摘要
我國公立醫院面對醫療產業環境改變及民營化風潮的雙重挑戰，進行組織調整與轉型，採取企業化的經營模式，降低營運成本，以提高經營績效，遂發展出護理人員外包策略。護理主管面臨人力結構的改變，居高不下的離職率，人力資源管理成為一大挑戰。本研究以實證研究方式，針對外包護理人員之護理品質相較於編制內及聘僱的護士是否有差異，作一深入比較及研究。
本研究護理品質評價方法包含查看病歷、訪問護士、觀察病患與訪問病患等四種方式，針對個別護理人員之護理過程與結果實施現況評值。從個案醫院之健保病房隨機抽取78位各不同僱用別護理人員所照顧之病患300位為研究對象。
研究發現個案醫院總體護理品質表現並未因為外包人力的進用明顯降低品質。三組僱用人員各構面護理品質表現一致以編制內最佳，其次是契約人員，外包人員品質最低。不同僱用別護理人員護理品質差異性，包括總體護理品質、護理計畫、護理指導與護理評值等構面之品質都有顯著差異，編制內與契約護理人員在總體護理品質、護理計畫與護理指導等構面品質相對於外包護理人員均較好。

The public hospitals in our country are facing the duplicated challenge of the environmental change of the medical care and the corporate trend. It is necessary for the public hospitals to take the reorganization and the running model of private enterprise to change style and decrease running cost and develop the strategy of the outsourcing of nursing workforce.
The manager of nursing will face the manpower change, high turnover rate, so it shall be a challenge of human source management. This study makes use of the evident study to compare the difference of the nursing quality between three categories of nursing workforce, namely the outsourcing, the temporarily hired and permanently hired nurses.
The method of evaluating the nursing quality of this study includes four methods: checking the lists, asking the nurses ,observing the patients and asking them. Focusing on the nursing process and results of individual to evaluate, picking up 300 patients cared by 78 different hiring nurses of public insurance wards from case hospital become our individual of study.
Our research shows that the total nursing quality does not reduce apparently due to the introducing of the outsourcing.
The nursing quality of the three hired groups shows the permanently hired group is the best, followed by temporally hired, and the least quality is the outsourcing group.
The nursing quality differences of different hired group include the total nursing quality, nursing plans, the nursing instruction and the nursing evaluation are significant difference. The quality of total nursing care , nursing plans and the nursing instructions among permanently and temporarily hired groups are better than the outsourcing.

第一章 緒論………………………………………………………….1
第一節 研究背景…………………………………………………...2
第二節 研究動機…………………………………………………...4
第三節 研究目的…………………………………………………...7
第二章 文獻探討…………………………………………………….8
第一節 人力資源彈性化...................................8
第二節 勞動派遣在企業之運用........................... 9
第三節 派遣勞工在醫院之運用............................11
第四節 護理品質的意義..................................13
第五節 護理品質之內涵..................................15
第六節 影響照護品質之相關因素..........................17
第七節 護理品質的評價方式與工具........................19
第三章 研究方法........................................22
第一節 研究變項及操作型定義............................22
第二節 研究工具........................................27
第三節 研究對象與資料收集..............................30
第四節 研究架構及假設..................................31
第五節 資料分析方法....................................33
第四章 研究結果........................................34
第一節 研究樣本基本資料................................34
第二節 各變項間的描述性分析............................38
第三節 差異性分析......................................39
第四節 廻歸分析........................................40
第五章 討論............................................61
第一節 整體護理品質....................................61
第二節 護理人員人口屬性不同護理品質之差異..............61
第三節 三組人員各構面護理品質之差異....................63
第四節 病房別護理品質之差異............................65
第五節 護理品質差異與管理因應策略......................67
第六章 結論與建議......................................69
第一節 研究結論........................................69
第二節 研究建議........................................70
第三節 研究限制........................................72
參考文獻................................................73
附錄一 護理品質評價問卷總表............................78
附錄二 護理品質評價問卷第一類病患適用..................84
附錄三 護理品質評價問卷第二類病患適用..................87
附錄四 護理品質評價問卷第三類病患適用..................91
附錄五 護理品質評價問卷第四類病患適用..................95
附錄六 住院病人分類量表說明............................98
附錄七 住院病人護理品質評值問卷評分表..................99
附錄八 住院病人分類鈎選表……………………………………..100

表目錄
表3-1 個案醫院三類聘僱護理人員僱用型態之比較.............23
表3-2 自變項操作型定義…………………………….............23
表3-3 依變項操作型定義…………………………….............25
表3-4 品質得分計算方式…………………………….............26
表3-5護理品質各構面題號與細項品質內容.....................28
表4-1、研究樣本護理人員人口學分佈表…………….............36
表4-2、研究樣本病人人口學分佈表...........................37
表4-3護理人員人口屬性各變項護理品質之描述性統計（一）.....43
表4-3護理人員人口屬性各變項護理品質之描述性統計（二）.....44
表4-4 三組病患人口屬性之卡方分析..........................45
表4-5影響總體護理品質之廻歸分析（依變項取Ln）.............46
表4-6影響總體護理品質之廻歸分析...........................47
表4-7影響護理評估品質之廻歸分析（依變項取Ln）.............48
表4-8影響護理評估品質之廻歸分析...........................49
表4-9影響護理計劃品質之廻歸分析（依變項取Ln）.............50
表4-10影響護理計劃品質之廻歸分析..........................51
表4-11影響護理指導品質之廻歸分析（依變項取Ln）............52
表4-12影響護理指導品質之廻歸分析..........................53
表4-13影響護理活動品質之廻歸分析（依變項取Ln）............54
表4-14影響護理活動品質之廻歸分析......................... 55

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