臺灣博碩士論文加值系統

護理人員碰到臨床上的狀況時，大多憑藉著本身經驗及專業知識做為制定決策的依據，加上護理人員常迫於時間壓力的情況下做出決策，導致難以準確估計決策的成效，做出最佳判斷。過去研究中已證實臨床上決策支援系統可以幫助護理人員進行診斷或治療上的決策，提升醫療服務之品質，且決策支援系統可以針對不同的病人，利用電腦知識庫或演算法推論，提供護理人員迅速且適當的建議。本研究依照臨床照護分類標準，針對急性疼痛、慢性疼痛、非特定性疼痛、失禁性皮膚炎四項護理診斷，實作護理過程之決策支援系統，包括病患評估子系統（評估）、護理計畫子系統（診斷、預期成果、計畫）與護理記錄子系統（評值）；系統驗證結果中急性疼痛、慢性疼痛、失禁性皮膚炎的敏感度分別為79.41%、54.14%、95.31%，特異度為92.31%、100%、64.54%，11項建議的鑑定性特徵及導因中有8項總正確率達85%以上。

When nurses encounter a clinical situation, they always make decisions based on their own experience and knowledge. Since they often need to make decisions within a short period of time, it is difficult to estimate the treatment outcome and choose a better strategy. Previous studies have demonstrated that clinical decision support systems are helpful to diagnose and/or make treatment decisions, therefore improving the quality of health care services. Moreover, decision support systems using knowledge-base or inference algorithms quickly provide appropriate recommendations to nurses for various patients. In this study, we employ Clinical Care Classification (CCC) System to establish a nursing process decision support system. Our system implements four nursing diagnoses – acute pain, chronic pain, unspecified pain, and incontinence associated dermatitis. This proposed system consists of patient assessing subsystem (assessment), care planning subsystem (nursing diagnosis, expected outcome, planning), and nursing recording subsystem (evaluation). The system verification results showed that the sensitivities of the nursing diagnoses including acute pain, chronic pain, and incontinence associated dermatitis were 79.41%, 54.14%, and 95.31% respectively; and the specificities were 92.31%, 100%, and 64.54% respectively. Within eleven recommended defining characteristics and related factors, eight items exhibits high percentage of correct (>85%).

碩士學位考試委員會審定書
誌 謝
論文摘要
Abstract
目　　錄
圖目錄
表目錄
縮寫對照表
第壹章 緒論
第一節 研究背景
第二節 研究動機
第三節 研究目的
第貳章 相關知識與文獻探討
第一節 護理過程
第二節 臨床照護分類標準
第三節 決策支援系統
第四節 文獻探討
第參章 研究方法
第一節 研究步驟
第二節 臨床照護分類標準之編碼系統
第三節 系統建置流程
第四節 系統架構與系統分析
第五節 系統驗證
第六節 相關技術及開發工具
第肆章 結果與討論
第一節 系統操作流程
第二節 系統驗證結果
第三節 討論
第伍章 結論
第一節 結論
第二節 未來展望
參考文獻
附錄一 護理措施總表

