精神科急性病房護理人力運用之探討

An Investigation of Nursing Manpower Application in an Acute Psychiatric Ward

本研究在於探討某醫學中心精神科急性病房常見之護理活動內容、平均工時與發生頻次，並計算出平均護理時數及所需護理人力。調查時間自民國八十九年六月五日至民國八十九年六月十八日止步共計十四天。護理活動的平均工時以觀察員觀察法，護理活動發生之頻次則以護理人員自我記錄法進行，護理活動信度採評分者信度，效度採專家內容效度。研究結果顯示精神科在性病房內共同護理活動共有98項:其中直接護理活動有的項(護理活動時數佔69.70%)，間接護理活動有17項(護理活動時數佔24.93%)，15項為相關護理活動(護理活動時數佔5.37%)。平均工時以「自殺事件處理」(120.139分/次)所花費的時間為最多，其次為「團體治療」(105.617分/次)發生頻次以「交班」(6.480次/天/人)為最多，其次為「單一劑量口服給藥」(3.642次/天/人)護理時數以「會談」(38.870分/人/天)為最多，其次為「護理記錄」(17.122分/人/天)，觀察巡視病房(15.819分/人/天)居第三9總計平均每病人每天所得到護理時數為2.49小時。本研究貢獻除建立精神科急性病房各項護理活動之定義、護理活動工時測量程序標準、工時測試及計時方式之外，對於各項護理活動平均工時與頻率均提供具體資料數據。研究結果可作為本院急性精神科病房的護理人員人力配置及工作分派與護理成本分析的依據外，更可發展為精神科病人分類的基礎。

The goal of this study was: (l)to investigate the content, average time required, and frequency of nursing activity in an acute psychiatric ward, (2)to calculate nursing care hours per patient per day (HPPD), (3)and to calculate the nursing manpower required. The research began on June 5, and ended on June 18, 2000; totaling 14 days. An observer recorded the time of nursing activity and nurses themselves recorded the frequency. A test for grader reliability was used. Validity was based on content validity and experts' opinions. There were 98 general nursing activities in this acute psychiatric ward, including 66 direct cares (nursing activity hours 69. 70%), 17 indirect cares (nursing activity hours 24.93%), and 15 related cares (nursing activity hours 5.37%). The most time-consuming nursing activity was to deal with the suicide events (120.139 min/ time); and the second one was group therapy (105.617 min/time). The most frequent nursing activity was to turn over duty (6.480 times/ day /person); and the second one was to administer a single dose of oral drug (3.642 times/day/person). The longest nursing hours in nursing activities was to interview(38.870min/person/ day); the second one was to record nursing activity (17 .122 min/person/ day) ' and the third one was to observe patients ( 15.819 min/person/day) . The nursing care hours HPPD was 2.49 hours. The interview included basic content of the psychiatric nursing activities. A safe environment was the most important condition in the ward round. There would be more benefit to patients if we took more direct nursing activities instead of activity recording. The research helped provide the basic data for nursing activity time, frequency, nursing manpower allocation and cost, definition of nursing activity and standard procedure of activity recording. It also helped develop patient classification system in the psychiatric ward.