ੰ੼৺͹გ၆ᇆᜩᗁᒚݡኳ͹ࢋЯ৵۞࠻ڱĂ ѣ97.3ƦӮܑϯĶ᜕நķߏ౵͹ࢋ۞Я৵ĄЯ ѩĂтڍਕ၆᜕ந۞ݡኳΐͽࢋՐ׶გטĂυ ਕឰᗁᒚݡኳჯ޺дᇾ໤̝˯Ą

(1)

ᄂΔᗁጯ̂ጯ᜕நጯրઘି଱ *ᄂΔᗁጯ̂ጯ᜕நጯੰᓾळି଱ **ᄂΔᗁጯ̂ጯܢనᗁੰ᜕நొઘ͹Ї צ͛͟ഇĈ95ѐ3͡29͟ ࣒Լ͟ഇĈ95ѐ9͡25͟ ତצΏྶĈ95ѐ10͡2͟

఼ੈү۰гӬĈᔨߋڑ ᄂΔᗁጯ̂ጯܢనᗁੰ᜕நొ 11031 έΔξӓᎸූ252ཱི ࿪ྖĈ(02)27372181ᖼ1220ć

็ৌĈ(02)27372181ᖼ1223; E-mail: chung@mail.tmch.org.tw

ઉ૵໰᜕۰ăᜪމăઉܲԊ׶߆ඉטؠ۰ ѣ˘࣎ૻধͷВТ۞ᙸ୕Ăԓ୕ਕܲᙋдЧᙷ

۞ᗁᒚಞٙౌਕ೩ֻ੼ݡኳ۞໰᜕Ą᜕நஎങ дЧᙷ۞ᗁᒚಞٙ̚ĂॲፂKoska(1989)አߤᗁ

ੰ੼৺͹გ၆ᇆᜩᗁᒚݡኳ͹ࢋЯ৵۞࠻ڱĂ ѣ97.3ƦӮܑϯĶ᜕நķߏ౵͹ࢋ۞Я৵ĄЯ ѩĂтڍਕ၆᜕ந۞ݡኳΐͽࢋՐ׶გטĂυ ਕឰᗁᒚݡኳჯ޺дᇾ໤̝˯Ą

઼࡚ᗁጯࡁտ፟ၹ(Institute of Medicine, IOM, 2005)૟໰᜕ݡኳؠཌྷࠎĈ࣎ˠ׶ཏវགྷϤ

ᗁᒚڇચٙਕᆧΐ۞ઉ૵඀ޘĂͷѩઉ૵඀ޘ

ࢋਕ௑Ъϫ݈૞ຽۢᙊٙᄮؠ۞ઉ૵Ą઼᜕࡚

நጯఙࠧ۞ઉ૵ݡኳ໰᜕૞छཏĂٺ1998ѐΏ

൳΍۞ͽĶݡኳ׶ඕڍүࠎࡁտໄهߛၹ۞ઉ

૵ݡኳඕڍሀёķ͛ౢ̚Ă޽΍Ķݡኳķӈߏ дീณ௡јඕၹă࿅඀׶ඕڍ۞ࢋ৵Ăˬ۰ك ѩม۞ᙯܼć׎நኢሀёߏޙϲдDonabedian

۞ ඕ ၹ ů ࿅ ඀ ů ඕ ڍ ۞ ็ ௚ ̶ ᙷ ߛ ၹ Ă ͽ ̈́ Holzemer ˬ࣎ᆸࢬ۞ࡁտΒ߁Ĉ࣎९ăᗁᒚ೩

ֻ۰׶ᗁᒚన౯มкᆸ৺۞̶ژ˯Ąώࡁտٙ

ޙၹ۞᜕நݡኳ޽ᇾߛၹĂ˵͔ϡDonabedian۞

̶ᙷߛၹֽซҖࡁտĄ

ڒࡌ܆Ćᎊ࡚ս*Ćᔨߋڑ**

(Delphi technique)

1-10 Delphi

50 Delphi

29 10 11

8 ᙯᔣෟĈ᜕நݡኳ޽ᇾĄ

(2)

