臺灣博碩士論文加值系統

在醫療體系中，護理人員扮演守護民眾健康的關鍵角色，提供連續性、個別化之照護，而有效率的護理交班，得以讓接班者迅速掌握病人的病情，減少重覆評估病人問題，增加照顧病人的時間，因此有效的溝通即成為十分重要的課題。基此，故本研究目的主要在瞭解影響新進護理人員交班易遺漏或不完整的項目，建構出新進護理人員交班完整性之組成因素。
本研究首先針對30位醫院的資深護理人員，進行新進護理人交班易遺漏項目的深度訪談，來蒐集新進護理人交班易遺漏事項，再對30位新進護理人員對交班看法進行訪談與問卷調查，並採用重要事件技術法(Critical Incident Technique；CIT)及頻次統計分析作為資料分析之方法，所得結果如下：新進護理人員交班遺漏項目之影響因素有八大項，分別是病況追蹤或處理、專業知識不足、認知、經驗不足、缺乏交班訓練、交班規範不熟悉、人員態度有待改善、家屬、輔助人員、儀器問題、工作安排、工作分配問題。此外，新進護理人員交班中最感困擾的事項分別是醫學專用名詞看不懂、交班內容很多，無法連貫、交班缺乏統合能力、交班缺乏邏輯性、交班時容易受接班人的態度而影響自己交班的情緒。
建議護理管理者可透過以下策略提升交班品質，首要加強對於交班重要性的認知，進而增加警覺性，共同重視交班的議題；舉辦系統性交班訓練課程，課後給予測驗，並將交班課程納入年度在職教育；定期稽核、舉辦座談會以了解執行概況和需求；編訂臨床護理手冊隨時提供查閱、透過資訊系統建立知識管理平台，以輔助交班工作；將交班情形列入績效考核中，讓護理人員重視交班之完整性。

In medical healthcare system, the nurse plays a key role in protecting the public health by providing continuity and individualized care. So an efficient nursing shift handover is able to allow the successor to grasp hold of the patient’s conditions quickly, reduce repetitive evaluation on the patient, and increase the patient caring time. Therefore, an efficient communication has become an important issue. Based on this, the purpose of this study is to understand the impacts caused by easily omitted and incomplete handover matters to new nurses by constructing the complete composition factors for the new nurses in the shift handover event.
An in-depth interview was initially conducted on 30 senior hospital nurses by this study on easily omitted handover matters to new nurses in order to gather the easily omitted matters of the event, and an interview and questionnaire investigation were then conducted on 30 new nurses towards their opinions on shift handover. The Critical Incident Technique (CIT) and frequency statistical analysis were adopted as the data analysis method. The research findings are listed as follows: There are eight major influential factors on easily omitted handover matters to new nurses, namely condition tracking and handling; a lack of expertise, cognition and experience; a lack of shift handover training; unfamiliar with the shift handover norms; improvement needed on personnel attitude; problems with the families, support staff and equipment; work arrangement; and work allocation problems. In addition, the most disturbing handover matters to new nurses are unable to understand the medical-specific terms, unable to connect too many handover contents, a lack of integration ability on handover matters, a lack of handover logic, and personal emotion that can be easily affected by the successor attitude during the shift handover process.
This study suggests a need for the nursing managers to improve the shift handover quality through the following strategies. The first priority is to strengthen the cognition towards the importance of shift handover, thereby increasing the alertness and paying attention to shift handover issue altogether; organize a systematic shift handover training course, conduct a test after the lessons, and introduce the shift handover course into the annual in-service education program; conduct periodic audit, and organize seminars to understand the implementation status and demands; compile clinical healthcare manual as a reference for momentarily reading, and establish a knowledge management platform through the information system to assist in the handover work schedules; and finally to include the shift handover conditions into the performance examination to allow the nursing staff to pay attention to the integrity of shift handover.

