臺灣博碩士論文加值系統

本研究目的是利用自然觀察研究之方法學─Behavioral Mapping為工具，收集急診室護理人員之工作活動項目之頻率，並計算急診室行政事務，臨床照顧、病歷記錄、個人活動、移位、醫療事務，護理人員與病人互動等各項工作活動的分配比例，並藉由CQI「病人滿意導向提案計劃」的介入，期改變護理人員工作行為，以提高護理人員生產力，達到提高護理服務品質及病人滿意度的目的。
本研究第一次調查時間為88年12月6日至88年12月13日，第二次調查時間為89年4月10日至4月17日，89年1月25日至3月30日實施介入計劃。調查地點為某地區教學醫院急診室，參與工作人員有護理人員13員、護理助理員3員。研究結果顯示，急診室在介入計劃前後臨床照顧的頻率比例增加3.7%、個人活動頻率減少6.6%、與病人互動增加2%，病人滿意度由介入前之68.2%增加至78.9%。
本研究除了驗證Behavioral Mapping方法適用於衡量急診室護理工作生產力的方法之外，以病人滿意觀點來改變護理活動內容後，可提昇病人滿意度。

The objective of this study, using Behavioral Mapping as a tool to collectdata of the frequency of various categories of work activities of nursing personnels in the emergency department. It also includes the calculation of the distribution ratio fo personnels in various work activities such as administrative matters, clinical care, medical charting, individual activities and movement, medical treatment, interaction between nursing personnels and patients, etc. In addition to the above, this study introduces the use of the “ Increasing personnels during work in order to increase their procuctivity and hence, achieving the objective of improving the quality of service and consequently patient satisfaction.
The first investigation period was from 89/4/10 to 89/4/17. The time period of actual implementation into the CQI plan being 89/1/25 to 89/3/30. The location of this study is the emergency department of a community teaching hospital. The personnels involved in this study were 13 nurses and 3 nursing assistants. The results of this study showed that when comparisons of pre-and —post implementation(of the ED CQI plan)were made, the frequency ratio of clinical care increased by 3.7%(p<.05), individual activity decreased by 6.6%(p<.005), interaction with patient increased by 1.1%, language and work related communications increased 1.2%, inter-personnel communications decreased 2.7%(p<.005)and patient satisfaction increased from 68.2%to 78.9%.
This study verified behavioral mapping as a suitable tool for the measurement of nursing personnel productivity and at the same time it can be used effectivity to achieve the objective of the plan to increase patient satisfaction.

第壹章緒論
第一節 前 言 1
第二節 研究背景 2
第三節 研究目的 5
第貳章文獻探討
第一節 護理活動 7
第二節 護理生產力 10
第三節 護理工作之測量與生產力 13
第四節 與病人滿意有關之護理活動 20
第參章研究方法
第一節 研究架構 26
第二節 操作型定義 27
第三節 研究假設 29
第四節 研究對象及研究時間 30
第五節 調查方法及工具 30
第六節 介入計劃 32
第七節 觀察資料的信度及效度 36
第八節 觀察資料的計算方法 37
第九節 資料整理及分析 38
第十節 研究設計 38
第肆章研究結果
第一節 研究樣本之描述 39
第二節 急診病人就醫型態 40
第三節 護理活動發生頻率 44
第伍章 討論
第一節 護理活動分類 61
第二節 方法學 63
第三節 檢傷分類與疾病嚴重度 66
第四節 Behavioral Mapping 與CQI 67
第五節 介入計劃與護理行為改變 68
第陸章 結論
第一節 結 論 70
第二節 研究限制 070
參考資料 72
圖表目錄
圖一 抽樣時段病患分佈 41
圖二 就醫人次及檢傷分級直方 42
圖三 88年12月 病人就醫時段曲線 43
圖四 89年 4月 病人就醫時段曲線 43
圖五 計劃介入前後護理活動改變比例 53
圖六 計劃介人前後護理助理員活動改變比例 55
圖七 計劃介人前後病人觀測比例 59
圖八 病人滿意度比較 60
表一 護理人員教育程度分佈 39
表二 護理人員年資及職稱 40
表三 就醫人次及檢傷統計 42
表四 計劃介入前護理活動頻率 48
表五 計劃介入後護理活動頻率 49
表六 計劃介入前後護理活動頻率比較 50
表七 計劃介入前後護理活動分類總合 51
表八 語言溝通活動 51
表九 直接與間接護理頻率比例 52
表十 護理人員自覺認知排序比較 54
表十一計劃介入前後病人特性比例 56
表十二計劃介入前病人特性觀察次數 57
表十三計劃介入後病人特性觀察次數 58
附錄目錄
附錄一 急診室分區平面圖 77
附錄二 護理活動記錄表 78
附錄三 病人滿意度問卷 79
附錄四 急診室護士工作項目分類表 80
附錄五 急診室護理工作執行表 81

中文部份：
徐南麗(1992).護理人力生產力之評估與應用(第一集).行政院國家科學委員會.
