臺灣博碩士論文加值系統

當人們享受醫療技術進步所帶來的好處時，其實也忽略了它也可能造成的傷害，醫療的照護系統是由複雜的流程、技術和人際互動所構成的，其中包含了許多不可預知的風險，所以醫院應致力提供民眾安全的就醫環境，醫護人員有適當的防護措施，就醫者也要有自我保護觀念，共同營造安全的就醫環境。
為瞭解手術病人對病人安全的認知，本研究以個案醫院之手術病人為研究母群體，實行問卷調查，以醫療使用者角度，對於術前解釋與說明、病人安全態度與認知的普遍情形，進行研究，問卷共回收336份（門診：52份，住院：284份），平均得分：3.95±0.43。
研究結果：手術病人安全與病人安全認知相關性最高（r=0.927），其次為病人安全態度（r=0.812），再來為術前解釋與說明（r=0.596），均呈現顯著正相關。『教育程度』（F=25.653,P<0.05）與手術病人安全有關，醫師有沒有查房會影響住院病人對手術安全的態度，此部份與病患的教育程度有關，顯示知識普及，對手術病人安全要求愈高。個案醫院需再加強增進病人安全的地方如下三方面所示：
□醫院管理：給藥指示不清楚、強化病人識別。
□醫療提供者：臨床教育訓練、合理工作分配。
□醫療使用者：病患因素、病患應主動告知過去病史。
　　手術病人安全與醫院管理、醫療提供者、醫療使用者均有相關，因此強調病人安全觀念的普及，除去醫院的潛在危險因子，營造安全的就醫環境，定可提昇醫療品質與減少糾紛。

When society has benefited from the advancement of medicine, we may also come to ignore its potential harms. The caring system of medicine is accumulated from complicated procedures, skills and interaction. It inevitably consists of unforeseen risks; therefore hospitals ought to strive to provide a safe environment for the society. Medical staffs and team will have an appropriate protection procedures implemented. As well as patients ought to know how to protect themselves in order to create mutually safe environment.
In order to have a better understanding of how much patients realise their own health and safety. This research uses individual cases from patients as primary group of study. Survey has been conducted in order to understand the general situation of these patients in regard to their knowledge on pre-operation briefing, and their attitudes towards the safety of the operations. 336 surveys has been returned (OPD：52, admission patients(inpatient)：284), Average score: 3.95±0.43
Research result：There is a highest correlation with Patient safety and patient knowledge towards safety (r=0.927), the second is patient attitude towards safety (r=0.812), thirdly comes operation pre-briefing (r=0.956), all shows relationships with subject of study. [educational levels] （F=25.653,P<0.05）is related to patient safety, whether the doctor visits the patient bed frequently will influence patient attitude towards the safety of the operation. This part is a contributing factor due to patient’s level of education which also shows a widespread of common knowledge. The higher the patient requests for the safety of the operation, individual hospitals ought to strengthen patient safety through the following：
□Hospital management : Unclear medication instructions, strengthen patient identification
□Medical treatment provider: More on hand training, reasonable job rotation and sharing of duties.
□Medical treatment users: patient factors, patient ought to provide past history of medication.
The safety of the operation is dependant on all three factors. Therefore, it is crucial to emphasize the commonality of knowledge for patients, getting rid of potential risks within the hospital.Thus to create a safe medical environment, elevating the quality of medical industry with less confrontation to the public.

目　　錄
致謝…………………………………………………………………..….. i
中文摘要………………………………………...…………..…………..i i
英文摘要…………………………………………………..…….……. i i i
第一章　　緒論……………..………………………………………….1
　　第一節　研究背景與動機…………………………………………1
　　第二節　研究目的………………………………………………...4
第二章　　文獻探討………………………………………………..….5
　　第一節　病人安全定義…………………………..………............5
第二節　醫療品質與手術病人安全………………………………7
第三節　國內、外病人安全相關研究及發展…………..……….12
第四節　醫療錯誤與手術病人安全…………………………….15
第三章　　研究方法………………………………………………….20
第一節　研究架構……………………………………………….20
第二節　研究流程…………………………………………….…22
第三節　研究變項定義………………………………………….23
　　第四節　研究方法及材料……………………………………….28
　　第五節　統計分析方法………………………………………….33
第四章　　研究結果………………………………………………….34
第一節　回收樣本的基本資料………………………………….34
第二節　描述性分析……………………………………...……..38
第三節　變項分析……………………………………………….55
第五章　　討論與建議………………………………………….……77
　　第一節　討論…………………………………………………….77
　　第二節　結論………………………………………………….…82
　　第三節　建議………………………………………………….....83
　　第四節　研究限制………………………………………….……84
參考文獻……………………………………………………………….85
中文部分………………………………………………………….85
英文部分.................................................................................85
附錄………………………………………………………………….…89
附錄一：病人安全認知調查問卷………………………..…….…89
表　目　錄
表2-1：病人安全定義…………………………………………………...6
表2-2：JCAHO，2004年美國病人安全目標………….………….…..10
表2-3：病人安全的國際發展………………………….………………14
表2-4：Leape與Cullen醫療錯誤類型之分類……………………….16
表3-1：基本資料定義………………………………………………….26
表3-2：研究變項定義………………………………………………….27
表3-3：再測信度結果一覽表………………………………………….30
表4-1：填答者基本資料……………………………………………….35
表4-2：填答者來院資料……………………………………………….37
表4-3：第一部份術前解釋與說明之描述性統計……………….……47
表4-4：第二部份病人安全態度之描述性統計………………………48
表4-5：第三部份病人安全認知之描述性統計……………………….51
表4-6：變項歸類合併表……………………………………………….55
表4-7：初步分析結果………………………………………………….57
表4-8：『教育程度』變項分析………………………………………….64
表4-9：『是否初次來院看診』變項分析………………………….……69
表4-10：『查房次數』變項分析………………………………………...72
表4-11：『就診科別』變項分析…………………………………...……73
表4-12：手術病人安全與相關變項之相關性………………………...76
表5-1：主要影響病人安全因素分類……………..…………..……….78
表5-2：可以增進病人安全的方法分類…………………………….…79
表5-3：個案醫院“病人安全”最需加強的部份分類……………….80
表5-4：分析結果分類，手術病人安全關心議題…………………...…81
圖　目　錄
圖3-1：資料分析架構圖……………………………………………….21
圖3-2：研究流程圖…………………………………………………….22

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