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研究生:陳子涵
研究生(外文):CHEN,TZU-HAN
論文名稱:產婦生產就醫經驗 ~ 以某區域教學醫院為例
論文名稱(外文):The Patient Experience of Maternal Care in a Regional Teaching Hospital
指導教授:葉德豐葉德豐引用關係
指導教授(外文):YEH,TE-FENG
口試委員:黃麗玲張育嘉
口試委員(外文):HUANG,LI-LINGCHANG,YU-CHIA
口試日期:2020-07-03
學位類別:碩士
校院名稱:中臺科技大學
系所名稱:醫療暨健康產業管理系碩士班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:中文
論文頁數:108
中文關鍵詞:病人經驗綜合評價產婦照護生產
外文關鍵詞:Patient experienceoverall evaluationmaternal carechildbirth
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背景:近年來,病人就醫經驗逐漸成為衡量醫療照護品質的重要指標,更是達到以病人為中心照護的核心。在現今少子化的社會中,產婦對於自己即將經歷的生產過程愈加重視;個案醫院亦為提供產婦優良的服務品質,於新建大樓內開設全新的產科病房以滿足就醫產婦的需求,並使其留下美好的就醫經驗。
目的:探討產婦生產服務過程的就醫經驗與住院期間對於醫療照護之評價,盼能藉著產婦的回饋,不斷精進服務品質。
方法:本研究採橫斷式調查研究,收案對象為於個案醫院生產之產婦,問卷內容包含基本資料、生產服務就醫經驗與對生產照護之綜合評價,並將就醫經驗區分為醫師服務、護理服務、照護過程、資訊提供與環境等構面。共發放 305 份問卷,回收有效問卷 302 份,回收率為 99.02 %。統計分析包含敘述性統計、t 檢定、單因子變異數分析(ANOVA)、皮爾森積差相關分析
與複迴歸分析等。
結果:本研究結果發現就醫經驗各構面間均有顯著相關,其中護理服務與照護過程具有高度正相關,其餘構面則除了環境構面與醫師服務、護理服務二構面為輕度相關外,其餘則為中度正相關。複迴歸分析中則發現,同一位醫師產檢與生產,有助於提升產婦生產經驗;高中職以下與多胞胎產婦對環境構面經驗感受平均分數較低;無職業或家庭主婦相比在職中之產婦以及家庭年收入在 41-60 萬元者,對於照護過程的經驗感受較低;無職業或家庭主婦以及距離醫院交通時間 10-19 分鐘者對於資訊提供構面經驗較低。在綜合評價上,醫師的綜合評價僅與醫師服務構面有顯著關聯。而護理服務、照護過程以及環境的經驗越好,則對護理師的綜合評價顯著正向關聯。
資訊提供構面與環境構面的得分越好,則對環境的綜合評價越高。照護過程、資訊提供與環境構面的得分越高,則整體照護的綜合評價越高。
結論:產婦個人特性與生產特性,對其就醫經驗的認知有顯著相關。在照護過程中,真正影響產婦對於護理照護評價的構面是在住院期間的護理照護以及住院照護過程的經驗。整體而言,護理服務對於產婦多面向的就醫經驗具有更大的影響力。而生產前資訊提供的困難則是造成產婦綜合評價較低的原因,此部分可以透過「醫病共享決策」(SDM)之推動來加以改善。

Background: In recent years, patients experience has gradually become an important indicator to measure the quality of care, and also the core to achieve patient-centered care. In today's society of declining fertility rate,mothers are paying more attention to the overall experience of the childbirth process. The case hospital also provides excellent service quality for mothers, new obstetric wards were opened to meet the needs of mothers to leave a good experience.
Objective: The experience of maternal service and the evaluation of healthcare during hospitalization for childbirth process would be explored to improve the service quality through patient feedbacks.
Method: A cross-sectional survey was conducted to survey the mothers who admitted for childbirth in the case hospital. The questionnaire included sociodemographic information, patient experience of childbirth services and global evaluation for healthcare. The patient experience was divided into physician services, nursing services, care process, information provision and environment. A total of 305 questionnaires were received, and 302 were effective, with a response rate of 99.02%. Statistical analyses included descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficient and multiple analysis.
