某醫學中心推動技術混合照護模式與成效評值

Establishment and Evaluation of the Skill-Mix Model in a Medical Center

本研究為一為期三年的中型研究計畫之第一階段性實驗，研究目的是建立與推動技術混合照護模式(Skill-mixedmodel)，比較以不同比例人員組合照護模式之工作成效、熟練度與滿意程度，以及對護理照顧品質與人力成本的影響。以類實驗研究設計，方便取樣內、外科病房各12個單位，依護理人員(100%、90%、85%)與團體照顧服務員(團服員)(0%、10%、15%)不同比例，組合配置三種技術混合照護模式。取樣單位之護理人員(n=433)與團服員(n=36)以自行設計之結構式問卷，分兩階段執行前、後測比較。結果顯示1.團服員所執行各項工作以生活照顧和環境管理的頻次最多，協助病人肢體活動(復健)的頻次最少；2.團服員於執行病人照顧各項工作的熟練度，以使用冰枕/裝冰袋冷敷的熟練度最高，最差的是復健/肢體運動；3.團服員對於執行病人照顧工作的滿意度，得分最高的項目是協助病人喝水或口腔潤濕及協助穿脫衣服；4.實施技術混合照護模式前後，護理人員對團服員工作執行頻率的瞭解及滿意度皆顯著提升(p<.05)；5.實施技術混合照護模式前後的護理人力成本及積欠時數並無顯著差異，不過在照護品質指標上，15%團服員配置比例之病房跌倒率下降且有顯著差異(p<.05)。

The purpose of this studywas to compare thework efficiency and proficiency, nurse satisfaction, care quality, and cost effectiveness before and after implementing the skill-mix nursing caremodel by using the investigation method with convenience samples. Researchers selected nurses from 24 medical-surgical wards withRN-toUAP(unlicensed assistive personnel) skill-mixratio percentages of 85%, 90% and 100% .There were 433 nurses and 36 UAPs that participated in the study and filled out the questionnaires. The results showed that: (1)UAP were most frequently doing environment management while least frequently ficilitating range of motion for patients, (2)The UAP most proficient at preparing ice water bags, and least proficient at ficilitating physical exercise, (3)UAP were most satisfied by helping with patients’daily care, (4)Nurse satisfaction was significantly different before and after implementing the skill-mix model(p<.05),and (5)The infection rate and patient fall rate were significantly different before and after implementing the skill-mix nursing caremodel(p< .05).