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    题名: 護理技術組合對病人照護結果之影響評估
    Effect of Nursing Skill Mix on Patient Care Quality
    作者: 蔣佩芳;Pei-Fang Chiang
    贡献者: 公共衛生學院環境醫學研究所碩士班
    关键词: 護理技術組合;病人照顧結果;護理人力配置;照顧服務員;nursing skill mix;patient care outcome;nursing manpower deployment;care giver
    日期: 2010
    上传时间: 2010-09-29 12:03:11 (UTC+8)
    摘要: 研究目的：國際研究顯示醫院護理人員照護病人數過多將提高醫療風險，人員於標準外多照顧一位病人，其入院30天內死亡與來不及搶救的機率皆增加至7%。台灣衛生署從2003年起也推動各項照護計畫，以提升照護品質。本研究目的為調查國內醫院護理人力配置現況，藉此探討加入照顧服務員是否為增進病人照護品質之配置方式。
    研究方法：調查衛生署97、98年度全責照護計畫中，5家試辦醫院的三個試辦病房和五個非試辦病房之病房，利用病房班報表，針對護理人力配置、病人嚴重度與住院病人結果，觀測每一病房的各班別一至兩個月，並利用零膨卜松迴歸模型進行實證分析，以檢視護理技術組合模式（Nurse Skill Mix Model）對病人照護結果的影響。
    結果：回收護理人員協助填寫之病房班報表1572份，有效問卷1471份。以8項失誤發生總人次衡量護理照護結果，發現提高護理工時、增加護理人員數可減少負面照護結果發生數，而增加計畫聘任照顧服務員比例，並未顯著減少負面事件，可能是計畫聘任照顧服務員所佔比例過低導致。
    結論：較高的護理工時及較多的護理人員數有助於減少負面照護結果，顯示在護理人力配置中，護理人員為不可或缺的人力資源，應藉提高護理人員數降低負面照顧結果，進而提升照護品質。

    Abstract

    Aims: Studies have shown concerns of hospital under staffing of nurse care for patients and the increase of medical risk. One nurse less than the standard care ratio, the likelihood of mortality and the odds of failure-to-rescue may increase for 7% within 30-day admission. The Department of Health (DOH) in Taiwan implemented several nursing care programs to improve the care quality. This study aimed to investigate the nursing manpower among hospitals, and to explore whether the affiliation of additional lay care giver improved patient care quality.

    Methods: We conducted a comparison study between 3-study wards and 5 non-study wards in 5 hospitals for “the total nursing health care program of DOH”. We used the nursing station reports to observe the nursing manpower deployment, patient severity, and patient outcome for one or two month.

    In the meanwhile, we used the zero-inflated Poisson regression model to conduct empirical analysis, and to check the effect of nursing skill mix model on patient care outcome.

    Result: A total of 1471 eligible questionnaires were collected from nurses and analysed. We measuring the nursing care outcome by measuring the 8 job-related mistakes. We found that raising work hours and number of nurses had reduced the negative patient outcomes. On the other hand, the lay care givers could not decrease negative outcomes.

    Conclusion: In the ward with more nurses and more work hours, the negative outcomes are decreased. Nurses are important manpower to improve the quality of care. We should enhance the number of nurse besides keeping the original to reduce negative outcome, and improve care quality.

    Key words: nursing skill mix, patient care outcome, nursing manpower deployment, care giver
    显示于类别:[環境醫學研究所(已停用)] 博碩士論文

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