[1]J. R. Graves, S. Corcoran, "The study of nursing informatics," Image - the Journal of Nursing Scholarship(21:4), 1989, pp. 227-31.
[2]V. K. Saba, "Nursing informatics: yesterday, today and tomorrow," International Nursing Review(48:3), 2001, pp. 177-187.
[3]I. CHO, N. STAGGERS, I. PARK, "Nurses' Responses to Differing Amounts and Information Content in a Diagnostic Computer-Based Decision Support Application," Computers Informatics Nursing(28:2), 2010, pp. 95-102.
[4]S. LEE, "Features of Computerized Clinical Decision Support Systems Supportive of Nursing Practice: A Literature Review," Computers Informatics Nursing(31:10), 2013, pp. 477-495.
[5]T. H. Payne, "Computer decision support systems," Chest(118:2_suppl), 2000, pp. 47S-52S.
[6]R. B. Haynes, N. Wilczynski, Computerized Clinical Decision Support System (CCDSS) Systematic Review Team, "Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: Methods of a decision-maker-researcher partnership systematic review," Implementation Science(5:12), 2010, pp. 12.
[7]陳秀枝，2009，與國際接軌－談台灣護理資訊現況與發展，護理雜誌，第五十六卷．第三期：5～11頁。
[8]American Nurses Association. "The Nursing Process," 2014, Available: http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-Need/Thenursingprocess.html.
[9]方妙君、邱秀環、孫肇玢，2003，護理過程，臺北市：匯華圖書出版股份有限公司。
[10]T.-T. Lee, "Nursing diagnoses: factors affecting their use in charting standardized care plans," Journal of Clinical Nursing(14:5), 2005, pp. 640-647.
[11]International Council of Nurses(ICN), "Nursing Workforce Profile Database Summary," 2014.
[12]Nursing Process. "Nursing Process: A Step by Step Guide," 2012, Available: http://nursingprocesssteps.com/.
[13]R. M. Carroll-Johnson, M. Paquette, N. A. N. D. Association, Classification of nursing diagnoses: proceedings of the tenth conference: Lippincott, 1994.
[14]TCOG癌症疼痛與症狀處理委員會，2007，癌症疼痛處理指引：國家衛生研究院。
[15]邱舜麗，2007，疼痛為生命第五元素，高醫醫訊月刊，第二十七卷．第四期：5頁。
[16]V. S. EdD, Clinical care classification (CCC) system manual: a guide to nursing documentation, Springer Publishing Company, New York , 2006.
[17]M. Gray, D. Weir, "Prevention and Treatment of Moisture‐Associated Skin Damage (Maceration) in the Periwound Skin," Journal of Wound Ostomy & Continence Nursing(34:2), 2007, pp. 153-157.
[18]周幸生、歐嘉美、蔡素華、康百淑、葉明珍、張秉宜、白司麥、程仁慧，1999，新臨床護理診斷，臺北市:華杏出版股份有限公司。
[19]J. Moss, M. Damrongsak, K. Gallichio, "Representing Critical Care Data Using the Clinical Care Classification," AMIA Annual Symposium Proceedings(2005), 2005, pp. 545-549,.
[20]G. A. Gorry, M. S. S. Morton, A framework for management information systems, Massachusetts Institute of Technology, 1971.
[21]黃裕珩，1999，建置護理診斷支援系統-以精神分裂症護理為研究對象，慈濟大學醫學資訊研究所碩士論文。
[22]D. J. Power, Decision support systems: concepts and resources for managers, Greenwood Publishing Group, 2002.
[23]J. A. Browne, B. G. Covington, Y. Davila, "Using Information Technology to Assist in Redesign of a Fall Prevention Program," Journal of Nursing Care Quality(19:3), 2004, pp. 218-225.
[24]H. F. Clarke, C. Bradley, S. Whytock, S. Handfield, R. Van Der Wal, S. Gundry, "Pressure ulcers: implementation of evidence-based nursing practice," Journal of Advanced Nursing(49:6), 2005, pp. 578-590.
[25]H.-Y. Huang, D. J. Wilkie, S.-P. Zong, D. Berry, D. Hairabedian, M. K. Judge, F. Stuart, C. Charles, "Developing a Computerized Data Collection and Decision Support System for Cancer Pain Management," Computers Informatics Nursing(21:4), 2003, pp. 206-217.
[26]T. T. Lee, C.-H. Yeh, L.-H. Ho, "Application of a computerized nursing care plan system in one hospital: experiences of ICU nurses in Taiwan," Journal of Advanced Nursing(39:1), 2002, pp. 61-67.
[27]Y. a. Kim, M. An, J. Park, H. Jung, Y. Kim, B. Chang, "New method of realization of nursing diagnosis based on 3N in an electronic medical record system," Studies In Health Technology And Informatics(129), 2007, pp. 364-366.
[28]A. T.-H. Hao, L.-P. Wu, A. Kumar, W.-S. Jian, L.-F. Huang, C.-C. Kao, et al., "Nursing process decision support system for urology ward," International Journal of Medical Informatics(82:7), 2013, pp. 604-612.
[29]V. D. Feeg, V. K. Saba, A. N. Feeg, "Testing a Bedside Personal Computer Clinical Care Classification System for Nursing Students Using Microsoft Access," Computers Informatics Nursing(26:6), 2008, pp. 339-349.
[30]S. Merkel, T. Voepel-Lewis, S. Malviya, "Pain Assessment in Infants and Young Children: The FLACC Scale: A behavioral tool to measure pain in young children," AJN The American Journal of Nursing(102:10), 2002, pp. 55-58.
[31]劉郁妘、陳婉宜、柯幸芳，2012，一位骨盆骨折幼兒及其主要照顧者之護理經驗， 志為護理-慈濟護理雜誌，第十一卷．第六期：97～107頁。
[32]D. H. Nix, "Validity and reliability of the Perineal Assessment Tool," Ostomy/wound management(48:2), 2002, pp. 43-6.
[33]J. Junkin, J. L. Selekof, "Beyond “diaper rash”: Incontinence‐associated dermatitis: Does it have you seeing RED?," Nursing2014(38:11), 2008, pp. 56hn1-56hn10.
[34]維基百科，ROC曲線，2014，Available: http://zh.wikipedia.org/wiki/ROC%E6%9B%B2%E7%BA%BF.
[35]陳亞輝、繆勇，2013，王者歸來：Struts2+Spring+Hibernate框架技術與專案實戰應用，臺北市：佳魁資訊股份有限公司。
[36]維基百科，MVC，2015， Available: http://zh.wikipedia.org/wiki/MVC.
[37]K. P. Tripathi, "A Review on Knowledge-based Expert System: Concept and Architecture," Artificial Intelligence Techniques - Novel Approaches & Practical Applications, 2011.