摘要………………………………………………………………… ⅠAbstract…………………………………………………………. Ⅱ
誌謝………………………………………………………………… Ⅲ
目錄…………………………………………………… Ⅳ
表目錄……………………………………………………… Ⅴ
圖目錄……………………………………………………… Ⅵ
第一章 緒論…………………………………………………… 1
第一節 研究背景……………………………………………… 1
第二節 研究問題與目的……………………………………… 3
第三節 研究流程與範圍……………………………………… 4
第二章 文獻探討……………………………………………… 5
第一節 護理交班的意義及功能……………………………… 5
第二節 交班之方式與規範…………………………………… 8
第三節 交班應具備之內容…………………………………… 12
第四節 影響交班完整性之因素……………………………… 15
第五節 如何有效交班………………………………………… 16
第六節 交班管理……………………………………………… 18
第三章 研究方法與設計……………………………………… 21
第一節 研究設計……………………………………………… 21
第二節 深度訪談法…………………………………………… 22
第三節 資料分析法…………………………………………… 24
第四章 研究結果……………………………………………… 28
第一節 基本資料分析………………………………………… 28
第二節 交班遺漏項目影響因素分析………………………… 29
第三節 新進護理人員交班現況分析………………………… 52
第五章 結論與建議…………………………………………… 61
第一節 結論…………………………………………………… 61
第二節 管理實務上之意涵…………………………………… 65
第三節 研究限制……………………………………………… 66
中文參考文獻……………………………………………………… 67
英文參考文獻……………………………………………………… 68
附錄一 醫院護理人員執行交班現況訪談記錄表…………… 72
附錄二 資淺或新進護理人員之交班缺失彙整表…………… 103
附錄三 改善新進護理人員交班敏感度之研究問卷………… 130
附錄四 簡歷…………………………………………………… 132
表目錄
表4-1 受訪人員基本資料…………………………………… 28
表4-2 服務科別分析表……………………………………… 52
表4-3 護理工作年資分析表………………………………… 52
表4-4 學歷分析表…………………………………………… 53
表4-5 新進人員在護理交班中感到最困擾的事項表……… 54
表4-6 醫院或護理部可提供提昇交班工作項目表………… 59
圖目錄
圖1-1 研究架構圖…………………………………………… 4
圖4-1 資淺護理人員交班遺漏項目………………………… 29
圖4-2 病況追蹤或處理遺漏項目…………………………… 30
圖4-3 專業知識不足遺漏項目……………………………… 37
圖4-4 認知、經驗不足遺漏項目…………………………… 42
圖4-5 缺乏交班訓練遺漏項目……………………………… 44
圖4-6 交班規範不熟悉遺漏項目…………………………… 46
圖4-7 人員態度有待改善遺漏項目………………………… 47
圖4-8 家屬、輔助人員、儀器問題遺漏項目……………… 48
圖4-9 工作安排、工作分配問題遺漏項目………………… 50

一、中文部分
文崇一和楊國樞（2000）。訪問調查法。社會及行為科學研究法下冊。臺北：東華。
方莉、明勇和游文瓊(2006)。外科病房交班內容完整性之改善專案。護理雜誌，(53)3，52-59。
王淑蓉、尹玓、李淑燕、林瑞青和曾雯琦（2007）。護理床邊交班之時間及內容分析。中華職業醫學雜誌，14（2），121-128。
李美華等譯著 (2004)。 社會科學研究方法。 Earl Babbie, The Practice of Social Research. 9th edition. CA:Wadsworth. 台北：時英。
汪素敏和鄭美玉（2000）。某區域教學醫院加護病房護理人員交班方式改善方案。國防醫學，31（3），271-280。
周碧琴、王麗玲、施靜宜、邱郁茹、林玉梅、李麗琴、趙倩和李碧雲（1997）。 護理人員交班改善方案。長庚護理，8（2），81-91。
胡幼慧（主編）（1996）。質性研究：理論、方法及木土女性研究實例。台北：巨流。
張玉霞和張瑞燕（2006）。提昇某急診加護病房護理交班完整性方案。志為護理，6（4），103-113。
張嘉娟、江靜儀、黃錦鳳和江健婷(1999)。交班改善方案之成效探討。長庚護理，(9)2，50-59。
莊麗玉和李建德（2009）。交班－護理人員的溝通。護理雜誌，56(3)， 93-98。
莊麗玉、陳慧倫、謝金梅和韓桂香（2009）。提升精神科急性病房護理人員交班內容之完整率。長庚護理，20（1），81-90。
陳秀蓮、林玉如、賴瑞婷、黃家萍、黃春戀和郭婷婷（2002）。急診病患轉送病房護理交班之改善方案。醫務管理期刊，3（3），104-116。
黃翠蓮（2007）。醫院護理人員執行病人交班安全之探討。未出版碩士論文，亞洲大學健康管理研究所，台中。
萬文隆（2004）。深度訪談在質性行研究中的應用。生活科技教育月刊，37（4），17-23。
劉寶玲、戴辛翎和林貴滿（2009）。提昇急診病人轉送病房護理交班完整性方案。志為護理，8（4），82-92。
蔡佳樺、李金媛、邱文旗、徐玉枝、洪珮娟和歐玉雯（2008）。提昇急診重症病患轉入加護病房護理交班完整率。北市醫學雜誌，5（6），1-10。

