| 摘要: | 本研究為探討技術混合照護模式實施後，護理人員自覺角色功能與護理活動改變情形，與其工作壓力相關變項和病人照護品質之相關性。本研究對象為三間全責照護模式試辦醫院內科病房護理人員共39位，以結構式問卷進行橫斷式研究，於全責照護模式實施後6個月進行調查，以了解護理人員自覺角色功能與護理活動改變情形。病人照護品質改變情形採單組前後測、類實驗性研究設計，探討技術混合照護模式實施前後各6個月中，每個月之病人照護品質指標的差異情形。結果顯示技術混合照護模式實施後，護理人員自覺其擔任教育者、督導管理者、領導者、委派者等角色功能增加；執行病人照護基本需求，例如協助病人翻身、維持身體清潔等直接護理活動減少；指導與確認輔助人員照護工作正確性與完整性、交班時間等間接護理活動增加；參與在職教育、會議等相關護理活動增加；工作壓力、憋尿情形增加。病人照護品質部份，護理人員自覺病人被重複確認及整體照護品質增加；病人照護品質指標中，唯有中部醫院試辦單位之病人跌倒率呈顯著減少。此研究結果中護理人員角色功能、護理活動、工作壓力，及病人照護品質於技術混合照護模式實施後的改變情形，可作為台灣醫療院所護理實務模式之參考。
The purpose of this study is to investigate the relationships among nurses’ perception of change in their role function, activities, nurse work stress, and patient care quality in a skill- mixed model. Participants were 39 registered nurses whose nursing work had been performed skill-mixed model for 6 months in 3 medical wards of hospitals. A self-report questionnaire was designed for this cross-section study. The changes of patient quality were focused on patient care index data which were gathered 6 months before and after the skill- mixed model, which is a pre-post test, quasi-experimental, study design. The results of this study revealed that nurses’ perception of nurse role function increased, such as educator, supervisor, manager, delegator, and leader. The nursing direct activities decreased, especially in helping patient change position, taking a bath, and changing diaper. On the other hands, the nursing indirect, relative, and personal activities increased, including conducting nursing assistant about skills of health care, confirming their work, certifying their document, time of duty shift, participating meeting and continuous education. Moreover, nurses’ perception of work stress, checking patient multiply, and patient care quality increased. The change of patient care quality was found in one index of the patient fall rate which was decreased significantly in one hospital. This study presented the nature of changes of nurses’ role function, activities, nursing work stress, and patient care quality in the skill-mixed model in Taiwan. The results of this study will serve as a reference model for nursing practice in the hospital in Taiwan. |
