某醫學中心出院準備服務及居家護理個案後續照護品質與滿意度調查

Monitoring Quality of Care and Satisfaction Following Discharge Planning and Home Nursing in a Teaching Hospital

本研究針對某醫學中心出院轉介服務的滿意度及病人在居家護理服務中後續照護之滿意度品質初探。本研究採立意取樣，抽取某醫學中心接受出院準備服務，且接受居家護理服務的42個病患，在出院後一個月、三個月及六個月進行三次的電訪及家訪追蹤。經過六個月追蹤後，有效個案為24位。結果顯示，接受居家護理的個案以年齡65歲以上、住院天數大於一個月者為多。經過六個月的追蹤後，發現其日常活動功能及工具性日常活動功能的依賴情形會隨出院時間愈長愈依賴。在出院轉介服務的滿意度方面，其「照護需求了解程度」及「照護需求問題諮詢」在六個月的追蹤期間，其滿意度有逐漸降低的趨勢；其「後續醫療照護安排」則在追蹤期間，個案呈現穩定的滿意度；而「病況追蹤之滿意度」在此三階段之追蹤，顯示個案偏不滿意。在居家護理服務滿意度方面，「護士的服務態度」一直是病患家屬最為滿意的項目；另外個案對於「健保局訂定的訪視次數」與「居家護理單位提供的社會資源」較不滿意。此研究結果可提供某醫學中心出院準備服務及居家護理服務的改善方案，並可作為未來出院轉介服務及居家護理服務滿意度調查之參考。

The purpose of this study was to investigate the satisfaction of patients who was referred by the discharge planning services to receive home nursing services. Satisfaction to discharge referrals and home nursing services was explored. A total of 42 patients who received the home nursing services by discharge referrals of the Chang Gung Memorial Hospital (CGMH) during August month of 1998 to April month of 1999 were interviewed via home visit or telephone follow-ups at one month, three month and six month after hospital discharge. At the end of the sixth month, only 24 cases remained in the home nursing services program. Results revealed that patients who received home nursing services were mostly aged 65 or above, and having the length of hospital stay longer than one month. During the period of six month follow-ups, dependencies in both activities of daily living (ADLs) and instrumental activities of daily living (IADLs) aggravated as the time passed by. In terms of the satisfaction to discharge referrals, satisfaction to of 'understanding to care needs' and 'consultation about care needs' decreased during the 6 months period. Subjects showed steady satisfaction to 'arrangement of follow-up health care arrangement.' Satisfaction to 'illness condition follow-ups' continued to be low over the 6 months period. In terms of the satisfaction to home nursing services, 'nurse's attitude' continued to be the item showed most satisfaction, and low satisfaction to 'regulated number of home visits' and 'comprehensiveness of the home nursing services' were found. The results of this study can provide a reference for further improving discharge planning and home nursing services in CGMH, and can provide baseline information for future study of the quality of services.