徐南麗(1995).護理人力生產力之評估與應用(第二集).行政院國家科學委員會.
曾珍麗(1989).病室護理人員工作量及病患直接護理需要之調查.榮總護理.6(2):87-96.
龔平邦(1989). 行為科學概論,第一、二、十二章.3rd edition.台北：三民出版社.
李亦園(1992),自然觀察研究法─楊國樞等,社會及行為科學研究法,第五章.3rd edition. 東華出版.
衛生署(1996). 改善醫院急診重症醫療計劃.
英文部份：
Melvin F. F. (1996). Keys to Patient Satisfaction in the Emergence Department: Results of Multiple Facility Study. Hospital & Health Services Administration, 41(4), 515-522.
Shukla, R.K.(1982). Nursing Care Productivity Hospital & Health Services Adimistration, 29(5): 45-58.
Neuman, W. L.(1997). Social Research Methods: Qualitative and Quantitative Approach 3th edition. pp.343-369.
Nelson, M. S.(1994). A triage-based emergency department patient classification system. Journal of Emergency Nursing. 20 (4): 511-516.
Pedersen, A., Antoon, M.L.(1997). A 4 years history of work redesign in two ICUs. Nursing Management. Oct:32B-32E.
Pedersen, A.(1997). A data-driven approach to work redesign in nursing units. Journal of Nursing Administration. April. 27(4): 49-54.
Redick, E. L.(1999). Applying Focus-PDCA to Solve Clinical Problem. Dimensions of Critical Care Nursing. 18(6):30-34.
McNeese-Smith, D.(1996). Increasing Employee Productivity, Job Satisfaction, and Organizational Commitment. Hospital & Health Services Administration. 41(2):161-175.
Jordan, S. D.(1994). Nursing Productivity in Rural Hospital. Nursing Management. 25. March: 58-62.
Burke, M. D., Madison. D. E.(1990). Artificial Intelligence in Emergency Department Triage. Journal of Ambulatory Care Management, 13(3):50-54.
Folders, S. S., Fischer.L. R., Kaminsky, K.(1994). What Is an Emergency? The Judgments of Two Physicians. Annals of Emergency Medicine. 23(4): 833-840.
Lowe, R. A.(1994). Refusing Care to Emergency Department Patients: Evaluation of Published Triage Guidelines. Annals of Emergency Medicine. 23(2):286-293.
Curtin, L. L.(1995). Nursing Productivity—From Data to Definition. Nursing Management. 26. April: 25-36.
Ozcan, Y. A., Shukla, R. K.(1993). The Effect of A Competency-Based Targeted Staff Development Program on Nursing Productivity. Journal of Nursing Staff Development. 9(2): 79-84.
Hu, S. C.(1994). Clinical and Demographic Characteristic of Adult Emergency Patient at the Taipei Veterans General Hospital. Journal of Formaosa Medical Association. 93(1):61-65.
