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題名：運用技術混合照護模式於護理工作負荷之探討
書刊名：長庚護理
作者：鄭麗華／陳淑賢／王文燕
作者(外文)：Cheng, Li-hua／Chen, Sue-hsien／Wang, Wen-yen
出版日期：2018
卷期：29:3=103
頁次：頁337-349
主題關鍵詞：技術混合照護模式；工作負荷；離職率；The skill-mixed model；Workload；Quit rate
原始連結：連回原系統網址new window
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研究目的：本研究是探討技術混合照護模式實施後，護理人員自覺其工作負荷、留任意願及加班時數、離職率之影響。研究方法：為回溯性研究設計，以次級資料分析法，於照護模式施行後4、8、16個月進行3階段資料收集。研究對象為北台灣區域教學醫院選取6個病房（3個有施行，3個無施行），比較有無施行病房之護理人員自覺降低工作負荷程度、留任意願、加班時數及離職率之結果。研究結果：輔助人員執行及耗時最多的工作項目以『一般性技術工作』佔最多，有施行技術混合照護模式的病房其加班時數及離職率，較無施行的病房有逐漸下降的趨勢。利用ANOVA檢測4、8、16 個月的執行結果：一、自覺降低工作負荷在介入後8、16 個月開始有顯著差異（8個月VS. 4個月：P ＜ .00；16個月VS. 4個月：P ＜ .00）。二、加班時數初期成效不明顯，但8 個月開始到16 個月皆有顯著差異（0個月VS. 8個月：P ＜ .01；0個月VS. 16個月：P ＜ .01）。三、離職率及留任意願則無顯著成效。結論：依據評鑑護病比基準配置三班的護理人員再加入輔助人員的混合照護模式，確實能降低護理人員的直接負荷，但此模式需長期推動才能看出護理留任及回流的成效，未來建議可納入推廣老化社會之醫療照護激增的轉型參考。
Objective: The purpose of this study is to explore the change of nurses' perception of workload, willing of intention to stay, overtime and quit rate after implementing the skill-mixed model. Method: This is a retrospective study. The secondary data analysis was collected after implementing the skill-mixed model for four, eight, and sixteen months. Total six acute wards three of those implemented this model but others didn't were enrolled from regional teaching hospital in North Taiwan. The change of nurses' perception of workload, willing of intention to stay, overtime and quit rate was compared between wards with or without implementing the skill-mixed model. Result: Our results demonstrated that the duties of the unlicensed assistants mostly belonged to ＂general basic work＂. The amount of overtime and proportion of quit both declined after implementing the skill-mixed model. The results collected from four, eight, or sixteen months after the model implementation were further analyzed by ANOVA. The results revealed that the overload perception declined significantly after eight and sixteen months skill-mixed model implementation as compared to that after four months implementation. (8 months vs. 4 months: P ＜ .001; 16 months vs. 4 months: P ＜ .001); 2. The overtime decreased significantly after 8 and 16 months implementation as compared to that before implementation. (0 month vs. 8 moths: P ＜ .01; 0 months vs. 16 months: P ＜ .01 ); 3. The willing of intention to stay and quit rate did not change significantly. Conclusion: Our results demonstrated that the proper patient–nurse ratio as designated by the hospital accreditation, adding the unlicensed assistants, could effectively attenuated not only the direct loading of nurses, but also the caring burdens of patients' family. The effect of this model on nursing intention to stay and return to workplace needed long term implementation. Therefore, our study suggested that the skill-mixed model could be used to help further Taiwan's healthcare delivery system transformation.