˘ă઼ᅫ᜕நݡኳ޽ᇾ

઼᜕࡚நםົ(American Nursing Associ- ation, ANA)ٺ1990ѐѝഇӈฟؕ࡭˧ٺ᜕நୂຏ

ّ޽ᇾ۞ќะ׶ෞᆊĂ֭౅࿅઼छ᜕நݡኳ̚

͕޺ᜈгซҖБ઼ّྤफ़ऱ൴ण۞߿જĄ఺࣎

Б઼ّ۞ྤफ़ऱࢍထѣ˟࣎͹ࢋ۞ϫᇾĂௐ˘

࣎ϫᇾߏ೩ֻͧྵّྤफ़ගᗁᒚ໰᜕፟ၹүࠎ ݡኳԼච߿જֹϡĂௐ˟࣎ϫᇾߏ൴णѣᙯ᜕

நˠ˧ᄃঽˠ໰᜕ඕڍ࠹ᙯّ̝Б઼ّྤफ़Ą ޙཉྤफ़ऱ࿅඀̚Ăௐ˘ՎಶߏࢋАԱז᜕ந

ୂຏّ޽ᇾĂ᜕நୂຏّ޽ᇾ͘Ίϫ݈ٙќะ

۞ ี ϫ ѣ ঽ ˠ ฀ ࣆ ă ѣ ๋ च ۞ ঽ ˠ ฀ ࣆ ă ᑅ ስă᜕நˠࣶ႕ຍޘăՏ͟ՏҜঽˠ᜕நॡᇴ

̈́໰᜕јࣶ஄Ъଐԛ(ANA, 2006a)Ą఺࣎ր௚ז 2005ѐ5͡д઼࡚Вѣ767छᗁੰΐˢĂΐˢ۞

ᗁੰ̶οд50࣎э׶ֲ࣯ࣖͧপડĄ

LangemoăAnderson׶Volden(2002)೩ז࡚

઼᜕நםົ(ANA)ٺ1994ѐซҖкล߱ඉரĂΝ Ᏸᙊ׶ෞࣃ᜕நඕڍĄ઼᜕࡚நםົдޙၹ۞

ܐഇĂؠཌྷݡኳॡĂಶՙؠଳϡDonabedian۞ݡ ኳሀёࠎߛၹĂͽঽˠඕڍă໰᜕࿅඀׶໰᜕

ඕၹࠎ޽ᇾĄז˞ௐ˟ล߱۞םአົᛉĂՀՙ ؠ˞˭Е޽ᇾีϫĈĞ˘ğ໰᜕ඕၹ޽ᇾĈ᜕

நˠࣶ۞ିֈ඀ޘă໰᜕јࣶ஄ЪଐԛăՏ͟

ՏҜঽˠ۞᜕நॡᇴĄĞ˟ğ໰᜕࿅඀޽ᇾĈ

᜕நˠࣶ႕ຍޘăჯ޺ϩቲԆፋ׶ঽˠ኎ିĄ Ğˬğ໰᜕ඕڍ޽ᇾĈঽˠ / छᛳ၆ፋ࣎໰᜕ă

ূ൭఍ந׶ିֈ۞႕ຍޘćள૱ְІ۞൴Ϡத (฀ࣆ)׶׀൴த(ᑅ˧ّሚႹ)Ą

Aydinඈˠ(2004)ٙనࢍ۞ΐэ᜕நඕڍඕ Ъّ޽ᇾ(California Nursing Outcomes Coalition Indicators, CalNOC)Ă׎̰टΒ߁˛ีĈ฀ࣆă ᑅስ஽ҖதăࡗՁ஽Җதă᜕நॡᇴ׶໰᜕ԫ ਕ஄Ъଐԛăঽˠˠ͟ᇴăොΊ᜕̀۞ିֈ඀

ޘ׶ঽˠ႕ຍޘĄТॡЧี޽ᇾౌѣ୻຾۞ؠ ཌྷ׶ќะྤफ़۞͞ڱĂ޽ᇾีϫ̙ኑᗔĂᇴณ

˵͌Ăҭ׎ΪଂඕڍΝ࠻᜕நݡኳĂົᛇ଀৿

ͻБࢬّĄ

Mitchell׶Lang(2004)аᜪధкᄃ໰᜕ݡኳ ѣᙯ͛ౢĂ̶֭ژ࿅Νֹٙϡ۞ઉ૵ඕڍݡኳ ሀё൴னд઼࡚׶ΐो̂ౌѣ૟˘ֱ౹າಡӘ Ι۞̰टᕩᛳࠎඕڍ޽ᇾ۞̶ᙷĂТॡ˵൴ன ዋ̷۞ҋԧ໰ᜪజᄮࠎߏѣड़᜕ّந߿જ۞౵

