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研究生:林碧珠
研究生(外文):Pi-Chu Lin
論文名稱:二維品質模式與麻醉前訪視滿意度
論文名稱(外文):Two-dimensional Analysis for Patient Satisfaction in Preanesthetic Visit
指導教授:陳大樑陳大樑引用關係
指導教授(外文):Ta-Liang Chen
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:132
中文關鍵詞:麻醉前訪視Kano’s二維品質病患滿意度顧客滿意係數
外文關鍵詞:Preanesthetic visitKano’s two-dimensional modelPatient satisfactionCustomer satisfaction coefficient.
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麻醉前訪視,是麻醉醫護人員對病患提供麻醉相關資訊與服務,並建立良好醫病關係的第一次接觸。本研究目的是以Kano‘s 二維品質模式,設計病患滿意度問卷,探討麻醉前訪視內容與病患滿意度之關係,以期分析關鍵品質要素為何,作為提高病患對醫療滿意度之參考。
本研究於台灣北部某醫學中心,通過該院人體試驗委員會審查後進行。對象為婦科排程手術住院病患,其中實驗組共107位病患,在麻醉醫師訪視之前,安排先觀看麻醉流程衛教影片;另外對照組111位病患,則未提供衛教影片。問卷於麻醉醫師訪視後及麻醉後共二次填答,問卷內容包括麻醉資訊來源、醫師訪視內容滿意度及重要性,以及麻醉前及麻醉後滿意度。問卷一致性(consistency),以Cronbach’s ?挴侅?,Kano’s model正向問題得到0.951,反向問題得到0.914,重要性問題得到0.924之值。統計分析以SPSS軟體檢定,p值≦ 0.05,視為統計學上有意義之差異。
結果發現:1)人口學特性(年齡、教育程度、職業、婚姻狀態、ASA等級)與麻醉滿意度,在Kano’s 模式之滿意度分類上,有多項達到顯著差異。有無麻醉經驗,則與此次麻醉滿意度無統計上顯著差異。2)麻醉衛教影片對滿意度之結果:實驗組在麻醉前滿意度平均得分4.28 ± 0.78分,對照組為3.72±1.04分,(p < .0001),達到顯著差異。3)根據顧客滿意度係數,可用來增加滿意度之前3名變項之影響力為44.40%,44.59%,以及45.30%。用來減低不滿意之前3名變項之影響力為58.08%,58.90%,以及64.74%。4)由皮氏相關係數檢定得知,病患在麻醉前對醫師與對資訊滿意度(實驗組r=.81,p=.00;對照組r=.88,p=.00),均呈現高度相關且達到顯著水準。5)13項資訊來源統計,實驗組或對照組,由麻醉醫師及病房衛教獲得資訊,為最大來源各為13項。6)多數病患的改善建議為在麻醉前應例行播放麻醉衛教影片,以及縮短訪視前病患等待時間。
結論:觀賞麻醉前衛教影片,可獲得高滿意度。由滿意度係數指標變項,配對不同人口特性,將可決策出提高病患醫療滿意度之可行方案。
Background: The customer satisfaction is one of the most crucial factors for quality service evaluation. Preanesthetic visit is the first step to build up good relationship between patient and anesthesiologist. This research aim at investigating the correlation between the two-dimensional patient satisfactions under different content of pre-anesthetic visit during gynecological service with general anesthesia for surgery .
Materials and Methods: The five-point scale questionnaire was designed mainly on Kano’s two-dimensional model. The experimental group was composed of 107 patients with a video about anesthetic process before visit, whereas 111 patients weren’t under the video watching procedure. All 218 patients were invited for answering the questionnaire after the visit and surgery respectively. The data were analyzed through SPSS (Version 13.0) software with statically significance when p≦0.05.
Results: 1) The demographic characteristics of patients ( such as age, educational level, career, marital status, ASA status) might affect the satisfaction classification in Kano’s model. However, previous experience of anesthesia or not made no significant difference in satisfaction. 2) Video-assisted preanesthetic-education program or not did show significant difference as the satisfaction scale between two groups were 4.28±0.78 and 3.72±1.04, ( p<.0001). 3) Concerning the Customer satisfaction (CS ) coefficient predict the impact of variables, the top 3 to extent of satisfaction variables impact were 44.40%, 44.59% ,and 45.30% ; the other top 3 to extent of dissatisfaction variables impact were 58.08%, 58.90%, and 64.74%. 4) There were high correlation and with significant difference (r=.81, p=.00) between satisfaction of anesthesiologist and pre-anesthesia informed level; but lower correlation and no significant difference between the satisfaction of pre- and post- anesthesia in Pearson’s correlation test. 5) The two major sources to get anesthesia information were coming from the visit of anesthesiologist and the patients’ group education before anesthesia.
Conclusion: There only 2 variables were the “Must-be” requirements in this research, difference classification in Kano’s model were found in advanced demographic characteristics of patients, and the impact of CS coefficient wound affect the considerations for priority setting.
In summary, this study suggested that using documentary video as the major resource about anesthesia and surgery for patients’ group education before preanesthesic visit is highly recommended. Also, long waiting before the visit was most complained by surgical patients.
目 錄
頁 數
致 謝…………………………………………… I
中文摘要…………………………………………… III
英文摘要…………………………………………… V
目 錄…………………………………………… VII
圖表目次…………………………………………… IX

第一章 緒 論
第一節 研究背景及動機.…………………… 1
第二節 研究目的……………………………. 2
第三節 研究流程……………………………. 3
第二章 文獻查證
第一節 麻醉前訪視與評估 .………………… 4
第二節 麻醉等級分類 ……………………… 10
第三節 醫療品質與麻醉滿意度 …………… 12
第四節 二維品質模式………………………… 17
第三章 研究方法
第一節 研究假設……………………………… 29
第二節 研究架構……………………………… 30
第三節 研究設計與工具……………………… 32
第四節 研究資料與統計分析………………… 40
第四章 分析與結果
第一節 信度與校度分析……………………… 41
第二節 問卷回收與問卷對象特性分析……… 42
第三節 麻醉相關資訊的來源………………… 48
第四節 Kano’s品質歸類與檢定……………… 52
第五節 麻醉前後的滿意度與重要性檢定…… 78
第五章 討 論
第一節 二維品質與麻醉訪視………………….. 106
第二節 滿意度與重要性……………………… 111
第三節 總結…………………………………… 113
第六章 結論與建議
第一節 結論 ………………………………… 115
第二節 病患建議……………………………… 115
第三節 研究限制與建議……………………… 116

參考資料
中文參考資料 ………………………………… 118
英文參考資料 ………………………………… 120
附錄
附錄一 研究計劃倫理委員會許可文件…….. 124
附錄二 麻醉主治醫師問卷…………………… 125
附錄三 病患問卷 …………………………… 127
參考資料
中文參考資料
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黃勇富,張文良,黃馨瑩,蔡碧珍,鄭夙雯(2002)•應用Kano模式於宅配服務品質需求之探討•品質月刊,07,33-42。
許慧娟(1995)•二維品質模式在服務品質上之應用-銀行存款之實證研究•碩士論文,台灣大學商學研究所,台北。
湯玲郎,鄭博仁(2001)•以KANO的二維品質模式,探討如何評估及改善醫療機構服務品質•工業工程學刊,18(2), 71-80。
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Clifton, P.J.(1984). Expectations and experiences of anesthesia in a District General Hospital. Anaesthesia, 39(3),281-285.
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