期刊論文
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3.劉麗芳、李選、賈佩芳、紀淑靜、尹裕君(20121200)。Exploring the Association between Nurse Workload and Nurse-Sensitive Patient Safety Outcome Indicators。The Journal of Nursing Research，20(4)，300-309。new window  new window
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6.Huang, L. C.、Lee, J. L.、Liang, Y. W.、Hsu, M. Y.、Cheng, J. F.、Mei, T. T.(2011)。The skill mix model: A preliminary study of changing nurse role functions in Taiwan。The Journal of Nursing Research，19(3)，220-229。  new window
7.毛義方、蔡忠融、徐雅媛、徐儆暉、毛鏡琪、盧士一、陳美蓮(20110600)。我國醫院員工超工時與輪班研究。勞工安全衛生研究季刊，19(2)，223-246。new window  延伸查詢new window
8.竇維正、李作英、張玲華、王桂芸(20130900)。臨床照護模式新思維。領導護理，14(3)，2-16。  延伸查詢new window
9.李慧琦、王秀紅、楊美賞(20141200)。技術混合照護模式之實施成效評析--文獻回顧。高雄護理雜誌，31(3)，26-38。  延伸查詢new window
10.陳幼梅、王秀紅、高靖秋、張淑真、張澤芸、曾惠珍、黃怡靜(2016)。臺灣護理照護分級制度之規劃與推動。台灣專科護理師學刊，2(1)，5-12。  延伸查詢new window
11.Brown, J.、Chapman, T.(2004)。Ward managers perceptions of the role healthcare assistants。British Journal of Nursing，139(5)，270-275。  new window
12.Van den Heede, K.、Sermeus, W.、Diya, L.、Clarke, S. P.、Lesaffre, E.、Vleugels, A.、Aiken, L. H.(2008)。Nurse staffing and patient outcomes in Belgian acute hospitals: Cross-sectional analysis of administrative data。International Journal of Nursing Studies，46(7)，928-939。  new window
13.黃麗玲、黃薇瑄、葉德豐、鍾燕宜、林川雄、黃建財(2015)。護理人員超時工作與疲勞之相關性分析。休閒運動保健學報，8，10-25。  延伸查詢new window
14.梅婷婷、李卓倫、梁亞文、黃立琪(20101200)。技術混合照護模式下護理人員自覺護理活動之改變。長庚護理，21(4)=72，417-429。new window  延伸查詢new window
15.張秉宜、王桂芸(20130800)。技術混合照護模式於臨床應用之省思。高雄護理雜誌，30(2)，1-10。  延伸查詢new window
16.Yang, P. H.、Hung, C. H.、Chen, Y. M.、Hu, C. Y.、Shieh, S. L.(2012)。The impact of different nursing skill mix models on patient outcomes in a respiratory care center。Worldviews on Evidence-Based Nursing，9(4)，227-233。  new window
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19.Naruse, T.、Taguchi, A.、Kuwahara, Y.、Nagata, S.、Murashima, S.(2013)。Effects of nonnursing assistance on home visit nurses' time spent in Japan: One group repeated pretest-posttest trial。Home Health Care Management & Practice，25(1)，18-22。  new window
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22.黃維珍、顏妙芬(2012)。探討護理工作負椅與住院病人護理照護滿意度之關係。寶建醫護與管理雜誌，20(1)，56-69。  延伸查詢new window
23.Capitulo, K. L.、Ankner, M. L.、Miller, J.(2001)。Professional responsibility versus mandatory overtime。Journal of Nursing Administration，31(6)，290-292。  new window
24.Chow, J.、Miguel, S. S.(2010)。Evaluation of the implementation of assistant in nursing workforce in haemodialysis units。International Journal of Nursing Practice，15(5)，484-491。  new window
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29.Lee, T. Y.、Yeh, M. L.、Chen, H. H.、Lien, G. H.(2005)。The skill mix practice model for nursing: Measuring outcome。Journal of Advanced Nursing，51(4)，406-413。  new window
30.劉永芳、張秉宜(20071200)。由護理人員觀點探討技術混合照護模式對臨床照護之影響。長庚護理，18(4)=60，487-498。new window  延伸查詢new window
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學位論文
1.蘇臻芳(2008)。技術混合照護模式之評價研究-以中部某區域醫院為例(碩士論文)。亞洲大學，台中。  延伸查詢new window
2.畢淑玉(2010)。探討工作負荷與護理人員心理健康、工作滿意度和疲潰之關係(碩士論文)。國立成功大學，台南。  延伸查詢new window
圖書
1.International Council of Nurses(2010)。Skill mix decision-making for nursing。Geneva：ICN。  new window
圖書論文
1.盧美秀(2009)。整合照護模式：技術混合照護模式可行性探討。護理專業問題研討。台北：五南。  延伸查詢new window
 
 
 
 
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