目的：探討三家不同層級醫院住院病人與護理人員對護理服務滿意度之缺口。方法：蒐集以2013年南部某醫療財團法人護理部結構式問卷「住院病人護理服務滿意度調查作業」之結果，進行統計病人及護理答題量表的統計分析。收集醫學中心25個病房、區域醫院24個病房，及地區醫院7個病房，總計1763個病人及1270個護理人員參與此次的調查研究。研究工具係依據文獻自行擬定的「護理服務滿意度調查表」。以Winsteps軟體進行Rasch(1960)分析檢測量表的單向度，並以平行模擬法來決定因素的個數。以病人答題量表的分數，以單因子變異數分析，判定醫院間滿意度的異同。依其模式估計出來的部門滿意度及試題的難度參數，以其測量標準誤計算出95%信賴區間，判定哪部門及哪題目出現滿意度缺口。結果：結果顯示，(1)此兩份量表（病人及護理的答卷）皆符合Rasch模式的預期，也就是測量具單一向度；(2)不同層級醫院間的病人服務滿意度，未呈統計顯著性的差異；(3) 高估滿意度缺口的5個部門；(4) 有3題出現高估的缺口（護理顯著大於病人的滿意度）及3題出現低估的缺口（護理顯著低於病人的滿意度）。結論：本研究利用圖示分析及檢定三家醫院的滿意度沒有顯著的不同。利用圖示分析及驗證哪部門及哪題目出現滿意度缺口。圖示分析的簡明效果，很容易呈現護理服務滿意度缺口，做為未來護理服務認知差距的改善參考。 Background: Many satisfaction surveys on patient perspective are conducted each year in a hospital. However, few focus on selecting for improvement the widest satisfaction gaps assessed by patients and nurses, especially those identified by the nurses.Aims: To investigate the satisfaction gaps in nursing services assessed by patients and nurses in 3 different types of hospitals.Sample: Secondary data were collected from databanks of nursing service records and surveys conducted by a hospital group in southern Taiwan. These data were used for a series of statistical analyses on both scales responded to by nurses and patients in 2013. Fifty-six nursing units (medical center: 25; regional hospital: 24; local hospital: 7) were assessed by 1763 patients and 1270 nurses.Methods: Two same-item questionnaires with 4-point Likert-type scales from the perspectives of patients and nurses were developed by healthcare experts in the studied hospital group. Rasch (1960) analysis was done using Winsteps software to investigate whether the scaled measurement was unidimensional. Parallel analysis was also used to determine the number of factors. One-way ANOVA was used to examine satisfaction difference among hospitals. A unique graphical representation was used to present satisfaction gaps determined with the nursing unit means and their 95% confidence interval (CI) of person and item parameters estimated using Rasch analysis.Results: (1) Both scales were unidimensional and fit the Rasch model’s expectations; (2) there were no significant differences in service satisfaction in the three hospitals; (3) five (8.9%) nurse units expressed satisfaction gaps; (4) nurses expressed significantly higher average satisfaction gaps than did patients’ perception on three (30%) items.Conclusion: The unique graphical representation with 95% CI that can be simply and clearly displayed the satisfaction gaps is recommended to present the differences in satisfaction in hospitals and/or on items in future.
