一般護理之家工作人員住民安全文化認知差異及組織特性對住民照護品質的影響

Resident Safety Culture Gap Among Nursing Home Workers and Organizational Characteristics’ Impact on Resident Care Quality in General Nursing Homes

目標：本研究旨在探討護理之家工作人員的住民安全文化認知差異及組織特性對住民照護品質的影響。方法：採探索性的橫斷式研究，於2019年3-6月，透過郵寄自編量表調查122家護理之家工作人員。住民安全文化包含護理之家工作、溝通、填答者的監督者、護理之家住民安全作為及整體評量；基本資料包含填答者社會人口變項及護理之家組織特性，例如護理之家屬性、權屬、規模、住民失能程度等。統計分析除描述性統計，次以配對t檢定檢視工作人員住民安全文化認知的差異，再以波以松迴歸探討住民安全文化認知落差及組織特性對住民非計畫性轉至急性醫院住院的影響。結果：本研究共發出750份問卷，回收403份，有效問卷399份。護理長與第一線工作人員在溝通、管理者、護理之家病安作為等構面上呈現顯著落差。受訪者的認知落差、護理之家所在地、屬性、權屬、開業年數、照護負荷、住民失能程度對住民非計畫性轉至急性醫院住院比率均對照護品質呈現顯著影響。結論：護理長與第一線工作人員對住民安全文化認知的落差，凸顯住民安全文化推動過程中的缺口，顯示職務角色間溝通的重要性；另，認知落差及組織特性均對住民非計畫性轉至急性醫院住院存在顯著影響。

Objectives: This study aims to investigate the differences in resident safety culture perceptions among nursing home staff and the impact of organizational characteristics on the quality of resident care. Methods: This is an exploratory cross-sectional research, utilizing a self-developed questionnaire distributed via mail survey to 122 nursing homes between March and June 2019. The resident safety culture comprised five dimensions: nursing home work, communication, supervisors of respondents, nursing home resident safety practices, and overall assessment. Basic demographic information included respondents’ sociodemographic variables and nursing home organizational characteristics such as location, affiliation, ownership, size, and resident functional status. Statistical analysis began with descriptive statistics to outline sample characteristics, followed by independent sample t-tests to explore differences in staff perceptions of resident safety culture. Lastly, a Poisson regression analysis was conducted to investigate the impact of staff perception gaps in resident safety culture and organizational characteristics on residents’ unplanned transfers to acute hospitals. Results: This study distributed a total of 750 questionnaires, receiving 403 responses, of which 399 were deemed valid. Significant discrepancies were observed between head nurses and frontliner in dimensions such as communication, managerial practices, and patient safety culture within nursing homes. Regression analysis indicated that the average disparity in perception of resident safety culture between frontliner and head nurses, as well as nursing home characteristics including location, affiliation, ownership, years in operation, workload, and the proportion of disabled residents, significantly influenced the rate of unplanned transfers of nursing home residents to acute hospital admissions. Conclusions: The discrepancy in perception of resident safety culture between head nurses and frontliner underscores deficiencies in implementing resident safety culture and emphasizes the necessity for enhanced inter-role communication. Moreover, the organizational characteristics of nursing homes influence the frequency of unplanned transfers of residents to acute hospital admissions.