技術混合照護模式下護理人員自覺護理活動之改變

The Changes of Nurses’ Perception of Nursing Activity in the Skill-Mixed Model

本研究目的是探討技術混合照護模式實施後，護理人員自覺其護理活動、工作壓力、工作負荷與超時工作之改變情形及其相關性。本研究為橫斷式研究設計，以結構式問卷於照護模式實施後6個月進行調查。研究對象為三間全責照護模式試辦醫院，內科病房護理人員共39位。結構式問卷之信效度採專家效度（CVI值： .9）及內在一致性檢測(Cronbach’s α= .964)，共有52個題項，內容包含基本資料及護理活動。護理活動分為直接、間接、相關護理活動及個人活動四類。研究結果顯示技術混合照護模式實施後，護理人員自覺直接護理活動減少，尤其是協助病人翻身、維持身體清潔等；間接護理活動顯著增加(p< .05)，增加的有指導與確認輔助人員照護工作正確性與完整性、交班時間等；相關護理活動顯著增加(p< .001)，如與照護團隊合作、參與在職教育與會議等；工作壓力顯著增加(p< .05)，及個人活動中自覺憋尿情形增加。相關性部分，只有相關護理活動與工作壓力、負荷及超時工作情形呈顯著正相關。研究發現技術混合照護模式中，護理人員對病人的基本照護之活動減少，間接及相關護理活動增加，工作壓力增加。結果可為臨床護理實務之參考。

Objective: The purpose of this study is to explore the changes of nurses’ perceptions of nursing activity, work stress, workload, overtime, and the relationship between variables after implementing the Skill-Mixed model. Method: This is a cross-sectional designed study. The structure questionnaire is used after implementing the Skill-Mixed model for 6 months. The 39 registered nurses were enrolled from the 3 Skill-Mixed model hospitals. The questionnaire consists of 52 items which include demographic data and nursing activity. The questionnaire contains expert face validity (mean CVI: .9) and internal consist reliability (Cronbach’s Alpha= .964). The nursing activities are divided into four categories including direct, indirect, related nursing activities, and personal activities. Result: The results reveal that nurses’ perception of activity decreased in direct nursing activity such as assisting patient’s position change and personal hygiene. The nurses’ perception of indirect activity increased (p< .05) such as conducting nurse assistants’ skills of health care, confirming nurse assistants’ works, and time of duty shift; while related nursing activities also increased (p< .05) such as collaborating with others in health team, participating continuous education and conference. At the same time, personal activity increased such as suppressing urine, and the nurses’ perception of work stress also increased. Only related nursing activity positively associated with work stress, workload, and overtime. Conclusion: The study finds that basic direct nursing activities decreased while indirect and related nursing activities and work stress increased in this Sill-Mixed model. The results of this study can serve as a reference for nursing practice in the hospital in Taiwan.