臨床護理人員之執業環境感受的探討

中文摘要 論文摘要 論文名稱：臨床護理人員之執業環境感受的探討 研究所名稱：臺北醫學大學護理學研究所 研究生姓名：馬瑞菊 畢業時間： 96 學年度第 1 學期 指導教授：張文英 臺北醫學大學護理學研究所副教授 為抑制不斷上升的醫療支出，醫院紛紛採行降低成本或緊縮人力的策略，如此不但影響護理人員的執業環境，間接地亦可能影響病患的照

護結果。故本研究目的旨在 ( 一 ) 建構中文版之護理人員執業環境感受問卷表； ( 二 ) 瞭解護理人員與醫師間之關係感受及護理人員之執業環境感受得分情形； ( 三 ) 比較不同護理人員之基本屬性，其執業環境感受之差異性； ( 四 ) 分析護理人員的基本屬性、對目前護理工作之滿意程度及對病人照護之品質評價與執業環境感受之相關性； ( 五 ) 比較不同醫院層級之護理人員，其離職意向與異常事件報告之差異性；( 六 ) 了解影響護理人員執業環境感受之因素。

本研究採橫斷式研究設計，針對某財團法人醫院之四個院區護理人員進行中文版護理人員執業環境量表之信效度測試及正式問卷調查。本研究工具是以 Dr. Marlene Kramer(2004) 所發展之結構式護理人員執業環境感受量表。問卷效度採雙次翻譯驗證、因素分析及再測信度、 Cronbach’s α 值檢定各構面之穩定性及內在一致性。資料統計方法包括描述性與推論性統計。

本研究共發出 1,607 份問卷，回收 1,019 份，有效問卷回收率為 63.4% 。結果顯示該研究機構護理人員與醫師關係之感受是良好的，且對執業環境感受屬喜好的。次構面中，以「教育支持」之執業環境感受最佳，而以「護理人力」之執業環境感受最差。四院區中以 D 院區護理人員對執業環境感受之平均得分高於其他三院區。護理人員對目前護理工作的滿意程度之平均分數為 6.24 分，屬於滿意之程度，並以 D 院區護理人員對目前工作滿意程度最高，而以 B 院區最低。護理人員對病人照護的品質評價之平均分數為 6.76 分，屬於安全、但不夠的評價，並以 D 院區護理人員對病人照護品質評價最高，而以 C 院區最低。護理人員對護理工作滿意程度及對病人照護品質評價，均與執業環境感受之平均得分達統計上顯著正相關 (p<.05) 。

在基本屬性之比較上，不同醫院層級之護理人員執業環境感受不同，以區域醫院顯著高於醫學中心 (p<.05) ，有子女之護理人員，其執業環境感受亦較正向，但年齡和護理工作年資與執業環境感受得分未達顯著差異 (p>.05) 。另在研究機構中有 433 位 (42.5%) 護理人員表示未來一年內有離職意向，其中又以 A 院區為最高，而 D 院區最低。然而，對執業環境感受較差的護理人員在未來一年內有顯著較高的離職意向。而有 556 位 (54.6%) 護理人員表示在過去一年內有發生過異常事件，其中又以 C 院區最高，而 A 院區最低。然無論有無發生過異常事件之護理人員，在執業環境之感受得分上並無顯著不同。在迴歸模式中，護理人員對目前護理工作滿意程度、對病人照護品質評價、離職意向、醫院地理位置等四變項均為影響執業環境感受之因子 (p < .05) ，解釋力為 27.0％。本研究結果希望能提出未來機構改善執業環境策略之參酌，以提昇病人的照護品質。

The Perceptions of Work Environment Among Clinical Nurses

英文摘要 Title of Thesis: The Perceptions of Work Environment Among Clinical Nurses

Institution: Graduate Institute of Nursing, Taipei Medical UniversityAuthor: Ma, Jui-ChuThesis directed by: Chang, Wen-Yin, Associate ProfessorIn order to control the increasing medical expenses, hospitals have to reduce the manpower to cope with the changes. The results not only affect nurses directly, but also impact on patient care indirectly. Therefore, the aims were to 1). develop the Chinese version of work environment perception questionnaire (WEP), 2). understand the relations between nurses and doctors and overall nurses’ WEP, 3). compare the differences between the characteristics of nurses and the WEP, 4). analyze the differences between the characteristics of nurses, the work satisfaction, and the quality of patient care evaluation and the WEP, 5). compare the differences between hospital levels and the intention to leave and incidence reports, and 6). explore factors that may affect nurses’ perceptions on WEP.The design was cross-sectional survey study. Nurses in four branches of a same hospital were piloted and surveyied. The WEP was originally developed by Dr. Marlene Kramer (2004). The Chinese version of WEP were conducted using translation and back translation, factors analyses, test –retest, and Cronbach’s α. Data were analyzed by descriptive and inferential statistics. Totally, 1,607 questionnaires were administrated and 1,019 questionnaires were returned. The response rate was 63.4%. The results indicated that the relation between nurses and doctors was good and favorable. Among subscales, the scores of education support were the highest and the nursing manpower was the lowest. The average score of WEP among nurses was the highest in Branch D than those of the other three branches. The average score of satisfaction related to current work was 6.24 points (total=10 points), pertaining to satisfy with work. Nurses in Branch D obtained the highest score on satisfaction; but nurses in Branch B were the lowest. The average score of nursing quality evaluation was 6.76 points, pertaining to safe, but not much more. Nurses in Branch D obtained the highest scores on nursing care quality evaluation, but nurses in Branch C were the lowest. A significant positive correlation was found between work satisfaction and nursing care quality evaluation and the scores of WEP (p<.05). There was a significant difference between hospital levels and the WEP. Of this, nurses who worked in the district hospitals had higher scores of WEP than did those who worked in the medical centers (p<.05). Nurses with children had positive perceptions on WEP. However, no significant difference was found (p>.05). About 433 nurses (42.5%) indicated they would leave the hospital in the coming year. Nurses with poor perception on WEP had higher intension to leave. About 556 nurses (54.6%) indicated that there were incident reports in the past year. Of this, nurses who work in Branch C had the highest incident reports. However, no significant difference was found. In the regression analytic mode, the work satisfaction, patient care quality evaluation, intension to leave, and hospital location were found as factors that affect nurses’ perceptions (p<.05). The variance of explanation was 27.0%. The findings provide as references for hospitals to look for strategies to improve future work environment for nurses and for quality patient care.