加護單位護理工作內容之分佈與工作量之探討

Exploring the Nursing Work Content and Workload in Intensive Care Units

背景：加護病房的護理照顧是全人照顧，護理人力、工作負荷是加護護理之重要課題，台灣醫療品質與工作內容大多採用APACHE II或TISS，藉由NAS量表呈現護理人力運用。目的：本研究透過護理活動計分（Nursing activities score, NAS）量表探討在各加護病房護理工作內容與工作量。方法:本研究以橫斷式研究設計，採立意取樣，以加護病房之護理人員為資料收集對象，採勾選NAS量表填答，收集病患護理照護內容。結果：（一）NAS score均在50％以上，且每一位病人使用73.1％的護理工時。（二）直接護理佔總護理時數83.0％～87.3％，行政教學學術活動佔總護理時數8.2～12％，間接護理佔總護理時數3.0～4.8％。（三）護理活動頻次最多之項目為：換氣支持、床邊監測與調整、行政管理事務、腎功能支持與代謝營養支持。結論／實務應用：由於護理活動中頻次及耗時佔前五位之項目包括非加護護理專業之項目，故建議引進輔助人力時應分攤目前護理活動中非護理專業部分之項目，才有助於解決當前加護護理工作量。

Background: The nursing care in intensive care unit is the holistic health care. The nursing workloads have been increased. Most of the medical quality and work content in Taiwan adopts APACHE II or TISS, and the use of nursing manpower is presented by NAS scale. Purpose: This study explored the content of nursing care in each intensive care unit and Workload through the Nursing activities score (NAS). Method: This study employed a cross-sectional research design and adopted a purposive sampling strategy. We recruited the intensive care unit nursing staff to complete the NAS scores and collect the nursing care content. Result: (1)All the NAS scores was above 50%, every nursing staff spend 73.1% of time in patient care. (2)Direct patient care accounts for 83%~87.3%, administrative teaching activities accounts for 8.2~12%, indirect patient care accounts for 3~4.8%. (3)The most frequently items for nursing activities are ventilator support,bed side monitoring and Adjustment, administrative and managerial task, renal support and metabolic support. Conclusion/Implication for Practice: Due to the top 5 highest frequency and time-consuming items in nursing activities include non-nursing care professional items, it is recommended to introduce auxiliary manpower to share the non-nursing care professional items in current nursing activities. It will help to solve the current nurse staffing.