急、重症與一般成人病房護理人員於新冠肺炎疫情中病人安全文化態度之變化

Changes in Patient Safety Culture Attitudes Among Emergency, Intensive Care, and General Ward Nurses During the COVID-19 Pandemic

背景：病人安全文化態度為醫療品質的指標之一，是全球醫療照護重視的議題。
目的：比較急、重症及一般成人病房護理人員於新冠肺炎疫情中對病人安全文化態度之變化。
方法：以回溯性研究法，在北部某區域型醫院收集2018年及2020年由臺灣病人安全文化態度網路調查系統之匿名問卷調查資料，選取對象為急、重症及一般成人病房護理人員，共1,540位護理人員之填寫結果，針對不同年份及不同單位護理人員對病人安全文化的態度總分及次構面進行分析。
結果：研究對象以女性、年齡21–30歲、專科及大學教育程度居多。護理人員在病人安全文化態度以「團隊合作」得分最高、「復原力」最低。2020年各構面得分均低於2018年，急、重症組平均得分低於一般成人病房組。次構面分析顯示一般成人病房組在「團隊合作」共3個次構面得分顯著高於急、重症組。兩次調查分數變化以一般成人病房組下降最多。
結論：／實務應用2020年新冠肺炎疫情期間整體得分呈現下降，且不論疫情前、後，急重症護理人員分數均較低，可能因病人病情嚴重，加上疫情中工作負荷及壓力增大；全體護理人員在「復原力」次構面得分最低，特別是一般病房的分數下降最多。強化護理人員的教育訓練和關注其心理健康對改善病人安全文化態度至關重要。管理者應提供感染控制、復原力課程和心理輔導，以幫助護理人員積極應對傳染病之挑戰，提高病人安全文化態度。

Background: Patient safety culture is an indicator of healthcare quality and a topic of global importance in medical care.
Purpose: In this study, the attitudes towards patient safety culture of nursing staff working in the emergency, intensive care, and general wards are compared before and during the COVID-19 pandemic.
Methods: A retrospective research design was utilized and an anonymous questionnaire survey conducted on the Taiwan Patient Safety Culture Survey web-based platform system was used to collect the data. The survey was administered in a regional hospital in northern Taiwan between 2018 and 2020. The 1,540 nursing personnel who participated in this study worked in the emergency, intensive care units, or general adult ward. The analysis focused on assessing participant attitudes towards patient safety culture in terms of both the overall score and sub-dimensions.
Results: The participants were mostly female and between 21 and 30 years old. A majority had completed a diploma or university education. The two analyses revealed the highest and lowest average scores were earned, respectively, in the“teamwork”and“resilience”dimensions of patient safety culture. In 2020, the average scores for all dimensions were lower than in 2018, and the average scores for the emergency and critical care group were lower than those for the general adult ward group. Sub-dimension analysis showed that the general adult ward group earned significantly higher scores in“teamwork”across all three sub-dimensions compared to the emergency and critical care groups. The general ward group exhibited the most significant score decline between the two surveys.
Conclusions/ Implications for Practice: Overall scores were found to have decreased during the COVID-19 pandemic period (2020). Notably, emergency and intensive care nurses earned consistently lower scores, likely due to the severity of patient conditions and increased pandemic-related workloads and stress.“Resilience”scores were the lowest among all nursing staff, with the most significant drop seen in general ward nurses. Enhancing nursing staff education and training as well as addressing their psychological well-being will be crucial to improving patient safety culture attitudes. Managers should provide infection control, resilience training, and psychological counseling to help nurses manage the challenges posed by infectious diseases effectively and enhance patient safety culture.