第五章 結論與建議
第三節 限制
壹、研究結果之推論性限制與改進
本研究因人力與物力限制採取立意取樣。取樣範圍只選擇南部一所大型公立 之醫學中心做取樣，發放問卷時未限制班別，故取樣時未能平均收集到三種班別 的受試者，有可能導致樣本不均，且在收集資料時未將目前班別納入收集供受試 者選填。
因健保總額實施，公私立醫院的營運方式各有差異，本研究所收集的樣本來 自公立醫院，故建議樣本分析結果，將僅適合推論到公立醫院的為主的醫療機構。
貳、研究方法的限制與改進
本研究採取橫斷式研究，故只能提供一個時間點的觀察分析，無法了解到隨 著時間演進，護理人員在工作壓力上和工作滿意度、憂鬱、離職意圖的影響，甚 至是背景變項的變遷所造成的改變。希望未來可以利用縱貫性研究與質性研究深 入探討相關議題。
採用縱貫性研究能在不同背景變項（如：年齡、年資、照顧人數）上看到對 護理工作壓力的影響變化，更深入了解變項間互相影響改變的情形。縱貫性研究 能長時間觀察護理人員在工作壓力上的變化情形，惟因研究受物力、財力等影響 未採用縱貫性研究。
本研究於試題分析和探索性、驗證性因素分析後，為更清楚護理工作壓力和 工作滿意度、憂鬱、離職意圖之間的相互影響路徑關係，故進行結構方程模式檢 驗，唯在文獻探討中未納入更多的相關資料說明解釋。
参、研究測量工具之建議與改進
針對本研究工具需要改進與建議部分。改進部分為本研究在進行初步試題分 析時，刪除了和總分相關較低第一題「電腦或網路故障」和無法歸納因素之第24 題「被主管批評」。在第一題的部分，現今臨床護理工作多以E化工作車或是行 動平板電腦進行診察、給藥、查閱相關檢驗或報告資料，提倡環保減少紙張的使
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用，並方便於床邊向病人或家屬解釋醫療處置，理當電腦或網路故障時影響會尤 其明顯，但此試題卻與總分相關低，實可再深入探討或使用質性研究給與受試者 回答；第24題「被主管批評」和因素六：與醫師、主管有衝突（#2被醫師批評、
#5與主管有衝突、#9與醫師有衝突）之題目內容相類似，未來建議題目可以更明 確或是簡化。
另外在因素一「工作負荷」中，此因素的題目有：調派到人員短缺的單位、
無法預期的人力及排班、需要做太多非護理的工作，例如文書工作、沒有足夠的 時間提供病人情緒上的支持、沒有足夠時間去完成我所有的護理工作、單位內沒 有足夠的護理人員，建議可以依照題目的內容將因素名稱改為人力安排或人力支 持或是人力管理來做為因素名稱，減少因因素名稱本身就帶有負向性質。
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附錄二「護理人員工作壓力與態度問卷」
親愛的同仁，您好:
有鑑於護理人員的工作壓力對其身心影響甚鉅，本研究主要目的在修 訂一份具信、效度的護理人員工作壓力量表，並探討本院護理人員工作壓 力現況及其相關因素。您的參與除了協助我們對問題有更深入一層的了解 外，也能提高本研究結果的應用價值。
衷心期盼您能協助我們完成這項研究。我們會謹守研究倫理，對您填 答的內容嚴格保密，絕不外流；另外，所有資料將僅呈現整體統計分析的 結果，不會進行個人的分析，請您放心填答。
本問卷共包含四部份，每個部分都有簡短的作答說明，答案沒有對與 錯，請您根據自己真實的經驗作答即可。
最後誠摯地感謝您的耐心填答，以協助本研究順利的進行。
國立屏東大學教育心理與輔導學系 指導教授：張麗麗 博士 研 究 生：高敏芳
聯絡方式：[email protected]
2014.12.22
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壹、基本資料 (請在適當的空格內填寫或打3) 1.性別：(1)□男 (2)□女
2.年齡： 歲 3.伴侶/婚姻狀態：
(1)□單身/未婚 (2)□同居/已婚 (3)□分居/離婚
(4)□伴侶已歿/喪偶 (5)其他(請說明) 4.教育程度：
(1)□專科(含二、三、五專) (2)□學院或大學 (3)□研究所以上 5.擔任護理工作的年資：
(1)□1年以內 (2)□1-3年 (3)□4-6年 (4)□7-9年 (5)□10年以上
6.服務科別（最近兩週的主要服務科別）：
(1)□內科 (2)□外科 (3)□兒科 (4)□婦產科 (5)□精神科 (6)□加護病房
(7)□急診 (8)□綜合科 (9)□安寧病房、血液腫瘤 7.負責照顧的病人數(以第六題的服務科別為準)：
(1) □5人以內 (2) □6-10人 (3) □11-15人 (4) □16-20人 (5) □21-25人 (6) □26-30人 (7) □30以上
8.子女人數：
(1)□無 (2)□1人 (3)□2人 (4)□3人 (5)□4人（含）以上。
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肆、護理工作態度與離職意圖
1. 對目前工作的整體滿意度 (請在直線上圈選一個數字)
非常 非常
不滿意 不滿意 尚可 滿意 滿意 1 2 3 4 5 6 7 8 9
請根據您最真實的想法，圈選一個適合的答案。
不 同 意
有 點 不 同 意
有 點 同 意
同 意
1. 我經常想調離目前服務的科別。... 1 2 3 4 2. 我經常想調離目前服務的醫院。... 1 2 3 4 3. 我經常想辭去護理工作。... 1 2 3 4 4. 明年我可能會開始找其他的工作。... 1 2 3 4
1. 我經常想調離目前服務的科別。... 1 2 3 4 2. 我經常想調離目前服務的醫院。... 1 2 3 4 3. 我經常想辭去護理工作。... 1 2 3 4 4. 明年我可能會開始找其他的工作。... 1 2 3 4