臺灣博碩士論文加值系統

背景與目的
推動「磁吸醫院」主要目的為提高臨床護理人員對工作環境的滿意度，及其對組織之認同，以提升臨床照護品質與護理專業自主性。本研究有四個研究目的：(1)瞭解樣本醫院護理人員對樣本醫院推行磁吸醫院之看法、認知與預期效益；(2)瞭解何種人口學變項會影響樣本醫院護理人員對磁吸醫院之看法、認知與預期效益；(3)探討樣本護理人員認知之磁吸醫院應該包含哪一些重要因素；(4)瞭解同一醫療體系所屬三家不同區域級醫院護理人員對磁吸醫院之看法、認知與預期效益是否存有不同的看法。

方法與材料
本研究採橫斷性研究設計(Cross-sectional research design)，應用一份自擬之「探討護理人員對磁吸醫院要素之認知、看法與預期效益」結構性問卷，針對某醫療體系所屬三家區域級醫院護理人員進行『無記名(anonymous)』評估研究調查。從2012年9月至同年12月，共計四個月的時間進行資料收集工作。本研究運用描述性統計(平均數、百分比、次數分配、標準差)以及推論性統計(信度分析、效度分析、項目分析、相關分析、獨立樣本T檢定、單因子變異數分析、路徑路分析)等統計分析方法進行假說驗證。

研究結果
本研究有效樣本為1,066份問卷，信度、效度、項目分析與相關分析結果顯示，本研究擬定之研究工具可用來收集假說驗證所需相關資料。獨立樣本T檢定與單因子變異數分析結果得知：研究樣本之「服務醫院別」、「服務科別」、「年齡」、「婚姻」、「職級」、「職稱」、「教育程度」與「服務年資」會影響其對磁吸醫院要素之認知、看法與對組織預期效益之看法；其次，研究亦發現年齡越高且工作年資越資深，工作滿意度越高，對護理工作有更正向的看法。路徑分析結果顯示，下列假設(H9, H11, H12, H13, H14)在三家醫院皆全部成立：(1)「病患照護品質」會受到「實證的品質」的影響；(2)「護理人員職場滿意度」會受到「病患照護品質」的影響；(3)「組織效益」會受到「病患照護品質」與「護理人員職場滿意度」的影響。路徑分析結果亦顯示，不同醫院護理人員，對推行磁吸醫院之看法、認知與對組織之預期效益卻實存有不同看法。

結論與建議
本研究提供「實證管理」為依據的研究結果，結果顯示護理人員認為「磁吸醫院」可創造優質醫療環境，所以其態度同意接受推行「磁吸醫院」。其次，研究擬定之問卷可瞭解護理人員對推行『磁吸醫院要素』所持有之態度，以及其接受『磁力醫院要素』所設定之各項內容與預期目標。再者，同一醫療體系不同醫院之護理人員，其對『磁力醫院要素』認知、與對組織之預期效益確實存有不同看法。有鑑於國內外仍缺乏推動「磁吸醫院要素」相關實證文獻，建議後續研究：(1)從組織行為觀點，瞭解護理人員對推行『磁吸醫院要素』看法差異之確切原因；(2)利用「質性研究」進行深度訪談，瞭解護理人員對建構磁性醫院的看法與可能執行之相關策略；(3)著重「量性」與「質性」並重的「混和模式」研究，以建構一套符合台灣國情之磁力醫院推行模式。

Backgrounds and purposes
The main purpose of promoting “Magnet Hospital” in hospitals is going to enhance nurses’ satisfaction of working environments, to identify their recognition of their organizations and to improve their clinical quality and professional autonomy of nursing professionals. Therefore, there are four research goals in this study: (1) to realize the opinions, cognitions and expect benefits of “Magnet Hospital” among nurses within sample hospitals; (2) to realize what kinds of demographic variables will affect nurses’ opinions, cognitions and expect benefits of “Magnet Hospital“ within sample hospitals; (3) to explore what are the most important elements of “Magnet Hospital“ should be included based on nurses’ viewpoints within sample hospitals; (4) to recognize whether there are differences opinions, cognitions and expect benefits of Magnet Hospital“ among nurses between sample hospitals within a health care system.

Methods and materials
This research applied a cross-sectional research design and a structured questionnaire to investigate nurses’ opinions, cognitions and expect benefits of “Magnet Hospital” within sample hospitals. In this study, research participants were recruited from three regional hospitals within a health care system, who had been worked there more than three months and were glad to participate in this research were invited as research samples. For data collection, all participants had to fill a questionnaire anonymous since September to December 2012. Both descriptive statistics (mean value, percentage, frequency distribution, standard deviation) and inferential statistics (Reliability analysis, Factor analysis, Item analysis, Correlation analysis, Independent T-test, One-Way ANOVA analysis, Path analysis) techniques were used to verify research hypothesis.

