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

Exploring the Impact of the Skill Mix Model on Clinical Care from Nurses’ Perspectives

行政院衛生署自92年即推動照顧服務員（以下簡稱照服員）訓練，期望藉由照服員參與臨床照護工作，改善醫療照護人力不足之困境，國內目前亦有多家醫院採行此一技術混合照護模式(skill mix model)。本研究旨在瞭解護理人員對照服員參與照護工作之技術混合照護模式的影響。研究採方便取樣，以北部某實施照服員制度之醫學中心三個內科病房之護理人員為對象，共回收40份有效問卷。研究結果：一、在41項由照服員執行之工作中，達50％以上護理人員勾選為「最常委派之工作」、同時亦為「能分擔護理人員工作負荷」之工作項目共10項。二、護理人員對照服員制度之評量：對執行病人照護之感受、及與照服員之工作關係感受方面，均有55％以上受測者表達正向評價；但對於照服員之專業程度及工作表現，則分別只有25％及35％受測者表示滿意。三、分析受測者基本資料對評量結果之影響，均無統計上顯著相關或差異。結論：本研究結果可以瞭解照服員臨床照護工作之屬性，並可提供醫院管理者實施技術混合照護模式之參考。

The skill mix model was adopted in several hospitals to solve the problem of nursing staff shortage after the Department of Health of Taiwan had developed the health care assistants (HCAs) training program in 2003. The purposes of this study were to explore the nurses’ perspectives of working with HCAs, as well as to further understand the impact on adopting the skill mix model clinically. A convenient sample of 40 nurses was recruited from 3 internal medicine wards of a medical center in northern Taiwan, where staff mix includes HCAs allocation. Results showed that among 41 tasks performed by HCAs, 10 were selected by over 50% respondents in both the “delegation most” and “effect on staff workload” part. In terms of nurses’ perspectives of the skill mix model, over 55% nurses perceived positively on client care and working relationships between HCAs and nurses. However, only 25% and 35% respondents expressed satisfaction with the HCA’s level of expertise and working performance, respectively. No statistical significance was found between demographic variables and nurses’ perspectives of HCAs. These results contributed to understanding the attributes of HCAs in nursing care context and providing reference in the implementation of the skill mix model.