臺灣博碩士論文加值系統

不正確的藥量計算為藥物疏失的一部份，其可能會危及病患安全。然目前並無適合評量的工具，因此，本研究發展藥量計算量表，來檢測護理人員的藥量計算能力。藥量計算量表為一結構性問卷，考題來自於臨床實際情境。研究問卷內容包含2部份，第一部份為背景，第二部份為20題藥量計算，分為時間、滴數、濃度及劑量等4個構面。量表品質其信度使用Cronbach’s α係數，建構效度採概念定義、操作定義、鑑定力指數（＞0.3或p＜0.05）、修正的項目總相關（＞0.3）及因素負荷量（＞0.3）來檢測。本研究為橫斷式描述性研究，取樣採立意取樣法，共招募3家教學醫院共216位護理人員為研究對象。經由信效度分析後，較多證據支持藥量計算量表不需刪除任何一題，而研究結果顯示護理人員的藥量計算平均分數為77.8±21.0，20題藥量計算4個構面答對率由高至低依序為：劑量（79.7％）、時間（77.7％）、濃度（77.1％）及滴數（76.7％），其中又以滴數對藥量計算的預測力最高，達71.5％，而在背景中，年齡（F(3, 210)=3.86，p＜0.05）、教育程度（t(213)= -2.04，p＜0.05）及工作年資（F(2, 212)=4.08，p＜0.05）在藥量計算能力上有顯著差異，另外，年齡（r= 0.22，p＜0.01）及工作年資（r= 0.19，p＜0.01）與藥量計算能力達顯著正相關。本研究藥量計算量表是適合評量護理人員藥量計算能力的工具，建議將其加入護理教科書及國家考試之用，而研究結果顯示護理人員在4個構面的藥量計算能力皆不足。

關鍵詞:藥量計算量表、護理人員、藥量計算能力、藥物疏失、病患安全

Inaccurate medication calculations are a part of medication errors, which may cause patient safety in danger. But no suitable tool for assessment at present; therefore, a MCQ
(medication calculation questionnaire) was developed to exam the nurses’ medication calculation skills. MCQ was a structure questionnaire that based on clinical situations and contained 2 parts. The first part was background. The second part was twenty items of medication calculation, which divided into 4 dimensions: timing, drop, concentration, and dose. Quality of MCQ was evaluated by Cronbach’s α coefficient in reliability with conceptual definition, operational definition, Upper minus Lower indices or Discrimination indices(＞0.3 or p＜0.05), corrected item-total correlation(＞0.3), and factor loading (＞0.3) in construct validity. The research was a cross-sectional, descriptive study using judgmental sampling. There were 216 nurses recruited totally from three teaching hospitals. After reliability and construct validity analysis, more evidences supported no one item of the MCQ need deleted and the results showed the mean score of MCQ test was 77.8±21.0 and the sequency of the correct rate of 4 dimensions of MCQ was dose(79.7%), timing(77.7%), concentration(77.1%), and drop(76.7%). The drop was the highest predictor within the 4 dimensions of MCQ, which could explained 71.5％ of variance. Among the background, a one-way analysis of variance (ANOVA) reached significant difference on age( F(3, 210)=3.86, p＜0.05), education(t(213)= -2.04, p＜0.05), and nursing experience( F(2, 212)=4.08, p＜0.05). Otherwise, age(r= 0.22, p＜0.01) and nursing experience(r= 0.19, p＜0.01) were positive correlated with medication calculation skills. The MCQ was adequate for assessment of nurses’ medication calculation skills, join the nursing textbook with official exam were suggested, and the results revealed nurses were not enough in 4 dimensions of medication calculation skills.

Key words: MCQ, nurses, medication calculation skills, medication error, patient safety

目錄
第一章 緒論
第一節 研究背景與重要性................................1
第二章 文獻查證
第一節 藥物疏失的影響..................................3
第二節 藥物疏失的主因..................................8
第三節 藥量計算疏失...................................13
第四節 藥量計算能力檢測相關研究.......................15
第三章 研究方法
第一節 研究目的.......................................19
第二節 研究問題.......................................20
第三節 研究設計.......................................21
第四節 樣本數估計.....................................22
第五節 研究對象.......................................23
第六節 研究工具發展...................................24
第七節 研究工具.......................................26
第八節 效度分析.......................................27
第九節 前趨研究信度分析...............................30
第十節 研究對象權益的維護.............................31
第十一節 資料處理及分析...............................32
第四章 研究架構
第一節 研究架構.......................................33
第五章 研究結果
第一節 量表品質.......................................34
第二節 護理人員背景...................................41
第三節 護理人員的藥量計算能力.........................45
第四節 護理人員背景在藥量計算能力之差異...............49
第五節 護理人員背景、4個構面的藥量計算能力與藥量計算能力
之相關.........................................53
第六節 藥量計算能力的預測因子.........................55
第六章 討論
第一節 量表品質.......................................56
第二節 護理人員的藥量計算能力.........................58
第三節 護理人員背景在藥量計算能力之差異...............60
第四節 護理人員背景與藥量計算能力之相關...............62
第五節 藥量計算能力的預測因子.........................62
第七章 結論、建議與研究限制
第一節 結論...........................................63
第二節 建議...........................................64
第三節 研究限制.......................................65
參考文獻
一、中文部份..........................................66
二、英文部份..........................................67
附錄
附錄一 專家效度名單...................................78
附錄二 研究問卷.......................................79
附錄三 IRB審查通過書.................................100
圖目錄
圖3-6 研究工具發展流程圖..............................25
圖4-1 研究架構........................................33
圖5-3-1a護理人員的藥量計算能力........................46
表目錄
表3-8專家效度（內容效度）指數.........................28
表3-9 前趨研究信度分析................................30
表5-1-1a項目分析：鑑定力..............................36
表5-1-1b項目分析：修正的項目總相關....................37
表5-1-2 KMO與Bartlett檢定............................39
表5-1-3 因素分析......................................39
表5-1-4 信度分析......................................40
表5-2 護理人員背景之分佈情形..........................43
表5-3-1a護理人員的藥量計算能力........................46
表5-3-1b護理人員的藥量計算能力........................47
表5-3-2 護理人員4個構面的藥量計算能力.................48
表5-4-1 護理人員背景在藥量計算能力之差異..............51
表5-4-2 單位Mann-Whitney test無母數分析...............52
表5-5 護理人員背景、4個構面的藥量計算能力與藥量計算能力之
相關............................................54

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