Results of the research
There were 1,066 valid samples (questionnaires) were be used to verifying research hypothesis. Based on the results of Reliability analysis, Factor analysis, Item analysis and Correlation analysis, all results displayed that the research questionnaire could be used to collect the essential information for examining research hypothesis. In addition, the results of Independent T-test and One-Way ANOVA analysis revealed that a nurse’s opinions, cognitions and expect benefits of “Magnet Hospital” will be affected by the variables of working hospitals, departments, age, marital status, Job grade, position, educational status and seniority. Moreover, results of this study also found that the older age and longer seniority of a nurse will lead her to have a higher satisfaction and a more positive attitude to her nursing works. The results of Path analysis, furthermore, showed the following hypotheses (H9, H11, H12, H13, H14) were all accepted in three sample hospitals: (1) “quality of patient care” will be affected by “quality of evidence”; (2) “working satisfaction of nurses” will be affected by “quality of patient care”; (3) “organizational benefits” will be affected by “quality of patient care” and “working satisfaction of nurses”. The results of path analysis also displayed that nurses are indeed to have different opinions, cognitions and expect benefits of Magnet Hospital in different hospitals.

Conclusion and suggestions
Firstly, the results of this study provided an evidence-based result for management, it displayed that nurses consider promoting the program of “Magnet Hospital” will help a hospital to create a high quality working environment, so they were agreed to accept and promote the program of “Magnet Hospital”. Secondary, the research questionnaire which was developed by this research were appropriated and suitable for understanding a nurses’ attitude and their acceptance of promoting the program of “Magnet Hospital”. Thirdly, nurses were indeed to have different opinions, cognitions and expect benefits of Magnet Hospital in different hospitals. It is because that there are still seldom literatures for recognizing nurses’ attitude of promoting the program of “Magnet Hospital principal elements”; this study suggests that further research could be focused on the following issues: (1) to realize the actual reasons of the difference viewpoint between nurses in different hospitals for promoting the program of “Magnet Hospital principal elements” based on the opinion of organizational behaviors; (2) to realize how to establish related strategies and to perform the program of “Magnet Hospital” based on nurses’ opinion by applying the method of deeply interview; (3) to establish an appropriate model of promoting the program of “Magnet Hospital” in Taiwan based on the research design of both quantity and quality approach by applying the technique of mixed-mode method.

中文摘要
英文摘要
目錄………………………………..………………………………………… i
表目錄…………………………………………………………..…………… ii
圖目錄………………………………………….…………………………… iii

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 文獻回顧…………………………………………..……………... 5
第一節 護理工作環境及法規………………………………… 5
一、 護理法規………………………………………… 5
二、台灣護理工作環境………………………………… 5
三、護理人力配置標準………………………………………… 7
第二節 護理工作特質……………………………………………… 8
一、護理工作負荷……………………………………………… 8
二、不健康工作環境的危險…………………………………… 9

三、健康的工作環境定義…………………………10

四、工作滿意與留任意願相關性…………………………… 10
第三節 區域醫院經營的困境……………………… 17
一、全民健康保險與總額預算制度…………………………… 17

二、全民健保實施後的台灣醫院產業………………………… 19
三、區域醫院經營管理之因應………………………………… 20
第四節 磁吸醫院對醫療環境之影響…………………………22
一、美國現況…………………………………………………… 22
第五節 推動磁吸醫院之預期成效益………………………..27
ㄧ、磁力醫院五大構面………………………...……………… 28
(ㄧ)、領導決策與管理層面………………………………….. 29
(二)、結構式賦權…………………………………………… 29
(三)、專業照護模式及團隊照護關係……………………….. 32
(四)、新知、創新及改進………………………………….. 33
(五)、實證的品質……………………………………………. 34
第六節 認知態度、行為理論模式…………………………………..39
ㄧ、認知態度、行為模式…………………………………….. 39
二、認知影響因素………………………...……………………. 41


頁碼
第七節 樣本醫院所屬經營體系簡介…………………………………..46
ㄧ、樣本醫院經營體系及工作現況簡介…………………………... 46
二、樣本醫院工作現況…...………………….…………………….46

第三章 研究方法...………………………....………………49
第一節研究架構與研究假設...………………....……………49
一、 研究架構...………………....………………....……49
第二節 研究變項概念型定義、操作型定義………………………… 50
ㄧ、概念型定義……………………………………………50
二、操作型定義.............................52
三、研究假設.......................................53
第三節 研究工具.............................. 57
第四節 研究步驟...............................63
第五節 研究設計、研究對象與施測方式..............64
第六節 資料處理與分析..........................65
第七節 倫理考量................................67

第四章 研究結果...………………....………………....……68
第一節 研究樣本醫院之人口學資料……………....……………68
第二節 項目鑑別度t檢定……………....………………....…76
第三節 問卷之建構信度分析...………………....……………81
第四節 問卷之建構效度分析..………………....……………87
第五節 問卷相關性分析……………………………………………..94
第六節 單因子變異數分析…………………………………………..99
第七節 路徑分析…………………………………………………….251

第五章 討論……………………………………………………………268

第六章 結論與建議……………………………………………………285
第一節 結論……………………………………………………………285
第二節 研究限制與建議…………………………………………….289

參考文獻……………....………………………………………291

附錄一：研究問卷
附錄二：人體試驗委員會同意臨床試驗證明
附錄三：人體試驗受試者同意書

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英文部分
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