臺灣博碩士論文加值系統

背景：病人安全是醫療照護的首要條件，也是維護醫療品質的關鍵指標，病人住院期間，除了防杜異常事件的發生，住院中的病人安全的主觀感受更是提供照護的重要考量，透過骨科住院病人自覺安全感受經驗，進而發展相關工具有助於測量，期「以病人為中心」全方位的發展病人安全主、客觀並行之醫療照護。
研究目的：研究分三階段進行，為了解(一)骨科住院病人自覺安全感的主觀感受經驗；(二)建構「骨科住院病人自覺安全感受」量表之信、效度；(三)探討骨科住院病人自覺安全感受之描述及其相關因素與預測因子。研究方法：本研究採三角交叉法研究設計(triangulation)，分為三階段：(一) 質性研究法之紮根理論 (ground theroy)；(二)量表之建構及信、效度；(三) 描述與相關研究。研究內容及結果：於某準醫學中心骨科病房收案，第一階段質性研究，共15人接受深度訪談，經編碼分析後，依紮根理論將各主要行為類屬整理成一個骨科病人住院期間自覺安全感受之經驗歷程。「我需要真正安全的照顧 - 不僅是預防跌倒」是核心類屬。前驅條件是受限的身體，病人在住院期間的感受是於「被支持的感受」與「被忽略的感受」之間交錯。當病人感受到被支持時，他們經歷的過程類屬包括「獲得關懷」，「可信賴的專業照護」、和「即時得到照護」。這些病人對他們的順利康復感到感激和自信；但是，有時候病人感受到被忽視時，他們會有「隱藏著擔憂」，與「害怕意外發生」這些病人會在住院期間，對他們的遭遇產生默默抱怨和敵意而不信任。第二階段量表建構，將第一階段之質性分析結果發展「骨科住院病人自覺安全感受」量表，共收集262位骨科住院病人，進行信效度檢定。效度方面：專家效度CVI值為.96；驗證性因素分析以20題六因素之模式為良好適配，六個因素分別命名為「支持關懷」、「專業同理」、「資訊完整」、「設備完善」、「即時照護」及「潛在風險」。信度檢定方面，總量表Cronbach's α係數為.85，六個構面α係數分別支持關懷為.92、專業同理為.89、資訊完整為.85、設備完善為.68、即時照護為.71、及潛在風險為.76，顯示「骨科住院病人自覺安全感受」量表有良好的信、效度。第三階段骨科住院病人自覺安全感受描述及其相關因素與預測力，骨科住院病人多數是女性(66%)、中老年人(80.9%)、小學(37.8%)與高中(25.8%)學歷、信奉佛教(66.8%)、退休無工作(61.5%)、夫妻(40.5%)或與小孩(34.0%)同住、至少有一種慢性病(100%)、皆已有住院經驗(100%)、住院次數超過4次(35.9%)、皆有開刀經驗(100%)、住院期間幾乎都有陪伴者(96.6%)、以及以子女(38.5%)或配偶(24.2%)照顧居多。以斯皮爾曼等級相關係數，各構面與人口學相關性結果，教育程度與專業同理、潛在風險，主要照顧者與即時照護、潛在風險之間具有顯著正相關；性別、職業與潛在風險，婚姻狀況與專業同理，宗教信仰與支持關懷，有無陪伴者與設備完善，之間具有顯著負相關。各構面與各構面相關性結果，關懷支持與專業同理、資訊完整、設備完善、及潛在風險具有顯著正相關，即時照護與潛在風險具有顯著正相關，具有顯著負相關唯即時照護與資訊完整。量表總分為110分，得分愈高則表示住院期間自覺安全感受越高，研究結果量表整體得分介於70~110分、平均為93.36分(SD=8.14)、單題平均值為4.24分(SD=0.83)，佛教對於「資訊完整」安全感受大於道教，子女照顧對於「即時照護」安全感受，大於親友照顧，依序是看護照顧，配偶照顧，以及無人照顧。基本屬性可解釋45%整體自覺安全感受；可解釋6%支持關懷，可解釋9%專業同理，可解釋5%資訊完整，可解釋6%設備完善，可解釋6%即時照護，以及可解釋6%潛在風險，影響因素有宗教信仰、有無陪伴者、主要照顧與職業。量表之六構面，支持關懷、專業同理、資訊完整、設備完善、即時照護、潛在風險，共可解釋94%整體自覺安全感受。建議：本研究「骨科手術住院病人自覺安全感」量表，從病人主觀經驗，隱藏在病人心理的安全問題所發展，具備理論架構及良好的信效度，適合提供臨床實務使用，不但可了解骨科住院病人自覺安全感的程度，未來亦可發展相關介入措施暨評量工具，以建立更全面「以病人為中心」的安全護理。

