| 研究生: |
黃小壎 Huang, Hsiao- hsun |
|---|---|
| 論文名稱: |
台灣地區護理人員就醫特性之探討 Exploring Characteristics of Hospital visits among Nurses in Taiwan |
| 指導教授: |
顏妙芬
Yen, Maiofen |
| 學位類別: |
碩士 Master |
| 系所名稱: |
醫學院 - 護理學系 Department of Nursing |
| 論文出版年: | 2008 |
| 畢業學年度: | 96 |
| 語文別: | 中文 |
| 論文頁數: | 74 |
| 中文關鍵詞: | 護理人員 、全民健康保險資料庫 、護理人員 、住院就醫 、全民健康保險資料庫 、住院就醫 |
| 外文關鍵詞: | Nurses, Hospitalization, Nurses, National Health Insurance Research Database, Hospitalization, National Health Insurance Research Database |
| 相關次數: | 點閱:162 下載:9 |
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目前國內有關護理人員健康議題的研究,大多以單一疾病為研究主題,但是對於以護理人員就醫特性來探討健康狀態的研究較為缺乏。因此本研究目的為了解護理人員住院就醫特性。
採用描述性研究設計,以 1997至2005年中華民國全民健保資料庫「住院醫療費用清單明細檔」,經「醫事人員基本資料檔」選取「以護理師及護士為執業登記的護理人員」為對象,將「住院醫療費用清單明細檔」與萃取出的護理人員進行串檔。串檔後在1997至2005年執業護理人員共99,842位,而住院就醫護理人員有23,547位,住院就醫為23.6%。以性別、年齡、工作年資、執業場所、住院天數、就醫次數、就醫場所、就醫科別、診斷類別、醫療費用等變項進行資料分析。研究結果以女性護理人員住院就醫佔多數為99.58%,住院就醫平均年齡為28.6歲,平均工作年資6.1年,執業場所以地區醫院為最多37.88%,平均住院天數為4.1天,住院就醫次數為1.7次,就醫場所選擇以區域醫院為最多37.84%,住院就醫科別以婦產科為最多。在疾病診斷的主診斷病因除正常生產外,以早產及迫切生產為最常見,而系統疾病診斷前七名排序分別為女性妊娠生產及產褥併發症、損傷及中毒、泌尿生殖系統疾病、呼吸系統疾病、消化系統疾病、腫瘤疾病、骨骼肌肉系統及結締組織疾病。每次平均住院醫療費用為22,098.1元,總醫療費用約為新台幣9億2,135萬元,以妊娠生產及產褥併發症之總醫療費用花費最高。
關於住院醫療費用在護理人力成本的影響,在1997至2005年期間住院就醫護理人員所花費的總醫療費用共損失919,245護理工作天,每年平均損失102,138護理工作天,平均每位住院就醫護理人員請假天數為4.3天,表示醫療院所每年因護理人員住院就醫需耗費新台幣1億237萬元人力成本的經濟損失。
因此建議護理主管對於懷孕的護理人員,安排照護段落時可就近護理站,避免人員長時間站立或過度來回護理站與病人單位,減少工作勞累的情形。護理部門能成立人力支援網絡,提供懷孕者請假時單位人力的補給。當護理主管進行工作設計時,考量工作流程的順暢及設備的完整,可將護理人員所使用的工作車進行改良能置放水杯的位置,而工作流程的設計以兩小時為一階段,提供護理人員有如廁的機會。也建議護理人員定期健康檢查的時機配合乳房攝影的篩檢,另外以月排班固定班別制取代輪班制,進行健檢的時機可配合護理人員的上班時段,以提升護理人員執行健檢的便利性。最後建議臨床護理人員可適度穿戴護膝的用具,以保護膝關節彎曲時的動作;另外建議醫療院所選購病床設備時,能考量以電動床取代傳統搖桿的病床,以減少護理人員需時常蹲下執行相關的護理活動。
Present studies associated with the health issues of nurses in Taiwan focus largely on individual diseases, while hospitalization characteristics of nurses are poorly studied. Hence, this study is aimed at providing an insight into the hospitalization characteristics of nurses.
This study used descriptive research design, file streaming was performed with data on “Inpatient expenditures by admissions” from the National Health Insurance Research Database for 1997 to 2005 and data on “Registered Nursing Practitioners” from the “Registry for medical personnel”. After file streaming, it was found that there were 23,547 nurses associated with hospitalization service among the 99,842 registered nursing practitioners from 1997 through 2005, leading to a hospitalization rate of 23.6%. Later, statistical analysis was performed with such variables as gender, age, years of work experience, employing agency, days of hospitalization, number of times of hospitalization, medical care type, diagnosis and expense. As to the results achieved in this study, we found that the female nurses had a hospitalization rate of 99.58%, an average hospitalization age of 28.6, an average work experience of 6.1 years, an average number of times of hospitalization of 1.7, and that a majority 37.88% of the female nurses were employed by a district hospital, a majority 37.84% of them were served by a district hospital and a majority of them were hospitalized gynecological reasons. As to diagnosis, early or threatened labor was most frequently seen in addition to normal delivery. As far as systematic diagnosis is concerned, gestagenic and puerperal complications, trauma and poisoning, urogenital diseases, respiratory diseases, digestive diseases, cancer diseases, musculoskeletal and connective tissue diseases ranked among top 7. On an average basis, NT$22,098.1 was spent per time of hospitalization resulting in an aggregate expense on hospitalization of NT$ 0. 92135 billion, and gestagenic and puerperal complications incurred the largest amount of hospitalization expense.
As far as the effect of hospitalization cost on manpower cost is concerned, 919,245 nursing work days were spent from 1997 through 2005 due to hospitalization of nurses with an annual cost of 102,138 nursing work days. On average, each hospitalized nurses took 4.3 days off, which meat that a manpower cost of NT$ 0.1237 billion was incurred annually in economic terms due to hospitalization of nurses.
Therefore it is suggested that nursing supervisors have a nearest nursing facility serve the pregnant nurses to avoid staying on their feet for long hours and fatigue due to frequent traveling between work site and nursing facility. A manpower assistance network should be established to reinforce manpower when pregnant nurses are off. In performing work design, nursing supervisor should take workflow fluency and facility integrity into consideration, for example, they could meliorate the vehicle in which a pregnant nurse works to enable the vehicle to hold a drinking container easily, while the schedule could be designed on a two-hour-session basis to allow the nurses a chance to go to the restroom. It’s also suggested that the nursing professions include a mammography in their regular physical check-up and that work shift be substituted with monthly permanent shift to have nursing professions coordinate their regular physical check-up with shift and enhance the flexibility of physical check Last of all, it’s suggested that clinic nurses wear knee shields to provide protection when bending their knees and that electric bed should be given priority over manual bed to reduce nursing bending moves for nursing professionals.
行政院衛生署(2005).行政院衛生署醫事執業人口.瀏覽日期:2006年7月10日.網址:http://www.doh.gov.tw