博碩士論文 etd-0630109-170850 詳細資訊


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姓名 鄭俐玲(Li-Ling Cheng) 電子郵件信箱 E-mail 資料不公開
畢業系所 高階經營碩士班(EMBA)
畢業學位 碩士(Master) 畢業時期 97學年第2學期
論文名稱(中) 專科護理師人力效益之探討:以南部某區域教學醫院
論文名稱(英) A Study of Nurse Practitioner on Human Resource Benefits:
Using a Certain Southern Teaching Hospital as a Study Case
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    摘要(中) 資源的分配、激烈競爭的排擠效應,使得醫療院所不僅要增進醫療技術而且要不斷改善醫療管理與效率進而達到良好的醫療品質。在臺灣,一個醫師之養成約需要十年,若是用專科護理師來取代住院醫師部分功能,只要護理師在相當工作經驗後接受短期訓練並通過考試即可,因此專科護理師在人力資源運用是比較經濟的,對於醫療照護人力效益是有實質的意義。
    因此本研究以南部某區域教學醫院的醫生、護理人員、病患及關係人與醫療相關其他人員為對象,分二部分進行:先以質性研究方式進行深度訪談,以收集研究對象對專科護理師制度之相關看法。再依據深度訪談的結果及文獻查證之內容,設計問卷,進行量化的問卷調查法,由醫療院所人資效率的趨勢來驗證專科護理師之價值,並探討相關醫護人員之個人屬性不同,是否會影響對於專科護理師的認知,以預測專科護理師獨立制度的建立是醫療體系未來發展的方向。
    研究結果發現:(一)本研究之受訪者有51.8%認為建立專科護理師獨立制度不僅是醫院、醫師以及病患之需求更可以提升整體醫院管理效率,而在醫師需求部分佔整體之28.4%,可見有一定程度之受訪者認為建立專科護理師獨立制度可適度分擔醫師之工作負擔。有47.2%的受訪者認為,專科護理師在醫療體系所扮演之角色是「醫師臨床助理」。此外,接近五成之受訪者認為專科護理師替代住院醫師具備節省成本、節省人力訓練時間、提昇效率、提昇醫療品質等優點。(二)不同年齡層之受訪者對擴展體系構面(F=3.495,p=.018)存在顯著差異,在擴展體系構面其年齡層越輕對於擴展體系構面之得分越低,可能表示年齡層越低之相關醫療人員,對於發展完善護理照護網絡、護理照護社區化等擴展體系構面之認知較低或較不認同;(三)由不同年資對各構面之單因子變異數分析可得
    知 ,不同年資之相關醫療從事人員對於擴展體系構面(F=4.153,p=.008),以Scheffe’s 法進行事後比較得知,在平均數面向上,5 年以上>3-5 年。相較而言,
    年資較深的相關醫療從事人員所獲得之平均得分較高;(四)不同每月平均收入在取代性構面(F=3.174,p=.046)存在顯著差異,在個人屬性之描述性統計中
    可瞭解,平均月收入120000 元以上高收入所得應該是醫師佔大多數(38.2%),但專科護理師本身對是否能適時提供住院醫師的即時支援,以及外界對於專科護理師的認同與認知程度,所獲得之平均得分較其他類別低。
    本研究認為未來在醫院政策面應有更明確之方向與制訂相關機制,使得專科護理師能夠發揮更大的效能。目前臺灣對於實施專科護理師的工作認定上還是相當的模糊,且對於專科護理師制度的建立也無太多著墨,所以在設計構面思考上未盡完善,而且參考一些國外專科護理師制度、執行、訓練等也未必能讓現在的工作者所認同。但根據本研究結果,已具進一步探討之必要,建議未來具體且完善的研究方案應為:擴大收案範圍至全省各級醫院,以提昇結果之推論性;並針對專科護理師之效益研擬更能深入探討之問卷,以作為未來研究之基礎。
    摘要(英) Due to under intense competitions and uneven resource allotments, many medical institutes are not only being pushed ahead with their medical technology but also constantly improving their medical management and efficiency for achieving higher medical quality. In Taiwan, it takes ten years to train a doctor; however, it is possible to have a NP (Nursing Practitioner) to substitute partial capacity of a resident;
    as long as the NP has equivalent working experiences, a short-term training and also to pass exams as well. Therefore, using a qualified NP in medical institutes is a more economical and practical way of utilizing human resource benefits; as far as for
    the medial caring services it also has a substantive significance.
