| 摘要: | 目的：病人安全文化、醫療異常事件處理認知及異常事件通報意願與醫療照護的品質維護有密切的關係，本研究主要探討在第一線接觸病人的護理人員其個人屬性、工作特性變項在病人安全文化、醫療異常事件處理認知與異常事件通報意願的相關性。方式：本研究為橫斷式研究，以結構式問卷收集資料，主要研究對象為台灣南部地區某區域教學醫院護理人員。發放269份問卷，回收有效問卷260份，有效回收率為96.65％，搜集之資料以SPSS 20.0版套裝軟體進行統計分析，使用包含描述性分析、獨立 t 檢定、單因子變異數分析、逐步迴歸分析等統計方法。
結果：
1.病人安全文化八個構面的平均分數，以「團隊安全風氣」3.92分最高、「工作生活平衡」2.03 分最低；整體病人安全文化以年齡40歲以上、具主管職務及病房單位有較顯著的正向感受。
2.醫療異常事件處理認知正確率，以「暴力事件通報廣播代號為888」98.1%最高、「醫院緊急事件廣播代號有暴力事件、火災、大量傷患、嬰兒失竊、停電」46.5%最低；年齡40歲以上、10年以上年資、具主管職務及N3進階層級人員的認知顯著較高。
3.異常事件通報意願，以鰥寡離者及無輪調經驗者顯著較高。
4.異常事件通報意願與病人安全文化、醫療異常事件處理認知呈現顯著正相關；病人安全文化中的工作狀況構面、醫療異常事件處理認知及無輪調經驗者是為異常事件通報意願顯著預測因子。
結論與建議：護理人員工作狀況、醫療異常事件處理認知及無輪調經驗為異常事件通報意願的主要影響因素；建議(1)強化教育訓練，包括新進人員職前教育訓練增加病人安全相關議題及增加在職人員病人安全教育訓練場次；(2)提高獎?措施以增加通報意願；(3)加強各職類醫事人員間橫向與縱向的溝通；(4)設置「輔助人力」以解決護理人力的不足。
Objective
The maintenance of medical care quality is closely related to patient safety culture,the cognition of medical incident processing ,and the intention of incident reporting. This paper mainly studies the relationship among clinical nurses’ personal attributes, job characteristics variation, patient safety culture, the cognition of medical incident processing and the intention of incident reporting.
Methods
A cross-sectional design was adopted in this study and structured questionnaires were used to collect the data. The participants in this study were the nurses worked in a regional teaching hospital in southern Taiwan. A total of 269 questionnaires were distributed and 260 of them were returned to the researcher (effective response rate was 96.65%). Statistical software SPSS 22.0 is used to analyze the collected data. The results provide descriptive analysis, independent sample t test, one-way analysis of variance (ANOVA), stepwise multiple regression analysis ,etc.
Results
1.For all staffs, among the eight domains’ mean score for the patinet safety culture , teamwork climate scored the highest(3.92), and Work-Life balance scored the lowest(2.03)；for the perception toward overall patient safety culture, staffs who is past 40 or working as a manager ,and ward unit has a relatively more significant positive feeling among different types of staffs.
2. Among the cognition of medical incident processing, “violence reporting whose broadcast code was 888” had highest correctness of 98.1%.In contrast, “hospital emergency incident whose broadcast code including violence, fire, mass casualty incident, baby being stolen and power failure” had lowest correctness of 46.5%. Staffs above 40 years old, having been worked more than 10 years, being supervisors or whose clinical ladder system are beyond N3 have significantly better cognition.
3.People who are widowers, widows or didn’t have transferring experience have more intention to report incidents.
4.The intention of incident reporting have significantly positive correlation with patient safety culture and cognition of processing medical incident.
5.In patient safety culture,working conditions,the cognition of medical incidents processing and people who didn’t have transferring experience are predictive factors of the intention of incidents reporting.
Conclusions
Nurses’ work condition, nurses’cognition of processing medical incident and nurses without transferring experience are three main affecting factors of intention of incident reporting. So we suggest (1)Arranging associated training,including adding patient safety issue in pre-service training for new employees and holding more training course of patient safety for formal mployees.(2)Provide more incentives to raise the intension of incident reporting.(3)Strengthen the horizontal and vertical communication.(4)Setting "assistant manpower" to resolve shortage of nursing manpower. |
