護理照護糾紛之分析與防範

Analysis and Prevention of Disputes on Nursing Practices

研究背景：由於護理人員對病人提供最直接的照護且照護的時間也比其他醫事人員要長，故發生糾紛的機會也相對較多，因此，護理業務糾紛之探討實屬必要。
研究目的：一為經由文獻整理及彙集護理人員實務經驗找出護理業務糾紛發生的諸項原因及這些護理業務糾紛發生的可能性有多大，二為探討護理人員面對這些護理業務糾紛之因應情形。
研究方法：採文獻整理及實務經驗整理出護理業務糾紛涵蓋之題項，並以德爾菲法找出適合之題項。正式問卷發放對象為個案醫院全體護理師，獲515份有效問卷。對回收問卷之資料處理方法含次數分配法、敘述統計、獨立樣本t檢定、因素分析、變異數分析等。
研究結果：護理業務糾紛發生的諸原因，依發生的可能性由高而低之前三項為：未注意病人安全之維護導致病人跌倒或受傷、未及早發現病人之病情改變導致病人的病情惡化以及病人病情出現異常變化時護理人員因誤判而未即時通知醫師或自行處理而延誤通知醫師。至於預防及處理護理業務糾紛的各種因應作法，依重要性由高而低之前三項為：正確執行護理技術並遵守標準作業程序、正確紀錄所說所作及觀察發現以及院方有建立一個誠實不必害怕受到懲罰的醫療疏失通報系統。
建議：各醫院應針對最可能發生的幾個護理業務糾紛設計對應之因應之道。並對因應預防及處理護理業務糾紛的各種重要的作法，平時就需加強對護理人員之訓練。

Background and Objective: Nurses provide direct care service for patients and the time they spend in directly caring the patients are much longer than other medical staffs. As a result, disputes could happen more frequently. Hence, it is necessary to explore the disputes on nursing practices. We attempted to find out the factors causing disputes on nursing practices, explored the probabilities of happening and tried to find out the ways to avoid disputes.
Methods: We searched the literature to gather practical experiences of nursing staff, and applied Delphi method to find out the major items of disputes. Questionnaire was distributed among nurses of our hospital and 515 valid copies had been retrieved. Statistical methods including frequency distribution, descriptive statistics, independent samples t-test, factor analysis, and ANOVA, etc. are applied for analyzing the data.
Results: The three top possible causes for nursing practice disputes are: 1. failure to pay attention to the safety of patients so that a patient fall or got injured. 2. failure to notice the changes in patients’ condition so that his or her condition deteriorate. 3. when there is an abnormal change in the patient's condition, the nursing staff misjudged the condition or tried to handle it by themselves, leading to a delay in reporting to the doctor. As for various measures to preventing and handling nursing practice disputes, the most important items are: 1. correct implementation of nursing techniques and compliance with standard operating procedures. 2. recording correctly what is said, done and findings observed. 3. establishing a negligence notification system advocating honest reporting free from punishment.
Suggestions: We suggest that each hospital should try to design corresponding solutions for the few nursing disputes that could happen most likely. For preventing and handling nursing practice disputes, it is necessary to strengthen ordinary training of the nursing staff.