Background: Patient’s safety is becoming a global issues. In hospital, we established a lot of safety policy and environment for preventing from unnecessary patients incidents. Orthopedic patients always had a threat of falling incidents due to their improper mobility. However, studies have rarely explored these relevant subjective experiences. Through the patients’ self-perceived safety experience of orthopedic patients during hospitalization, it is expected to achieve a "patient-centered care".
Purpose: (1) Exploring the subjective feelings and experiences of self-perceived safety of orthopedic patients during hospitalization; (2) To establish the reliability and validity of “Self-Perceived Safety Scale among Orthopedic Surgical Inpatients, SPSSOSI”. (3) Investigating the description of self-perceived safety feeling and the related factors, and prediction from orthopedic patients during hospitalization.
Methods: This study is established as 3 stages: (1). qualitative research method of grounded theory; (2). refer to the generic result of the first stage qualitative research method, develop and construct the first draft of the “scale of self- perceived safety of orthopedic patients during hospitalization, SSPSOP”; (3). cross-sectional survey and related research.
Contents and results: The first stage, qualitative research method of grounded theory, fifteen orthopedic patients, 11 females and 4 males, aged 21 to 79 years participated in in-depth interviews. ‘I need true safety care-not only preventive fall’ was the core category, and ‘restricted physical autonomy’ was the antecedent condition. The patients lived with the “feeling supported” and “feeling neglect” during the hospitalization process. As the patients feeling supported process, they experienced “Getting caring”, “reliable professional care”, and “instant care”. However, sometimes the patients had feeling neglect, when they experienced “worries hidden in my mind” and “fear of accident”. Finally, these patients may have trust, appreciation and self-confidence for their smoothly recovery. However, some patients may have doubt, silently complains and hostility about their encountering during hospitalization period.
The second stage, developed scale of “Self-Perceived Safety Scale among Orthopedic Surgical Inpatients”. The first stage qualitative analysis results were developed into the second stage of the scale construction, and a total of 262 orthopedic hospitalized patients were collected. We perform the “Self-Perceived Safety Feeling Scale among Orthopedic Surgical Inpatients” to construct the reliability and validity. The Content Validity Index, CVI =.96; confirmatory factor analysis takes 20 questionnaires of 6 factors modes as good adaptation, which are named as “support and caring”, “professional and empathy”, “complete information”, “perfect equipment”, “instant care”, and “potential risks”. In the validity, the total scales Cronbach's α =.85 subscale of support and caring=.92, profession and empathy=.89, complete information=.85, perfect equipment=.68, instant care=.71, and potential risks=.76. It indicates that the “Self-Perceived Safety Feeling Scale among Orthopedic Surgical Inpatients” has good reliability and validity. The third stage, descriptive of orthopedic surgical inpatients, the female (66%), middle-aged and elderly (80.9%), primary school (37.8%), and high school (25.8%), buddhist (66.8%), retired (61.5%), living with a child (34.0%) or couples (40.5 %), at least one chronic disease (100%), hospitalization experience (100%), hospitalization more than 4 times (35.9%), all having surgery experience (100%), companions (96.6%), and having children (38.5%) or spouses (24.2%) for taking care of during the hospitalization.The result of spearman correlation coefficient with dimensions and demographic characteristics, significant negative correlation between religious belief and "support and caring", positive correlation between education and “profession and empathy”, and negative correlation between marital status and "instant care". Patients who believe in Buddhism had higher self- perceived safety of "complete information” than Taoism. Patients had higher self- perceived safety of "instant care" from children’s accompany than relatives and friends, then the assistant, next in spouse. The demographic characteristics explain 45% of the overall self- perceived safety; can explain 6% support and caring, can explain 9% profession and empathy, can explain 5% complete information, can explain 6% perfect equipment, can explain 6% instant care, and can explain 6% of potential risks, the influencing factors are religious beliefs, presence or absence of companions, major care and occupation. The six domains of the scale support care, professionalism, complete information, complete equipment, immediate care, and potential risks, which can explain 94% of the overall self-perceived safety.
Suggestion: These findings can guide healthcare professionals to provide appropriate interventions of in sighting the hidden patients’ safe concerns to establish a more comprehensive and patient-centered safety care for patients to perceive their true safety during hospitalization. “Self-Perceived Safety Scale among Orthopedic Surgical Inpatients” has good reliability and validity, which can understand the degree of conscious safety of inpatients in orthopedic surgery. In the future, relevant intervention measures and assessment instrument can also be developed to provide clinical practice and use of in patients.