Results: The results of this study showed that there was a high positive correlation between nursing services and care process, while other factors were moderately positive correlated with the exception to the environment, physician services, and nursing services for mild correlation. Regression analysis found that having the same doctor in obstetric examination and delivery would improve the childbirth experience. Mothers of high school or lower education and of multiple births had low experience in terms of environment. For those who housewives and without occupation and with annual family income of 410,000 to 600,000 NTD, they showed low experience in the caring experience. These who housewives and without occupation and those who had 10 to 19 minutes traveling time also had lower experience in term of information provision. In terms of overall evaluation for physicians, patients only cared about the experience of physician care. As nursing services, care process and environment improved, these factors contributed positively to the overall evaluation of nurses. Higher scores of information provision and environment would improve the overall evaluation of the environment. Higher scores in care process, information provision and environment would increase patient’s evaluation in the overall care.
Conclusion: There was a significant association between the personal characteristics of mothers and the characteristics of labour to their cognition of the experience. During the care process, the real influence of maternal evaluation of such service was the in-hospital care and the experience of in-hospital care process.
In general, nursing services did impose more impact on multiple aspects of maternal experience for patients. The difficulty of information provision was generally the reason for low global evaluation of maternity service, which could be improved by encouraging shared decision making (SDM) before labour delivery.
中文摘要 ................................................................... I
Abstract ................................................................. III
表目錄 ....................................................................VII
圖目錄 .................................................................. VIII
第一章 緒論 ................................................................ 1
第一節 研究背景與動機 ....................................................... 1
第二節 問題的形成 ........................................................... 3
第三節 研究目的 ............................................................. 4
第四節 研究流程 ............................................................. 5
第五節 名詞解釋 ............................................................. 7
第二章 文獻探討 ............................................................. 8
第一節 產婦生產就醫經驗之探討 ................................................ 8
第二節 醫療服務品質 ........................................................ 17
第三節 住院滿意度 .......................................................... 25
第三章 研究方法 ............................................................ 27
第一節 研究架構 ............................................................ 28
第二節 研究假說 ............................................................ 29
第三節 研究對象 ............................................................ 30
第四節 研究工具 ............................................................ 31
第五節 資料處理與統計 ...................................................... 38
第四章 研究結果與分析 ...................................................... 39
第一節 信度分析 ............................................................ 39
第二節 研究樣本分析 ........................................................ 40
第三節 產婦特性對就醫經驗與綜合評價之關聯性分析 .............................. 46
第四節 綜合評價與就醫經驗之關聯性 ........................................... 70
第五章 討論 ............................................................... 75
第六章 結論及建議........................................................... 79
第一節 研究結論............................................................. 79
第二節 建議................................................................ 81
參考文獻................................................................... 83
一、中文部分................................................................ 83
二、英文部分................................................................ 86
附 錄 一................................................................... 94
附 錄 二................................................................... 98
表目錄
表 2-1 醫療服務品質定義及探討............................................... 23
表 3-1 產婦生產經驗及其計分方式 ............................................ 33
表 3-2 研究變項操作型定義................................................... 36
表 3-3 專家內容效度名單與背景一覽表.......................................... 37
表 4-1 問卷各構面之信度..................................................... 39
表 4-2-1 產婦個人特性之描述性統計(n=302)................................... 40
表 4-2-2 產婦生產特性之描述性統計(n=302)................................... 42
表 4-2-3 問卷題項之描述性統計............................................... 43
表 4-2-4 問卷構面之描述性統計............................................... 45
表 4-3-1 產婦個人、生產特性與醫師、護理師及環境構面之雙變項分析 ............... 48
表 4-3-2 產婦個人、生產特性與醫師、護理師及環境構面之迴歸分析 ................. 50
表 4-3-3 產婦個人、生產特性與照護過程構面之雙變項分析......................... 54
表 4-3-4 產婦個人、生產特性與照護過程構面之迴歸分析 .......................... 57
表 4-3-5 產婦個人、生產特性與資訊提供構面之雙變項分析......................... 61
表 4-3-6 產婦個人、生產特性與資訊提供構面之迴歸分析 .......................... 63
表 4-3-7 產婦個人、生產特性與綜合評價之雙變項分析..............................66
表 4-3-8 產婦個人、生產特性與綜合評價之迴歸分析 .............................. 68
表 4-4-1 各構面之皮爾森相關因素分析 ......................................... 71
表 4-4-2 各構面與整體評價之迴歸分析 ......................................... 72
表4-4-3 照護過程與資訊提供次構面迴歸分析......................................74
圖目錄
圖 1-1 研究流程圖 .......................................................... 6
圖 2-1 PZB 服務品質從十個構面縮減五個構面 ................................... 18
圖 2-2 PZB 服務品質缺口五之構面 ............................................ 19
圖 2-3 PZB 服務品質模式 ................................................... 21
圖 3-1 研究架構............................................................ 28
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