台灣地區護理之家服務現況之探討
中文摘要
本研究目的在瞭解我國護理之家服務的現況，並探討醫療機構附設護理之家與獨立型態護理之家服 務現況之差異。本研究屬相關性研究，採橫斷式調查法，針對台灣地區直轄市及各縣市，於民國 89 年 3 月底前開業，且有 6 個月以上經營資料的護理之家共 115 家來收集資料。其中屬於醫療機構附 設型態者有 65 家，獨立型態者有 50 家。收案時間為 89 年 10 月上旬至 11 月下旬，共發出 115 份問 卷，回收 115 份，回收問卷有效率為 100 。資料以描述性統計、卡方檢定、 t 檢定及無母數分析等 統計方法進行處理與分析。
研究結果發現： 1. 就機構的基本特性比較醫療機構附設型態與獨立型態護理之家的差異，前者屬私 人經營者較少，負責護理人員學歷較高，每床總樓地板面積較大，房舍多屬自有，均有統計上的顯 著差異（ p<0.001 ）；在限制精神疾病及有問題行為的失智症病人入住，會依個案的醫療照護需求、身心及家庭狀況作整體評估，以及收費等方面，前者均較後者為多，有統計上顯著差異（限制入 住條件： p<0.001 ；整體評估： p<0.05 ；收費： p<0.001 ）；在轉介方面，前者多侷限利用自己所 屬醫院的資源，而後者會與鄰近多家醫院建立轉介關係，於統計上有顯著差異（ p<0.001 ）。 2. 就 機構的人力配置比較，前者護理人員白班人力較多；多採三班制；薪資較高，有統計上顯著差異
（白班人力： p<0.001 ；班別： p<0.01 ；薪資：護理師 p<0.05 ；護士 p<0.01 ）。病患服務員人力、
班別及薪資方面，兩者於統計上無顯著差異。在聘用物理治療、社工、藥劑、營養等專業人員方面
，前者聘用的比率較高，有統計上顯著差異（ p<0.001 ）。 3. 就機構的病人特性，前者的病人年齡 較後者年長一些，疾病診斷及生活依賴程度雷同，前者的病人多來自醫院，後者的病人則多來自家 中。 4. 就機構提供的服務內容比較，在醫療服務項目方面，前者開立醫囑及處方與提供疼痛處置等 服務較多，而在護理服務項目方面，前者較少將侵入性之技術性護理活動，交由病患服務員執行，
於統計上均有顯著差異（ p<0.05 ）。在復健服務、生活照顧及社會支持等服務項目方面，兩者於統 計上則無顯著差異。 5. 就機構的服務結果比較，前者使用急性醫療的情形較多，泌尿道感染率及死 亡率，前者略高，但於統計上無顯著差異。
本研究結果可提供各級主管機關輔導業者有效經營，教育與衛生機關或專業團體規劃專業人員養成 及繼續教育，以及政府制定相關政策的參考，進而提升護理之家服務品質。An exploratory study of the current nursing home services in Taiwan
英文摘要
The purpose of this thesis was to examine the current nursing homes services in Taiwan,and explore the difference between h ospital-based and free-standing nursing homes. We investigated all nursing homes in Taiwan. These nursing homes should be opened before March 1990. Totally, we had 115 nursing homes. There were 65 hospital-base nursing homes and 50 free-stand ing nursing homes. The period of data collections was from Oct 2000 to Nov 2000. All nursing homes would response to our study. The successful rate is 100%. All data were analyzed by using descriptive statistics, chi-square test, t-test and mann-whit ney u test.
Several phenomena were presented in the analyzed data:
1. most of hospital-base nursing homes are publicly owned. The education background of nursing leaders were higher, space o f each beds were larger and most of them had their own buildings. All of these had significant difference （ p<0.001 ）； Bot h of them would like to restrict the admission of psychological and problem behavior dementia cases. They would evaluate of each cases individually according to the care requirement, physical-mental condition and family condition. However, the hosp ital-based nursing home would charge much money than free-standing nursing home with a significant difference （ restrict t he admission of cases ： p<0.001 ； evaluate ： p<0.05 ； charge ： p<0.001 ） .
2. hospital-based nursing homes would have more nursing staffs. They would work 8 hours everyday with much high paid. Ot her service staffs, including of physical therapists, social workers, pharmacists, nutritionists….etc, the former would have mor e these specialists than the latter. All of these have significant difference （ human source ： p<0.001 ； salary of nurse speci alist: p <0.05 ； salary of nurse p<0.01 ） .
3. hospital-based nursing homes would had more elder cases. Besides, most cases of them were transferred from hospital. And most of free-standing nursing homes cases were came from homes. The former would have their own hospital to support them . The latter would ask local hospital to cooperate. It has a significant difference （ p<0.001 ） .
4. hospital-based nursing homes would have much service on medicine and pain-control. They would do the most invasive nu rsing procedures by nurses ， All of these have significant difference （ p<0.05 ） . There are no significant difference on the services of physical therapy, life care and social support.
5. The results of care, hospital-based nursing homes would have more chance to perform immediate care. But they had a high incidence of UTI and mortality rate. all of these are no significant difference.
Our study could offer the references for all authorities, to support those established organizations, for nursing education and st affs training. It is also useful for reference to government introduce policy of “nursing home”. It would enhance the quality of nursing home.