目　　次

摘要 i
目次 ii
表目次 viii
圖目次 x
附件目次 xi
第一章 緒論
第一節 研究背景 1
第二節 研究重要性及動機 5
第三節 研究目的 10
第四節 研究問題 11
第五節 名詞解釋 12
第二章 文獻探討
第一節 病人安全定義與病人安全相關概念 13
第二節 病人對病人安全的看法 18
第三節 病人安全測量方法 20
第四節 骨科手術病人安全 23
第三章 研究方法
第一節 研究架構 28
第二節 研究設計 29
第三節 第一階段質性研 30
第四節 第二階段發展量表及檢定量表信效度 34
第五節 第三階段橫斷式相關性研 41
第六節 倫理考量 44
第四章 研究結果
第一節 質性研究 45
第二節 量表建構及信、效度檢定 55
第三節 住院中病人自覺安全感受之描述、相關及預測力 78
 
第五章 討論
第一節 質性研究 93
第二節 量表建構及信、效度檢定 99
第三節 住院中病人自覺安全感受之描述、相關及預測力 106
第六章 結論與建議
第一節 結論 117
第二節 研究限制 119
第三節 護理之應用與建議 121
參考文獻
中文部分 123
外文部分 126

表目次
表4.1.1 骨科接受手術病人基本屬性
表4.2.1 專家基本資料
表4.2.2 專家效度暨建議
表4.2.3 住院中病人自覺安全感受量表項目分析
表4.2.4 住院中病人自覺安全感受量表轉軸後的成份矩陣
表4.2.5 住院中病人自覺安全感受量表四因素量表之構面分析表
表4.2.6 住院中病人自覺安全感受模式所有觀察變項之偏態及峰度分配
表4.2.7 住院中病人自覺安全感受不同模式配適指標比較
表4.2.8 住院中病人自覺安全感受量表六因素假設測量模式參數估計表
表4.2.9 住院中病人自覺安全感受量表因素的標準化參數估計
表4.2.10 住院中病人自覺安全感受量表個別項目信度和潛在變項組合信度
表4.2.11 住院中病人自覺安全感受量表信度分析表
表4.3.1 骨科住院中病人個案人口學特性一覽表
表4.3.2 骨科住院中病人自我安全感受量表各構面與人口學相關分析表
表4.3.3 骨科住院中病人自覺安全感受各構面相關分析表
表4.3.4 單因子變數分析(ANOVA)，基本屬性與住院中自我安全感受分析表
表4.3.5 骨科住院病人人口學變項與資訊完整之變異數分析
表4.3.6 骨科住院病人人口學變項與即時照護之變異數分析
表4.3.7 骨科住院病人「宗教信仰」對「支持關懷」構面預測分析
表4.3.8 骨科住院病人「教育程度」對「專業同理」構面預測分析
表4.3.9 骨科住院病人「有無陪伴者」對「設備完善」構面預測分析
表4.3.10 骨科住院病人「主要照顧者」對「即時照護」構面預測分析
表4.3.11 骨科住院病人「主要照顧者」、「職業」對「潛在風險」構面預測分析
表4.3.12 骨科住院病人「基本屬性」對「整體自我安全感受」及量表各構面預測分析
表4.3.13 量表各構面對「整體自覺安全感受」逐步多元迴歸分析結果
表4.3.14 骨科住院中病人自我安全感受量表各題得分情形一覽表
表4.3.15 骨科住院中病人自我安全感受量表各構面得分及分布情形

圖目次
圖3.1.1 研究架構圖
圖3.3.1 量表建構架構圖
圖3.5.1 相關研究建構架構圖
圖4.1.1 概念架構圖-我需要真正的安全-不僅注意是否跌倒骨科住院病人自覺安全感受經驗歷程
圖4.2.1 住院中病人自覺安全感受一級四因素CFA模式
圖4.2.2 住院中病人自覺安全感受一級六因素CFA模式
圖4.2.3 住院中病人自覺安全感受四因素假設模式之標準化參數估計值
圖4.2.4 住院中病人自覺安全感受六因素假設模式之標準化參數估計值
 
附錄目次
附錄一 骨科住院病人自覺安全感量表初稿
附錄二 骨科住院病人自我安全感受預試量表
附件三 骨科住院病人自我安全感受量表
附件四 人體試驗委員會臨床試驗案同意函

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