交接班資訊的架構對接班新手護理師病患狀況掌握之影響

Abstract

護理師交接班為醫院內的典型日常作業，在這段過程，交接護理師傳遞重要的病患照護資訊與照護責任給予接班護理師，並在交接班的過程中建立對病患共享的心智模型(Shared Mental Model)，以促進照護活動的延續性，並達到醫療目標，確保病患在不同護理師間安全的轉移。有效的交接班不僅有助於病患照護延續與提升病患安全，更可以促進照護團隊合作與提升作業效率。過去的研究也指出，散落與缺乏結構化的交接班資訊，為造成無效交接班的主因。近年來，臺灣出現護士荒，導致護理師們工作量大增且需超時工作，為了解決護理師短缺問題，醫院聘用許多新手護理師來填補空缺，這些未經過完整護理訓練的新手護理師，因為經驗與專業上的不足，難以提供一致的照護品質。本研究探討資訊結構對於新手護理師資訊交接的影響，比較不同的資訊結構組織方式(SBAR或病徵導向)是否會影響新手護理師交接班狀況察覺績效? 本研究在手持裝置上，設計兩種不同資訊組織方式(SBAR組織方式與病徵導向)的護理師交接班電子查核表作為交班資訊，16位年資未滿1年的新手醫學中心護理師扮演接班護理師，進行模擬加護病房交接班，接班護理師接收交班資訊後，填答狀況察覺問卷。對狀況察覺每一階段答對題數進行統計分析，結果顯示，病徵導向交接班電子查核表，對於新手護理師形成狀況察覺第三階段的預測，顯著優於SBAR結構化方法。因此，病徵導向護理師交接班電子查核表較SBAR組織方式，更能夠有效輔助新手護理師進行病患異常問題後續的計畫擬訂與執行。

Handover is a process that off-going staffs transfer critical information and responsibility to oncoming staffs during shift change or transfer to another department. Handover is a typical daily activity and plays an important role in ensuring continuity of care and patient safety. Nurses can build the shared mental model during the handover. Effective handover can not only reduce length, cost of patient stay, and care pathway variance, but also improve quality indicators. Studies found that the leading problem in handover is the scattered information and omissions caused by large amount of information. Recently, Taiwan faces nursing manpower shortage. To solve this problem, hospitals have recruited lots of novices who are lack of the proficiency and experience. Thus, the purpose of this study was to investigate the effect of different nursing handover’s information structures (i.e. SBAR and symptom-oriented formats) on the novices’ situation awareness. We designed the two formats of nursing handover information, i.e., SBAR and symptom-oriented structure, on a mobile device. 16 novice nurses(less than 1 year experience) in a medical center participated in the experiment. Through statistical analysis of scores on each phase of situation awareness, we found that the novices, using the symptom-oriented handover information, could perform better in developing precautious measures.