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1 93 從病人安全談優質健康照護環境杜玉卿 1 王瑞霞 2* 1 高雄醫學大學護理學系護理學博士班研究生 2 高雄醫學大學護理學系教授兼系主任摘要 : 病人安全被視為是護理品質的指標, 護理人員對於擔負維護病人安全的責任責無旁貸當今全世界許多國家皆面臨健康照護人員短缺的問題, 而照護人力不足與病人安全確實存在著密切的相關性許多健康照護專業組織共同推動的正向工作環境, 其目的是希望透過建構優良的醫療保健工作環境來達成提升健康服務品質的目標營造優質健康照護環境以保障病人安全, 需要護理人員就醫者及政策制訂者全體共同關注與參與本文以 Donabedian(1988) 所建構結構過程結果的分類結構品質分析理論模式, 論述以病人安全為基礎的優質健康照護環境應涵蓋的各層面指標項目, 除了藉此喚起大眾重視優質健康照護環境對就醫者本身安全的影響, 也希望藉由落實各層面的指標項目營造優質健康照護環境, 以做為確保病人安全之參考未來可進一步針對各層面指標項目收集資料進行實證性研究分析, 將有助於優質健康照護環境之建構及護理專業未來之發展關鍵詞 : 病人安全正向工作環境優質健康照護環境護理人力根本原因分析 Institute of Medicine, [IOM] 44,000~98,000Kohn, Corrigan, & Donaldson, Donabedian 1988 IOM 2003 safe effective patient-centered IOM Kohn et al., error bias accident International Council of Nursing, [ICN] ICN, 2009a *

2 94 Care Environment and Patient Safety ICN 2007 nursing matter ICN, 2009b Rothberg Abraham Lindenauer Rose 2005cost-effectiveness analysis 8 OR =.33, 95% CI =.13.80, p =.014Cho & Yun, % OR = 1.09, 95% CI = Cho, Hwang, & Kim, 2008 Stone et al., 2007 Benner 1982 novice advanced beginner Yang 2003 N Wu, Lipshutz, & Pronovost, 2008 root cause analysis, RCA Wu et al., Blakemore, 2009 Cho et al., 2008; Cho & Yun, 2009; Stone et al., 2007 Yang, 2003

3 ICN, 2007 Blakemore, Stone et al., 2007; Yang, 2003 Wu & Lee, Donabedian RCA

4 96 Care Environment and Patient Safety Wu et al., [Yin, Y. C. (2008). Nursing manpower, patients safety and nursing quality. VGH Nursing, 25(4), ] [Lin, C. F., Lu, M. S., & Chung, C. C. (2007). The development of nursing quality indicators. Chang Gung Nursing, 18(4), ] [Hou, S. M. (2003). Medical Education and Patient s Safety. Journal of Medical Education, 7(2), ] [Hsu, T. F. (2007). Application of root cause analysis in healthcare. The Journal of Nursing, 54(6), ] [Taiwan Joint Commission on Hospital Accreditation. (2007, May 15). Patient information safety net. Retrieved January 5, 2010, from [Huang, Y. Y., Liao, M. C., Chen, Y. H., & Deng, C. H. (2009). Promoting the accuracy of chemotherapy medication administration for nurses: An application of root cause analysis. The Journal of Nursing, 56(3), ] Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), Blakemore, S. (2009). Why patient safety must be at the top of the agenda at every level. Nursing Standard, 23(45), Cho, S. H., Hwang, J. H., & Kim, J. (2008). Nurse staffing and patient mortality in intensive care units. Nursing Research, 57(5), Cho, S. H., & Yun, S. C. (2009). Bed-to-nurse ratios, provision of basic nursing care, and in-hospital and 30-day mortality among acute stroke patients admitted to an intensive care

5 97 unit: Cross-sectional analysis of survey and administrative data. International Journal of Nursing Studies, 46(8), Donabedian, A. (1988). The quality of care. How can it be assessed? JAMA: The Journal of the American Medical Association, 260(12), International Council of Nurses. (2007). Positive practice environments for health care quality workplaces for quality care. Retrieved January 5, 2010, from news.htm International Council of Nurses. (2009a, July 1). Global survey of nurses highlights views of profession, health care environments. Retrieved January 5, 2010, from International Council of Nurses. (2009b, July 3). Positive Practice Environments for health care quality workplaces for quality care. Retrieved January 5, 2010, from Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (1999). To err is human: Building a safer health system. Washington, DC: National Academy Press. Rothberg, M. L. B., Abraham, I., Lindenauer, P. K., & Rose, D. (2005). Improving nurse-to-patient staffing ratios as a costeffective safety Intervention. Medical Care, 43(8), Stone, P. W., Mooney-Kane, C., Larson, E. L., Horan, T., Glance, L. G., Zwanziger, J., et al. (2007). Nurse working conditions and patient safety outcomes. Medical Care, 45(6), Wu, A. W., Lipshutz, A. K. M., & Pronovost, P. J. (2008). Effectiveness and efficiency of root cause analysis in medicine. JAMA: The Journal of the American Medical Association, 299(6), Wu, S. H., & Lee, J. L. (2006). A comparison study of nursing care quality in different working status nursing staffs: An example of one local hospital. The Journal of Nursing Research, 14(3), Yang, K. P. (2003). Relationships between nurse staffing and patient outcomes. The Journal of Nursing Research, 11(3),

6 98 Care Environment and Patient Safety High-Quality Nursing Health Care Environment: The Patient Safety Perspective Yu-Ching Tu 1 Ruey-Hsia Wang 2 * 1 RN, MSN, Doctoral Student, College of Nursing, Kaohsiung Medical University; 2 RN, PhD, Professor & Director, College of Nursing, Kaohsiung Medical University. Abstract: Patient safety is regarded as an important indicator of nursing care quality, and nurses hold frontline responsibility to maintain patient safety. Many countries now face healthcare provider shortfalls, and recognize a close correlation between adequate manpower and patient safety. Many healthcare organizations work to foster positive work environments in order to improve health service quality. The active participation and buy in of nurses, patients and policymakers are critical to maximize healthcare environment quality and improve patient safety. This article adopts Donabedian s theoretical Structure-Process-Outcome model of quality (Donabedian, 1988) and presumes all high-quality healthcare environment indicators to be linked to patient safety. In addition to raising public awareness regarding the influence of healthcare environment quality on patient safety, this research suggests certain indicators for tracking and assessing healthcare environment quality. Future research may design an empirical study based on these indicators to help further enhance healthcare environment quality and the professional development of nurses. Key Words: patient safety, positive practice environment, high-quality healthcare environment, nurse staffing, root cause analysis. Accepted for publication: February 15, 2011 *Address correspondence to: Ruey-Hsia Wang, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan, ROC. Tel: +886 (7) ext. 2641; wrhsia@kmu.edu.tw

rights and interests of doctors and patients. But it is insufficient jurisprudential basis and legitimacy crisis of legal forms through the form of mi

rights and interests of doctors and patients. But it is insufficient jurisprudential basis and legitimacy crisis of legal forms through the form of mi 1 Vol. 3 6 No. 1 36 2 0 1 8 1 Hebei Law Science Jan. 2 0 1 8 DOI 10. 16494 /j. cnki. 1002-3933. 2018. 01. 011 511436 DF36 A 1002-3933 2018 01-0117-13 Study on the Jurisprudential Basis on the Implementation