臺灣博碩士論文加值系統

背景與目的
跌倒是住院病人重要的議題，其相關因素很多。全民健康保險總額預算制度實施後，首當其衝的是護理人力，醫院為降低成本普遍遇缺不補。佔床率的高低攸關病人在醫療照護上的品質，亦影響護理人員離職意願。護理人員在自發性通報病人跌倒事件的遵從性高，因此住院病人跌倒事件與醫療品質指標之間的關聯性，值得進一步探討。
研究方法
研究者擷取2012年至2015年度間，計七個單位的住院病人於異常事件通報系統中，有關病人於住院期間發生之跌倒事件相關資料。進行描述性統計、卡方檢定，並以二元羅吉斯迴歸分析，探討依變項與自變項之間的關係及關鍵的影響，以勝算比來顯示相關強度之大小。
研究結果
2012年至2015年共有412位住院病人於住院期間發生之跌倒事件，男性高於女性，65歲以上的病人佔53.4%。事件發生後對病人健康的影響程度為有傷害之比率為28.2%。二元羅吉斯迴歸分析得知護理人員離職率、床位等級、事發地點、對象年齡及事件發生前的獨立活動功能狀態為住院病人跌倒事件發生後，對病人健康的影響程度之主要影響因素。
結論與建議
本研究呈現某區域教學醫院2012年至2015年，住院病人於住院期間發生之跌倒事件及其影響因素，希望提供有效資訊予醫療機構決策者，俾利提升住院病人之安全醫療環境。

Background
Falling accident is a critical issue to inpatients and a lot of factors cause its happening. After the global budget of health insurance taking effect, the first impact to the hospital is the nursing manpower. In order to reduce the cost, in general, the hospital will not fill up the position while a nurse resigns. The occupancy rate has a great impact on the quality of medical care and whether a nurse is willing to stay or not. In terms of spontaneously notified the issues on inpatient falls, nurses are highly in compliance with the rule. Therefore, it is worthy to further study on the connection between inpatient falls and medical quality indicators.

Methods
The study is based on the information received from seven different units’ Abnormal Event Notification System on fall events that occurred during hospitalization from 2012 to 2015. Using the method of descriptive statistics, chi-square test, and regression analysis, the researcher is to study the relationship and the key factor between the dependent variable and the independent variables.The correlation intensity is displayed by the odds ratio.

Results
During the hospitalization period of 2012-2015, there were 412 inpatients fall cases, with men’s ratio higher than women, and 53.4% ≥ the age of 65. The rate of falling accident causing direct impact to the inpatients’ health is 28.2%. The regression analysis shows that nurse’s turnover rate, the beds level, the location of the incident, the age of a patient, and a patient’s independent activity before the event were the main factors to affect patient’s health.

Conclusions
The study is based on the 2012-2015 data of a regional teaching hospital and the main purpose is to find out what factors cause inpatients’ falling accident. The researcher hopes to provide useful information to the decision makers of medical institutions that will help to improve medical environment safety for inpatients.

中文摘要 I
ABSTRACT II
表目錄 V
圖目錄 VII
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 2
第三節 研究目的 3
第二章 文獻探討 4
第一節 病人安全政策起源 4
第二節 台灣病人安全通報系統 6
第三節 跌倒相關概念 8
第四節 臺灣護理人員執業概況 19
第五節 護理年資與病人安全認知之間的關係 22
第六節 病床等級與病人安全 23
第七節 佔床率 24
第三章 研究方法 26
第一節 名詞定義 26
第二節 研究流程 28
第三節 資料來源 29
第四節 研究變項 29
第五節 研究假設 31
第六節 研究架構 33
第七節 研究倫理考量 34
第八節 資料處理及統計分析 34
第四章 研究結果 35
第一節 描述性統計 35
第二節 卡方檢定 41
第三節 二元羅吉斯迴歸 47
第五章 討論 52
第六章 結論 55
第一節 結論及建議 55
第二節 研究限制 56
第三節 未來研究 57
參考文獻 58

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