Rieder, K. A. & Lensing, S. B.(1987). Nursing Productivity: Evolution of a System Model. Nursing Manggement. 18(8):33-42.
Beisaubin, E.V. etc.(1985). Behavioral Mapping to Plan a New Emergency Center. Journal of Ambulatory Care Management. 8(3): 36-43.
Kirsch, E., Judy T.(1990). Outpatient and Short-Stay Patient Classification Systems. Nursing Management. 21(9): 118-122.
Williamson, W. J., Johnson, J., (1988). Understanding Evaluating and Improving Nursing Productivity. 19(5):49-54.
Hunter, M. etc.(1962) The Measurement of Characteristic Patterns of Ward Behavior in Chronic Schizophrenics. Journal of Consulting Psychology. 26:69-73.
Marilyn M, Bader. M.(1988) Nursing care behaviors that predict patient satisfaction. Journal of Nursing Assurance. 1988; 2(3): 11-17.
Stahler, G. J. etc.(1984). The Evaluation of an Environmental Remodeling Program on a Psychiatric Geriatric Ward. The Journal of Social Psychology. 123: 101-113.
Devlin, A. S.(1992). Psychiatric Ward Renovation: Staff Perception and Patient Behavior. Environment and Behavior. 24(1): 66-84.
Bethel, S., Ridder, J.(1994). Evaluating Nursing Practice: Satisfaction at What cost? Nursing Management. 25(9):41-48.
Strongwater, S. L.(1996). Clinicle Process Redesign. Aspen Publishers Inc. Gaithersburg, Maryland.
Ferrell, M. J.(1988). The Relationship of Continuing Education Offerings to Self-Reported Change in Behavior. The Journal of Continuing Education in Nursing. 19(1): 21-24.
Mcnaul, F. W., McLees, J. P.(1992). A Comparison of Educational Methods to Emhance Nursing Performance in Pain Assessment. The Journal of Continuing Education in Nursing. 23(6): 267-271.
Leebov, W.(1991). The Health Care Manager’s Guide to Continous Quality Improvement. Developing Measure to Monitor Performance. 53-61.
Semonin, H.R.(1991). Caring From the Patient’s Perspective in the Emergency Department. Journal of Emergency Nursing. 17(6): 429-430.
Rasper, J. L.(1996). A Cognitive Approach to Patient Satisfaction With Emergency Department Nursing Care. Journal of Nursing Care Quality. 1996; 10:48-58.
Megivern, K., Halm M.A., Jones G. Measuring Patient Satisfaction As an Outcome of Nursing Care. Journal of Nursing Care Quality. 6:9-24.
Lewis, K.E., Woodside R.E.(1992). Patient Satisfaction With Care in The Emergency Department, Journal of Advanced Nursing. 17: 959-964.
Bader, M.(1998) Nursing care Behaviors that Predict Patient Satisfaction. Journal of Nursing Quality Assurance. 2:11-17.
Rhee, K.J., Bird J.(1996). Perceptions and Satisfaction with Emergency Department Care. Journal of Emergency Nursing. 14: 79-83.
Thompson, D. A., etc. Effects of Actual Waiting Time, Information Delivery and Expressive Quality in Patient Satisfaction in the Emergency Department. Annals of Emergency Medicine. 28:657-669.
Clark, C.A., Pokorny, M.E., Brown S.T.(1996). Consumer Satisfaction With Nursing Care in a Rural Community Hospital Emergency. Journal of Nursing Care Quality. 10:49-57.
Bruce, M. T., Bowman, J. M., Brown, S.T.(1998). Factors that Influence Patient Satisfaction in the Emergency Department. Journal of Nursing Quality.1998; 13(2): 31-37.
Krishel, S., Baraff, L. J. Effect of Emergency Department Information on Patient Satisfaction. Annals of Emergency Medicine. 22(3): 568-572.
Mack, J.L., File, K. M, Prince, R. A.(1995). The Effect of Urgency on Patient Satisfaction and Future Emergency Department Choice. Health Care Management Review. 1995; 20(2): 7-15.