一般護理之家照護標準作業流程項目需求探討

Importance-performance analysis for the evaluation of care standard operating procedures in Taiwan nursing homes

10.6288/TJPH.202002_39(1).108101

梁亞文(YIA-WUN LIANG)；林育秀(YU-HSIU LIN)；蘇侰寧(CHUN-NING SU)

一般護理之家 ； 照護 ； 標準作業流程 ； 重要－表現分析法 ； nursing home ； caring ； standard operating procedure ； importance-performance analysis

台灣公共衛生雜誌

39卷1期（2020 / 02 / 26）

90 - 101

繁體中文

目標：本研究旨在探討臺灣一般護理之家對照護標準作業流程的重要性及需要性，作為政府協助擬訂照護標準作業流程項目的優先順序參考。方法：本研究為一橫斷性研究，以結構式問卷調查一般護家管理者對照護標準作業流程項目的重要性及需要性認知。統計分析先以成對樣本t檢定檢視受調查者對照護標準作業流程項目的重要性及需要性認知間是否存在顯著差異，再以「重要-表現分析法」探討重要性高需要性高的項目。結果：53個照護項目中有34個項目之重要性顯著高於需要性；31項照護項目落在第一象限（重要性高需要性高），應列為優先考量訂定照護標準作業流程的項目。結論：一般護家照護標準作業流程可強化護理人員及照顧服務員提供完整、正確的照護，達到照護有效性以及降低變異性。本研究發現一般護家重要性高且需要性高的照護標準作業流程項目，且發現需求項目因規模而有不同，主管機關可依研究結果，考量規模因素，制定公版流程供一般護家參考，提升住民照護品質。

Objectives: The aim of this study is to identify and prioritize standard operating procedures (SOPs) for nursing home care based on the perceptions of their importance and desirability reported by nursing home administrators. Methods: This was a cross-sectional study. Structured questionnaires were used to measure the perceptions of importance and desirability toward SOPs for care among nursing homes administrators. A paired t-test was used to test the differences between the administrators' perceptions of the importance and desirability of these SOPs. Importance-performance analysis (IPA) was adopted to explore the ＂concentrate here＂ items for further improvement. Results: For 34 SOPs, the perceived importance was significantly higher than the perceived performance. In quadrant I items (i.e., concentrate here), administrators perceived SOPs as highly important, and perceptions of desirability were above average, indicating that these SOPs required the greatest attention. Conclusions: Nursing home SOPs not only ensure that nurses and nursing assistants provide complete and accurate nursing home care but also improve the care effectiveness and reduce the care variability. This study revealed that the nursing home scale affects the SOP desirability. The results are useful for identifying areas for strategic focus to facilitate the development of SOPs for nursing home care.

