建構優質護理執業環境改善策略

Constructing the Improvement Strategy of a High Quality Nursing Practice Environment

本研究旨在瞭解護理人員對目前執業環境的滿意度，並針對較不滿意部分，設計改善策略。採問卷調查法和專家座談法，對象為急性醫療機構之所有護理人員，採方便取樣，選擇某醫學大學附屬醫院之所有專任護理人員。研究工具採用自行設計，經信效度檢定後的「護理執業環境量表」，填答方式從非常滿意5分到非常不滿意1分。共發出問卷450份，有效回收342份，有效回收率76%。結果發現：護理人員對總體的護理工作執業環境的滿意度為3.85（SD=0.66），6大構面的滿意度平均值為3.46（SD=0.81）。經專家座談彙整20項改善策略為：設立輔導員津貼、設立教學獎勵金、提升能力進階津貼、有計畫的進行交叉訓練、強化護理長溝通協調功能、落實醫療疑義的反應與協調、落實各單位職責分工、建置護理資訊系統、建置資訊化護理計畫、聘任足夠護理人力、增進護佐功能、建立關懷信箱、增置申訴管道、發送新人關懷小卡、新人和輔導員座談會及電話關懷、舉辦員工座談會、舉辦紓解工作壓力的教育和措施、塑造關懷的職場氣氛、成立支持團體和社團，以及建立考核、晉升制度，並即時獎勵或晉升。以上專家意見可作為未來醫院建構優質護理工作執業環境之參考。Purpose of the Study: This descriptive cross-sectional study was to explore the satisfaction of the nursing practice environment and to design improvement strategies for the parts of unsatisfied.Method: This study used a questionnaire and focused group discussion to investigate. The participants came from the nursing staff of an affiliated hospital of a medical university. The psychometric properties of this questionnaire included reliability and validity. This scale is a 5 point Likert scale, from strongly unsatisfied (1) to strongly satisfied (5). There were 450 participants in total and we had 342 effective samples with the return rate 76%.Results: The result of satisfaction of the nursing practice environment was 3.85 (SD=0.66), and the average of satisfaction in six major parts was 3.46 (SD=0.81). Twenty improvement projects summarized by specialists were: 1. To set up preceptor's allowance, 2. to set up instruction reward, 3. to set up clinical competence advanced allowance, 4. to implement cross-training, 5. to enhance the function of communication and coordination in head nurses, 6. to fulfill the reaction and coordination on medical questions, 7. to fulfill the accountability of each department, 8. to create nursing information system, 9. to computerize the nursing plan, 10. to recruit sufficient staff, 11. to improve nurses aid's job function, 12. to set up mail box of caring, 13. to set up complaint channel, 14. to send care cards to new staff, 15. To hold staff symposium, 16. to hold group discussion and telephone within new staff and preceptor, 17. to instruct nurse show to release pressure, 18. to create a careful atmosphere in the working place, 19. to set up supporting groups, and 20. to set up an assessment and promotion system and to reward or promote based on the result of assessment in time.Conclusion: The opinion of specialist can be used a reference to construct a high quality nursing practice environment.