急性病房人員對技術混合照護模式之工作感受及相關因素調查

A Survey Study of Acute Care Staff's Work Perception of Skill-Mixed Care Model and the Related Factors

10.29494/LN.201812_19(4).0003

楊佩瑄(Pei-Hsuan Yang)；陳幼梅(Yao-Mei Chen)

急性病房 ； 護理佐理員 ； 技術混合照護模式 ； 工作感受 ； acute care ward ； nurse aids ； skill-mixed care model ； work perception

領導護理

19卷4期（2018 / 12 / 01）

21 - 40

繁體中文

台灣醫療環境因應健保支付制度改變的各項策略，使護理師工作量及壓力遽增，影響護理人力留任，因此全國醫療機構的共同目標是建立護理友善職場，運用技術混合照護模式將工作分級，以降低護理人員工作負荷。本研究目的在調查同仁對技術混合照護模式之工作感受及相關因素，以供制度推動參考。本研究採描述相關性調查設計，於2017年12月13日至31日，以方便取樣選擇南部某醫學中心急性病房護理師及護佐進行結構式線上問卷調查。以JMP13.0統計套裝軟體，分析研究對象回答之工作頻率、個人屬性、以及對技術混合照護模式之工作感受。結果顯示肝膽內科及血液腫瘤內科病房護理師之工作感受最為正向；絕大多數護佐和護理師自覺工作項目頻率相當；顯著差異出現在護佐自覺執行較多衛材盤點更換、檢查輸送前準備及維護病人活動安全，執行較少更換清潔尿套或人工肛門袋。護理師委派頻率高的庶務性工作包括協助住院需求補給、衛材物料及文件單張的補給，技術性工作則以病人清潔及翻身舒適為主。絕大多數研究對象認同技術混合照護模式，且認為應該推廣。建議機構主管應參考病房屬性、病人照護需求及病室周轉率之差異，作為排班與分派護佐人力之依據，才能有效降低護理師工作負荷，使技術混合照護效益極大化

Taiwanese medical environment has adopted various strategies against the changing payment policies of National Health Insurance. As a result, nurses' workload and stress level have increased and thus affect nurse retention. Medical institutions around the world have made efforts to establish a positive workplace for nurses by applying skill-mixed care model to reduce workload. The purpose of this study is to investigate acute care staff's work perception and the related factors of skill-mixed care model. The results would provide advices for future model development. A descriptive-correlational study design and convenience sampling were used to collect data, from 13th to 31st of December in 2017, in a medical center of southern Taiwan. The structured questionnaires were applied online and 128 nurses and 6 nurse aids were surveyed for the frequency of assigned tasks, their work perception, and personal characteristics. Data were analyzed by using JMP 13.0 statistical software package. The results showed that nurses in hematology/oncology ward and hepatobiliary ward had more positive work perception of skill-mixed care model. Among all tasks, most were reported comparable between nurses and nurse aids. Yet, nurse aids reported more frequently assigned for inventory control of medical supply, preparing patients for transporting outbound, and preventing potential activity safety hazard, but less on changing urinary bags. The most frequently assigned general affairs by nurses were supporting admission need and supplying, medical devices and documentation; whereas major technical tasks are keeping patient clean, comfortable, and appropriate positioning. The majority of nurses and nurse aids supported and agreed to introduce the model widely to all inpatient wards in the hospital. Hospital administrators are suggested to plan the allocation and arrange the shift schedules of nurse aids in accordance with patient care requirements, turnover of beds, and features on each ward. The ultimate goal is to downsize the nonprofessional workload of nurses and to maximize the effectiveness of the skill-mixed care model.

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