1. 周繡玲, HL,楊立華, L,馮容芬, RF(2009)。建立傷口照護標準─以壓瘡傷口為例。亞東學報，29，243-256。
   連結：
2. 梁亞文, YW(2018)。台灣一般護理之家評鑑：十年回顧與展望。台灣衛誌，37，615-625。
   連結：
3. 謝汶鈺, WY,薛雅云, YC,李芳菁, FC(2017)。護理之家感染密度改善專案。彰化護理，24，39-47。
   連結：
4. Nursing Home Alert. Federal Nursing Home Regulations and State Laws. Available at: http://www.nursinghomealert.com/federal-nursing-home-regulations-and-state-laws. Accessed May 1, 2019.
5. Castle, NG,Anderson, RA(2011).Caregiver staffing in nursing homes and their influence on quality of care: using dynamic panel estimation methods.Med Care,49,545-552.
6. Cherubini, A,Eusebi, P,Dell’Aquila, G(2012).Predictors of hospitalization in Italian nursing home residents: the U.L.I.S.S.E. project.J Am Med Dir Assoc,13,84.e5-84.e10.
7. Department of Health, Social Services and Public Safety. Care standards for nursing homes. Available at: https://www.rqia.org.uk/RQIA/media/RQIA/Resources/Standards/nursing_homes_standards_-_april_2015.pdf. Accessed August 22, 2019.
8. Donabedian, A.(1985).The Methods and Findings of Quality Assessment and Monitoring: An Illustrated Analysis.Ann Arbor, MI:Health Administration Press.
9. Horn, SD,Buerhaus, P,Bergstrom, N,Smout, RJ(2005).RN staffing time and outcomes of long-stay nursing home residents: pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care.Am J Nurs,105,58-70.
10. Intrator, O,Castle, NG,Mor, V(1999).Facility characteristics associated with hospitalization of nursing home residents: results of a national study.Med Care,37,228-237.
11. Matzler, K,Bailom, F,Hinterhuber, H,Renzl, B,Pichler, J(2004).The asymmetric relationship between attribute-level performance and overall customer satisfaction: a reconsideration of the importance-performance analysis.Ind Market Manag,33,271-277.
12. Mikulić, J,Prebežac, D(2008).Prioritizing improvement of service attributes using impact range-performance analysis and impact-asymmetry analysis.Manag Serv Qual,18,559-576.
13. Ministry of Health, Singapore. Enhance nursing home standards. Available at: http://policy.nl.go.kr/cmmn/FileDown.do?atchFileId=107155&fileSn=2881. Accessed August 22, 2019.
14. Myers, J(2001).Measuring Customer Satisfaction: Hot Buttons and Other Measurement Issues.Chicago, IL:American Marketing Association.
15. Shieh, JI,Wu, HH(2009).Applying importance-performance analysis to compare the changes of a convenient store.Qual Quant,43,391-400.
16. 朱芳業, FY(2011)。標準化在醫療產業的應用。亞東醫院品質季刊，3，10-13。
17. 吳麗鴻, LH,吳美娟, MC(2008)。運用品管手法改善疥瘡院內感染。秀傳醫學雜誌，8，101-113。
18. 李美華（譯）, M(1998).社會科學研究方法.台北=Taipei:時英出版社=Taiwan Elite Press.
19. 胡月娟, YJ,江蕙娟, HC,林豐裕, FY(2014)。護理之家住民口腔照護指引的建立與成效評值。護理暨健康照護研究，10，143-153。
20. 許雪貞, HC,莊素完, SW,李順倫, SL(2006)。提升某加護中心壓瘡癒合率之專案。護理雜誌，53，44-51。
21. 陳玉枝, YC,郭淑瑜, SY,林麗華, LH,簡淑芬, SF(2008)。實施護理人員「跌倒防範教育」對跌倒事件知識、態度及行為之探討。榮總護理，25，12-20。
22. 陳材旭, TH(2010)。嘉義=Chiayi，國立中正大學企業管理所=Department of Business Administration, National Chung Cheng University。
23. 陳真慧, CH,鄭玉玲, YL,陳雅紅, YH,洪彩雲, TY,李華蘭, HL,陶耀華, YH(2007)。降低加護病房病患壓瘡發生率之改善方案。源遠護理，1，34-47。
24. 蔡佳吟, CY,侯淑英, SY(2010)。精神科急性病房預防跌倒改善專案。精神衛生護理雜誌，5，29-39。
25. 衛生福利部：一般護理之家評鑑專區。http://webcare.twaea.org.tw/。引用2019/05/01。Ministry of Health and Welfare, R.O.C. (Taiwan). Evaluation of general nursing homes. Available at: http://webcare.twaea.org.tw/. Accessed May 1, 2019. [In Chinese]
26. 衛生福利部統計處：105年醫事機構現況及服務量統計年報。https://dep.mohw.gov.tw/DOS/cp-3555-37237-113.html。引用2019/08/17。Department of Statistics, Ministry of Health and Welfare, R.O.C. (Taiwan). 2016 statistical analysis of the status and service volume of medical institutions. Available at: https://dep.mohw.gov.tw/DOS/cp-3555-37237-113.html. Accessed August 17, 2019. [In Chinese]
27. 賴惠玲, HL,吳淑瓊, SC,江東亮, TL(1996)。城鄉及兩代間對護理之家看法的先驅性研究。護理雜誌，43，55-63。
28. 羅春月, CY(2009)。新北市=New Taipei City，真理大學管理科學研究所=Aletheia University。
29. 藺寶珍, PC,楊美賞, MS,陳彰惠, CH(2005)。提升長期照護機構的給藥安全。長期照護雜誌，9，193-203。