績效等量表。健康狀態量表之資料先以特定軟體加以整理並計算生理健康及心理健康構面分數，再採用SPSS 12.0進行描述性統計與研究假設檢定。此外，利用階層迴歸分析檢測「有無取得認證」在護理人員健康行為（或健康狀態、工作績效）預測模式之貢獻程度。 結果 兩組護理人員除了宗教信仰及值班狀況有明顯差別外，其他人口學變項相近。在醫院屬性方面，取得認證者有5家為教學醫院、2家為非教學醫院；未取得認證者有3家為教學醫院、4家為非教學醫院。整體而言，受訪護理人員之健康行為、健康狀態及工作績效得分，經標準化後分別為65.4、72.3及74.7。進一步就有無取得認證加以比較，發現未取得認證者在三項量表總體及部分構面之得分普遍較高，其中健康行為及健康狀態達統計上顯著差異（p< 0.05）。在階層迴歸分析中，「有無取得認證」對生理健康構面預測力之貢獻達顯著程度（p< 0.05），在其它預測模式中則無顯著貢獻。 結論與建議 兩組醫院護理人員個人屬性相近，且健康行為與健康狀態及工作績效成正相關。值得注意的是，在健康指標及工作績效方面，未取得認證者普遍較佳，推測可能原因為醫院取得認證後反而疏於推廣及執行健康促進相關活動；相對地，未取得認證之醫院受到行政院衛生署相關鼓勵計畫之影響，反而較為重視與積極舉辦相關活動。如何促進醫療人員的健康行為，使其保持最佳的健康狀況，進而提供最專業的醫療照護，將成為現今政策制定者及醫院經營者當務之急。也建議相關單位在推動「健康促進醫院」認證上，應仿照醫院評鑑制度，每隔數年評核一次，持續監督取得認證醫院確實執行健康促進活動之成效，以免造成醫院營造健康促進環境上之鬆懈。
並列摘要
Objectives Health-promoting Hospitals are intended to create a supportive environment for health promotion, within which through quality healthcare services are provided not only to patients and community residents in need, but also to the employees who help provide. In this process, medical personnel are both the core actors and the beneficiaries of the devotion of “Health-promoting Hospital.” However, no previous empirical evidence has examined if a significance difference exists between nursing personnel in hospitals with or without a health-promoting hospital accreditation, in terms of their health-promoting behaviors, job performance, and health status. Methods In the study, a purposive sampling approach was adopted. The participants are nursing personnel from the fourteen selected regional hospitals (seven possessing the accreditation and seven not). 420 questionnaires were mailed to the participants during the time period from May, 2009 to August, 2009, and 389 copies were collected (92.6%). In addition to demographic characteristics, the questionnaire includes instruments on health-promoting behaviors, health status and work performance. The scale response to health status is first recoded to calculate the scores for the physical component scale and mental component scale, respectively; then SPSS 12.0 is used to carry out the descriptive statistics and hypothesis testing. Furthermore, a hierarchical regression is adopted to examine the effect of health-promoting hospital accreditation on the health-promoting behaviors, health status and work performance of nursing personnel, respectively. Results The two surveyed groups are similar on demographical variables except for on religion and work arrangement. Concerning the attributes of hospitals, among the hospitals with the accreditation, five of them are teaching hospitals and two not, while among the hospitals without the accreditation, three are teaching hospitals and the other four not. Overall, the scores on health-promoting behaviors, health status and work performance of the participants are 65.4, 72.3, and 74.7, respectively, after standardization. On in-depth examination shows that participants in hospitals without accreditation have higher scores on the three instruments with significant differences on both health-promoting behaviors and health status (p< 0.05). In the hierarchical regression, the effect of “having the accreditation or not” on physical health aspect is found significant (p<0.05), while not significant on other aspects. Conclusion and Suggestion To sum up, the two groups of nursing personnel share similar attributes and health-promoting behaviors are positively correlated to health status and work performance. It is worth noting that, participants from the non-accredited hospitals generally have higher scores on health indicators and work performance. The possible reason is that hospitals may become inactive on supporting and implementing related activities of health promotion after acquiring the accreditation. On the contrary, the non-accredited hospitals may put more effort into the project of health promotion under the encouragement of the Department of Health, Executive Yuan. It is an urgent task of the policy makers and hospital administrators to enhance the health-promoting behaviors of the medical personnel so that they remain in the optimal health status and thus provide professional services. This research also suggests that the authorities should conduct regular accreditation every few years on the health-promoting hospitals, so as to ensure the effectiveness and constant devotion of the accredited hospitals in creating a health-promoting environment.