| 摘要: | 背景及動機
我國老年人口快速成長導致長期照顧的需求增加，而照顧服務員(以下簡稱照服員) 之人力需求不容忽視。目前長期照顧機構(以下簡稱長照機構)在不同的體系管理及住民需求的差異下，機構內所需的照護能力也須有所區隔；加上機構管理者對照服員工作委派可能產生差異，因此照服員所提供的工作內容需明確規範。
研究目的
瞭解長照機構特性、員工特性及長照機構管理者所評估之照服員工作內容獨立性，並探討可能影響長照機構照服員工作內容獨立性之相關因素。
研究方法
以結構式問卷為研究工具(Cronbach’s α值0.83)，機構管理者為觀察單位(observation unit)進行橫斷式調查，問卷回收163份。以單變項統計分析(平均值、標準差、變異係數等)描述機構負責人或護理長以管理者角度所評估理想之照服員工作內容(生活、技術、管理、醫療及社會五大構面)獨立性。雙變項統計分析包含t檢定、GLM及皮爾森相關係數。
研究結果
管理者在生活照顧方面給予照服員最高的工作獨立性，其次為社會需求之照顧、管理相關活動、醫療服務活動與技術性護理活動。其中，技術性護理活動較缺乏共識。平均佔床率與生活照顧呈顯著相關(P=0.047)，而機構經營型態(P=0.01)和照服員總人數(P=0.043)皆與技術性護理活動呈顯著相關；機構縣市老年人口比率亦與技術性護理活動呈顯著負相關(P=0.047，r=-0.156)；實際開放床數(P=0.042)、照服員總人數(P=0.039)、專職照服員人數(P=0.044)和現有住民數(P =0.043)皆與醫療服務活動呈現顯著相關。
結論
機構規模越小，管理者對於照服員的工作獨立性期待較高，可能因人力較缺乏所致。建議政府應重視機構管理者的角度，考量機構特性的差異，以作為法規修改增訂之參考依據。其中尤需檢視規模較小之長照機構工作委派，加強訓練照服員可執行之照護活動，並於未來制定照服員工作規範或發展照服員分級證照制度。建議機構管理者進行策略性人力資源管理及組織間策略聯盟，透過有效管理避免照護人力不足；亦可建立照服員工作說明書，避免由照服員替代專業人力，因而影響照護品質。
Background
The need for long-term care is increasing as elderly population in Taiwan grows rapidly. Therefore, the manpower demand for nursing aides is noticeable. Currently, the different categories of long-term care institutions are managed by the separate authorities, and the required ability of care needs to be differentiated due to the different needs of residents. Furthermore, the discrepancies of the ideal job contents performed by nursing aides may be created during job delegation initiated by the managers in long-term care institutions. Therefore, job descriptions that were provided to nursing aides should be specific.
Objectives
This thesis examined the characteristics of long-term institutions, employees, and job content independence of nursing aides evaluated by the managers of long-term care institutions. Factors associated with job content independence of nursing aides in long-term care institution were also discussed.
Methods
This cross-sectional research used a structured questionnaire (Cronbach’s α=0.83) as research instrument, and institutional manager as observation unit. In total, 163 valid samples were collected. Univariate analysis, such as frequency, mean, SD, C.V. etc., was used to describe job content independence (five domains: daily living, technical nursing, management, medical care, and social living) of nursing aides that were evaluated by institutional superintendent or nursing head as a manager of the long term care institution. Bivariate statistics were also used, which include t-test, GLM, and Pearson correlation coefficient.
Results
The daily living domain received the highest score of job content independence from the managers, and followed by social living, management, medical care, and technical nursing. Among the five domains, the domain of technical nursing showed the greatest variation in ideal job independence. In the daily living domain, only occupancy rates showed significant difference (P=0.047). In the technical nursing domain, type of institution and total number of nursing aides were two items showing significant differences (P=0.01, and P=0.043, respectively). There was a statistically significant negative association between the rate of elderly population in county and the technical nursing domain (P=0.047, r=-0.156). Actual number of beds (P=0.042), total number of nursing aides (P=0.039), number of full-time nursing aides (P=0.044), and number of residents (P=0.043) showed significantly differences, respectively, in the medical domain.
Conclusion
As the scale of long term care institution became smaller, ideal job content independence evaluated by manager would be higher, possibly because of lacking manpower and relevant regulations in institutions. The results of the present study suggest that the authorities should value the viewpoint of long term care managers and consider the differential characteristics of the institutions as a basis of regulation amendments. The authorities should examine the job delegation in small-scale long term care institutions, strengthen the training in terms of care activities of nursing aides, and in the near future, establish the job regulation or issue the license certification for nursing aides. It is suggested that the long-term care managers may adopt strategic human resource management, and affiliate across institutions to effectively diminish insufficiency of care manpower. It is also noted that authorities need to specify job tasks of nursing aides through formulating the job specification for nursing aides in order to raise their care quality. |