    This study is a research that is based on a certain southern teaching medical hospital’s doctors, nurses, patients, medical services and other medical related people.It is divided into two parts to proceed: first, collect information from quality based
    researching interviews of targeting people in order to study their perspectives toward to the system of NP. Then, a quantifiable survey is being designed according to the result of the interviews and some other verified literature content; therefore, the merit
    of NP can be proven by the medical hospital’s human resource efficiency trend.Further discussion on whether medical professional personnel attributes can affect theperception of NP; to anticipate an establishment of independent NP system in the
    future medical system.
    According to the research results: (1) 51.8% participants of the interviews think that the establishment of independent NP system is not only a demand from hospitals, doctors as well as the patients. It may even promote overall hospitals management efficiency. The demand 28.4% accounts come from doctors; to a certain extent that many participants believe to establish an independent NP system can possible to share an appropriate amount of doctors’ workloads. 47.2% participants believed that the act of NPs in medical system is “Physician Assistant”. In addition, about 50% participant thought that the NPs can substitute residents and they can cut down cost,be economized the use of manpower training time, improve efficiency, promote medical service quality and so on. (2) A remarkable difference in “Expanding System Construction Interface”(F=3.495,p=.018)is found because the participants come from different age groups. The younger participants are, the lower they score.
    Thus, it is possibly to say when come to develop nursing care network and community medical caring Expanding System Construction Interface that the
    younger medical professionals are, the lower understanding and less recognizing they are. (3) According to different seniority of every single interface variance analysis; the differences of seniority medical professionals in “Expanding System Construction Interface”(F=4.153,p=.008), after comparing with Scheffe’s method,has scored above an average: above five years > 3-5. In comparison, one who has
    more seniority has obtained a higher score. (4) Monthly income in the SubstitutionConstruction Interface (F=3.174, p=.046) has a remarkable difference. According to the description of personnel attributes; doctors who have the average monthly
    income above 120,000NTD have occupied the majority (38.2%). However, in comparing with other categories; to provide resident's immediate supports, as well as others’ understanding and recognizing of the NPs have obtained a lower score.
    The purpose of this research is to believe that there should be more explicit direction and further related implementation in all the future hospital policy, in order
    to enable the NPs to make full use of their ability. At the moment, there is a rather vague definition of NPs’ job in Taiwan; in fact, the establishment of NPs’ system has not much explication either. Therefore, while evaluating overseas’ system, method and training, it may not be approved by the present medical professionals without
    envisaging a thoughtful systematic construction first. However, according to the findings of this research; it is necessary to have a further discussion. It is to suggesting a future specific and comprehensive plan: expanding case acceptance throughout all
    level of hospitals in Taiwan to promote the result of inference; designing a further discussion survey of focusing on NPs’ beneficial results as for the future research foundation.
    關鍵字(中)
  • 醫療照護
  • 專科護理師
  • 人力效益
  • 關鍵字(英)
  • Human Resource of Benefit
  • Medical Care
  • Nurse Practitioner
  • 論文目次 摘要..........................................................................................i
    Abstract................................................................................ iii
    誌謝詞.....................................................................................v
    目錄............................................................................................vi
    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 研究目的...................................................................3
    第二章 文獻探討............................................................................................4
    第一節 人力資源管理...........................................................4
    第二節 民國96 年醫療機構現況及醫院醫療服務量統計分析...........................................................................................8
    第三節 醫療院所之人力資源與應用.................................10
    第四節 專科護理師的國內外現況.....................................13
    第三章 研究方法..........................................................................................19
    第一節 研究架構及假設.....................................................19
    第二節 研究方法.................................................................21
    第三節 問卷設計.................................................................22
    第四節 統計分析方法.........................................................23
    第四章 資料分析與討論.....................................................24
    第一節 質性研究深度訪談結果.........................................24
    第二節 問卷調查分析.........................................................34
    第三節 描述統計.................................................................36
    第四節 推論統計分析.........................................................43
    第五章 結論與建議.............................................................49
    第一節 研究結論.................................................................49
    第二節 研究限制及建議.....................................................55
    參考文獻.........................................................................................58
    附錄一 研究問卷................................................................61
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    口試委員
  • 陳世哲 - 召集委員
  • 李英俊 - 委員
  • 葉淑娟 - 指導教授
  • 口試日期 2009-06-12 繳交日期 2009-06-30

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