二、英文部份
Amamski, P.(2007)）.Implement a handoff communication approach. Nursing Management, January, 10-12.
Baldwin, L., McGinnis C. (1994). A Computer-Generated shift Report. Nursing Management,25（9）, 61-64.
Benson, E., Rippin-Sisler, C., Jabuscb, K., & Keast, S. (2007).Improving nursing shift to shift report. Journal of Nursing Care Quality, 22(1), 80－84.
Bradford, B. B.(1964). Overcoming the barriers to intershift communication. Management of Personnel Quarterly,3（2）, 17-19.
Cahill, J. (1997). Patient’s perceptions of bedside handovers. Journal of clinical Nursing, 7, 351-359.
Denzin, N. (1978). The research act: A theoretical introduction to sociological methods. New York: McGraw-Hill.
Denzin, N. K. and Lincoln, Y. S. (2007).Collecting and Interpreting Qualitative Materials, Sage Publishes.
Ekman, I., & Segesten, K. (1995). Disputed power of medical control: The hidden message in the ritual of oral shift re-ports. Journal of Advanced Nursing, 22(6), 1006-1011.
Flanagan J. C.(1954). The critical incident technique. Psychological Bulletin, 51(5), 327-358.
Hansten, R.(2003).Streamline change of shift report. Nursing Management, 34(8), 58-59.
Hays, M. M. (2003). The phenomenal shift report: A paradox. Journal for Nurses in Staff Development, 19(1), 25-33.
Inger, E.,＆ Kerstin, S.(1995).Deputed Power of medical Control: the hidden message in the ritual of oral shift reports. Journal of Advanced Nursing, 22(5), 1006-1011.
Kerr, M. P. (2002). A qualitative study of shift handover practice and function from a socio-technical perspective. Journal of Advanced Nursing, 37(2), 125-134.
Kilpack, V., & Dobson-Brassard, S.(1987). Intershift report:Oral communication using the nursing process. Journal of Advanced Nursing, 19(5), 266-270.
Kosnik, L. K., Brown J.,＆ Maund. T.,.(2007).Patient safety: Learning from the aviation industry. Nursing Management, January, 26-30.
Lamond, D.(2000).The information content of the nurse change of shift report:a comparative study. Journal of Advanced Nursing,31(4),794-804.
McKenna, L.(1997). Improving the nursing handover report. Professional Nurse,12(9), 637-639.
McMahon, R.(1990).What are we saying? Nursing Times, 86(30),38-40.
Meiβner, A., Hasselhorn, H. M. , Estryn-Beha, M. , Nezet, O., Pokorski, J. , ＆Dinah G.(2007). Nurses'' perception of shift handovers in Europe - results from the European Nurses'' Early Exit Study. Journal of Advanced Nursing, 57(5), 535-542.
Miller, M. B.＆Crabtree, B. F.(1992)Primary care research：A multimethod typology and qualitative road map, doing qualitative research. Newbury Park, CA：Stage.
Nestel, D., Kneebone, R., ＆ Baret, A.(2005).Teaching communication skill for handover: perioperative specialist practitioners. Medical Education, 39(11), 1157.
Patton, M. Q. (1990). Qualitative evaluation and research methods. London: Sage Publications.
Payne, S., Hardey, M. ＆ Coleman, P.(2000). Interactions between nurses during handover in elderly care. Journal of Advanced Nursing, 32(2), 277-285.
Philpin, S. (2006). Handing Over: Transmission of information between nurses in an intensive therapy unit. Nursing in Critical Care, 11(2), 86-93.
Priest, C. S., & Holmberg, S. K. (2000). A new model for the mental health nursing change of shift report. Journal of Psychosocial Nursing & Mental Health Services, 38(8), 36-43.
Reiley, P. J., ＆ Stengrevics, S. S. (1989). Change-of-shift report：Put it in writing. Nursing Management, 20(9), 54-56.
Smith, C.(1986). Upgrade your shift reports with the three R’s. Nursing, 16(2), 62-64.
Spear, L. A.(1996).The Writing of Nurse Managers：A Neglected Area of Professional Communication Research. Business Communication Quarterly, 59(1), 54-66.
Speas, J. (2006). Bolster staff relations with shift report. Nursing Management, 37(10), 82-83.
Streitenberger, K., Breen-Reid, K., & Harris, C. (2006). Hand-offs in care-can we make them safer? Pediatric Clinics of North America, 53(6), 1185-1195.
Webster, J.(1999). Practitioner-centred reseach: an evaluation of the implementation of the bedside hand–over. Journal of Advanced Nursing, 30(6), 1375-1382.
Williams, A. J.(1998). Managing Change in the nursing handover. Nursing Standard, 12(18), 38-42.
Wilson, M. J.(2007). A template for safe and concise handover. MedSurg Nursing,16(3), 201-206.
Young, P., Maguire, M., & Ovitt, E. (1988). Implementing changes in critical care shift report. Dimensions of Critical Care Nursing, 7(6), 374-380.