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運用競值途徑於醫院護理部門組織文化領導 型態與組織效能關係之研究

本研究的目的是:一、瞭解護理人員之基本特性與醫院護理部門的組織文化及組織效能間的關係。

二、瞭解護理主任、護理長之基本特性與領導型態間的關係。三、瞭解護理主管自評領導型態與部 屬評護理主管之領導型態是否相同。四、瞭解護理部門的組織文化、領導型態與組織效能間是否相 關。五、瞭解各醫院護理部門之組織文化、領導型態與組織效能的競值類型。六、瞭解醫學中心、

區域醫院與地區醫院之護理部門的組織文化、領導型態與組織效能之契合狀態。綜合研究結果提出 具體建議,以為提昇醫院護理部門組織效能之參考。

本研究參考多位學者所使用之競值途徑理論評量工具與問卷修編而成的結構式問卷表為研究工具;

研究對象為台北市內、且經行政院衛生署八十五至八十七年醫院評鑑及教學醫院評鑑為醫學中心、

區域醫院與地區醫院之護理人員,本研究共發出 1993 份,回收之有效問卷 1794 份(有效問卷回收 率 90.01% )。

研究結果發現:一、護理人員之基本特性與醫院護理部門的組織文化有顯著相關。二、護理主任、

護理長之基本特性與自評領導型態均無顯著差異。三、護理主管之自評之領導型態得分,均明顯高 於部屬評護理主管之領導型態得分。四、護理人員之基本特性與醫院護理部門的組織效能有顯著相 關。五、醫院護理部門之組織文化、領導型態與組織效能三者間有顯著相關。六、醫學中心、區域 醫院及地區醫院之護理部門的組織文化及組織效能有顯著差異。七、醫學中心、區域醫院及地區醫 院之護理部門的領導型態未有顯著差異。八、在競值途徑下,三家醫學中心之護理部門的組織文化

、領導型態及組織效能之契合狀態均為部分趨同部分趨異;區域醫院十一家中,有四家呈現高度趨 同、其餘七家呈現部分趨同部分趨異;地區醫院十四家中,有一家呈現高度趨同、二家呈現高度趨 異、其餘十一家呈現部分趨同部分趨異。

上述之研究發現可提供護理管理者之參考。同時建議: 1 、護理行政者,要了解自己部門的組織文 化、並營造護理部門整體性的組織文化;護理領導者要了解自己的領導型態,適當調整、配合或塑 造組織文化,以提昇組織效能;加強各層護理主管與部屬之溝通;適當採行留任措施,降低流動率。

2 、在護理教育方面,要加強新進人員之職前訓練,協助員工適應整個社會化過程。 3 、對未來之 研究方面,能做深入訪談;長期追蹤;擴及台北市外之教學醫院;並可增加其他變項來探討。

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The application of competing values approach to the relatio nships in organizational culture, leadership styles and orga nizational effectiveness in the nursing department of hospit

als

The purpose of this study was to examine the accuracy and reproducibility of intracranial pressure (ICP) measured by the exte rnal ventricular drainage (EVD) system. The effect of specific gravity (SpGr) of cerebral spinal fluid (CSF) on the accuracy of the EVD-measured-ICP was also determined. Sixty-two subjects with EVD system were included. The ventriculostomy cathet er connected to both the ICP monitor and EVD system was used to measure ICP. ICP was repeatedly measured 6 times in thre e positions: head at 0 degree, head up 15 degree and head up 30 degree. The accuracy of the EVD-measured-ICP was determi ned using the Pearson’s correlation, paired t-test, and Bland-Altman method. Analysis of the reproducibility of ICP measurem ents by EVD system was done with the Pearson’s correlation and coefficient of variation (CV).

The mean of ICP between two measurements was significantly correlated (r = .93, p < .001) at head 0 degree position, and the bias (mean difference) showed significant differences (p < .001), the standard deviation was 2.0 ± 1.6 mmHg, and the limit of agreement (bias ± 2SD) were between - 1.2 and 5.2 mmHg. Position at head up 15 degree displayed significant correlation (r

= .94, p < .001), the bias showed significant differences

(p < .001), and the standard deviation was 2.1 ± 1.5 mmHg, with the limits of agreement being - 0.9 and 5.2 mmHg. At head u p 30 degree, the correlation between measurements was significant (r = .95, p < .001), the bias had significant difference (p < . 001), the standard deviation was 2.0 ± 1.6 mmHg, and the limits of agreement were - 1.2 and 4.9 mmHg. There was no signifi cant correlation between SpGr of CSF and difference of mean ICP by EVD system and monitor measurements (p > .05).

The EVD-measured-ICP had good reproducibility (p < .001). But the CV at head 0 degree was 3.69%, head up 15 degree was 6.62%, and head up 30 degree was 7.88%. The CV became worse as the head elevated.

In conclusion, the agreement of ICP measurements between the EVD system and monitor was poor, and the SpGr of CSF did not affect this result. Therefore, the EVD system cannot replace the monitor for ICP measurement. The results suggested good measurement at supine position when ICP was measured by the EVD system.

Key words: External ventricular drainage system, Intracranial pressure measurement, Accuracy, Reproducibility

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