某區域教學醫院護理人員執業環境知覺之調查性研究

A Survey of the Perception of Nurses toward the Practice Environment at a Regional Teaching Hospital in Central Taiwan

背景：實證研究顯示護理執業環境顯著影響護理人員的留任和照護品質，由於區域醫院的護理人員占所有執業人力之多數，探討該層級醫療院所護理人員對於執業環境的看法有其重要性。目的：探討某區域教學醫院護理人員對於當前護理執業環境之知覺現況。方法　採橫斷面研究設計，以中部某區域教學醫院474位護理人員為對象，採匿名方式填答問卷，研究工具包含基本資料表及中文版護理執業環境量表。結果　護理人員整體對執業環境的知覺持中上滿意度，唯對「足夠人力與各類資源」感到最不滿意。不同執業單位及不同臨床進階層級護理人員對執業環境的知覺有差異。以護理執業環境量表五個次量表為預測變項進行區別分析，形成新的組合變項—良好的工作現場人力團隊及合宜的護理行政管理環境，分別可區隔不同執業單位及不同臨床進階層級護理人員對於執業環境的知覺，即病房單位護理人員對工作現場人力團隊的執業環境知覺，較急重症單位及特殊單位不滿意；而N2層級護理人員對合宜的護理行政管理的執業環境知覺，較N1及N不滿意。結論／實務應用　建議區域教學醫院能提升整體護理人力與資源、促進病房單位的醫護合作關係以及增進N2層級護理人員對於行政管理與參與決策的看法等，以促進護理人員對工作環境的正向知覺。

Background: The nursing practice environment has been shown to wield significant influence on nursing retention and nursing quality of care. Because a large percentage of Taiwan nurses currently work at regional teaching hospitals, exploring the perception toward the practice environment of nurses working at this type of hospital is important. Purpose: This study explored the perception of nurses working at a regional teaching hospital in central Taiwan toward their practice environment. Methods: A cross-sectional research design with a sample of 474 nurses from a regional hospital in central Taiwan was conducted. Instruments including the demographic data and the Chinese-version Practice Environment Scale-Nursing Work Index (CPES-NWI) were anonymously self-administered. Results: Overall, participants were moderately satisfied with their practice environment, with the greatest dissatisfaction focused on staffing and resource adequacy. Work unit and nursing level, respectively, had significant impacts on perceptions regarding the practice environment. Furthermore, discriminant analysis identified two new compound variables: 1) adequate staffing resources and partnership in the workplace and 2) supportive administrative management environment. Participants who worked in medical and surgical units were significantly more dissatisfied with the adequacy of staffing resources and partnership in the workplace than participants who worked in acute/intensive and special units. Participants at the N2 level were significantly more dissatisfied with the supportive nature of the administrative management environment. Conclusions / Implications for Practice: These findings support that the nursing practice environment of regional hospitals may be improved using several measures, including: modifying the staffing and resource adequacy of nurses, fostering collaborative nurse-physician relationships, and further involving nurses in administrative management and decision-making.