近年來護理人力不足是一項重要的全球議題,國內的醫療機構更是為了因應全民健保,護理人力的彈性運用成了重要的策略。然而國內有關護理人力研究較少探討護理人力的運用對病人照護結果之影響,有鑑於此,本研究目的為探討台灣的護理人力概況並了解護理人員背景、護理工作負荷及工作環境對病人照護品質之影響。 研究方法採簡單隨機取樣,收案對象以中部某醫學中心及某地區教學醫院內、外科病房之護理人員及病人家屬為研究對象,問卷各發放225人次,問卷內容包含護理品質之結構面(護理人力組合、護理時數)、過程面(護理評估、護理計畫及感染控制)及結果面(病人滿意度及照護結果指標)、工作環境及工作負荷等,另外由護理長提供14個護理單位的護理品質結果相關數據資料,用以分析護理站之整體照護品質。將問卷結果建檔,以SPSS 17.0版分析結果,使用描述性統計、t檢定、單因子變異數分析、皮爾森相關係數統計方法分析,以了解護理人力對病人照護品質成果之影響。 研究結果顯示護理人員的年齡、年資、職級越高,其在照護品質之過程面較為完整;年齡、年資、職級、教育程度對品質結果面有顯著差異;在工作負荷部份,護理人員每日工作時數、休假天數、每班的照護病人數對照護品質過程面、結果面及病患滿意度有顯著差異;在工作環境部分,薪資、工作成就、繼續教育、績效考核對於品質過程面達正相關。另外,在護理站整體照護品質的分析結果顯示:工作負荷部分,包含單位佔床率越高其感染率越高;單位佔床率及照護病人的依賴程度越高,其照護滿意度則越低。 本研究結果可作為醫療行政單位制定合理護理人力配置時的考量,亦可提供臨床護理主管人力運用與工作分派之依據,以及提升護理照護品質之參考。
Nursing shortage has become a worldwide issue in recent years. In order to implement the National Health Insurance system, flexible manpower management has become an important strategy for many medical institutions in Taiwan. However, very few studies have focused on the impact of nursing manpower management on patient health care. Therefore, this study presents an overview of nursing manpower in Taiwan and discusses the effect of nursing factors, including the background of nurses, workload, and work environment, on the quality of patient health care. A random sampling method was used in this study, which recruited nursing staff and patients’ family members from the internal and surgery wards of a medical center and a local teaching hospital in central Taiwan. Questionnaires were completed by 225 participants, the questions in which covered the aspects of structure (nursing manpower coordination and total working hours), process (nursing assessment . nursing care plan and infection control ) and outcome (patient satisfaction and care outcome indicators), workload and working environment. In addition, the overall quality of patient care was analyzed for each nursing station using data provided by the head nurse of each of the 14 stations. The data collected from the questionnaires were analyzed by descriptive statistics, the t-test, one-way ANOVA, and Pearson’s correlation using SPSS 17.0 software, and the results were then used to assess the impact of nursing manpower on the quality of patient health care. The results showed that nurses of greater age, experience and ranking achieved better patient health care. Age, experience, ranking and education had a significant impact on the quality of patient health care. In terms of nursing workload, daily work hours, vacation days, and the number of patients cared for on each shift had significant effects on process outcome. Regarding working environment, salary, work achievements, continuing education, and performance evaluation were positively correlated with the quality of patient health care. In addition, based on analysis of the overall quality of patient health care at each nursing station, the data associated with workload showed that wards with higher average bed occupancy rates had a higher patient infection rate, and in wards with higher bed occupancy rates and a higher patient dependency, patient satisfaction was lower. The findings of this study may improve the quality of nursing health care, as the results can be used to recommendations for the medical administration authority when considering revision of the minimum nurse staffing standards. The findings can also serve as a useful reference for nursing coordinators when managing nursing manpower and task allocation.
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