ָ΃ܑĄઉ૵ܳซҖࠎдѝഇ۞ࡁ੅ົ̚జᄮ ࠎߏ̚มಫ̬ඕڍĂ1996ѐ۞ࡁ੅ົ૟ઉ૵Ϡ

߿ ݡ ኳ ෛ ࠎ ߏ ˘ ჌ ໰ ᜕ ඕ ڍ ۞ ̶ ᙷ Ă ̰ ट Β ߁Ĉઉ૵ېၗă֗វΑਕّېၗ׶˘ਠّ۞Ϡ

߿ݡኳ۞̶ᙷĄ

᜕நݡኳ޽ᇾ۞ޙϲܧ૱ࢦࢋĂ่̙Ξͽ ቁ᜕ܲநݡኳĂТॡΞͽ೩᜕ֻநҖ߆˯۞׎

΁ϡ౉ĂּтĈHolgeăAschăOlsonăkravitz׶

Sauve(2002)ಶ൴ण᜕நݡኳ޽ᇾֽෞᆊ᜕நˠ

˧۞ᅮՐĂ֭ͷរᙋ˞9ี᜕நݡኳ޽ᇾځពᄃ

᜕நˠࣶ / ঽˠͧதѣᙯĄANA(2006b)ޙᛉϏ

ֽ۞᜕நୂຏ޽ᇾ̙ᑕྍΪԊࢨдઉ૵ېၗ۞

ԼචĂ҃ᑕᕖणזዋ̷۞ҋԧ໰᜕ăणனઉ૵

ܳซҖࠎăঽˠҝੰ͇ᇴٕ࠻෧Ѩᇴăᄃઉ૵

ѣᙯ۞Ϡ߿ݡኳăঽˠҋᛇઉ૵඀ޘ׶ࢎؠѣ ᇾ໤үຽ۞াې఍நඈĄ

˟ă઼̰ᗁᒚݡኳ޽ᇾ

έ៉ϫ݈۞ᗁᒚݡኳੵ˞ତצᗁੰෞᝥ̝

ෞ८γĂ࠹ᙯ۞ෞᆊ̍׍ֶෞᆊ၆෪Ξͽ̶ࠎ ˬᙷĈෞᆊᗁᒚ፟ၹࠎ͹ăෞᆊొܝࠎ͹׶᜕

நࠎ͹ඈĄ׎̚ෞᆊᗁᒚ፟ၹ۞޽ᇾր௚ѣĈ έ៉ᗁᒚݡኳጯົ(Taiwan College of Healthcare ExecutivesĂ2003)Ă2001ѐฟؕࡁ൴۞THIS (Taiwan Healthcare Indicator System)ăέ៉ᗁඉ

ົ (Taiwan Joint Commission on Hospital

Accreditation)Ă2001ѐ͔ซ۞TQIP(Taiwan

Quality Indicator Project)Ąෞᆊొܝ۞ઇڱ౵ܕ

(3)

ޝ͌ˠซҖĂΪѣдѝഇѣ2ቔ͛ౢĂӈ੼ඈˠ (1997)۞ೇઉొܝෞᝥćӓăᙌăՂ׶ૺ(1996)

۞ٸडቢ෧ᕝొܝᗁᒚݡኳෞҤ޽ᇾࡁտĄ

ˬă᜕நݡኳ޽ᇾ

ෞᆊ᜕நࠎ͹۞ࡁտಡӘĂ׎̚7ቔଳϡ Rush Medicus Tool-Monitoring the Quality of Nursing CareĂ֭ౌΪଂ̚มၡפ˘ֱีϫүࠎ

૞ࡊ᜕நݡኳ۞ෞᆊ(ڒĂ1992ćषă฾ăᛂă ͳĂ1992ćषă฾ăቼĂ1993ćषă฾ăڒă

໅Ă1993ćषă฾ăᓦĂ1995ć໅Ă1997ćष ඈĂ2002)ć2ቔࠎ᜕ந̝छ໰᜕ݡኳ޽ᇾ(໅Ă 2001ć໅ăषĂ2001)Ă1ቔࠎҋҖనࢍ۞ҝੰঽ ˠ᜕நݡኳෞࣃܑĂ̰टΒ߁ĈેҖ᜕நෞҤ

֭үࡔᐂăᑢࢎ᜕நࢍထăቁ၁ેҖᗁᒚ׶᜕

நନ߉ăેҖ᜕நϫᇾ̝ෞࣃ׶ቁ၁ેҖ᜕ந ߆ඉඈĂВѣ76̈ี(ᖎĂ1995)Ăѩયס̝ޢౌ

՟ѣˠГଳϡ࿅ĂϺϏѣ޺ᜈّ۞᜕ந޽ᇾྤ

फ़۞ќะᄃ̶ژĄ

ϤٺRush Medicus Tool۞޽ᇾีϫВѣ268

ีĂีϫ͉кЯѩᗁੰдќะྤफ़˯ѣޝ̂۞

ӧᙱĄ።ѐֽᗁੰ᜕ந௡۞ෞᝥĂ၆᜕நݡኳ

۞೩چѣޝ̂۞ᇆᜩᄃӄৈĂ2003ѐ੓າטᗁ

ੰ ۞ ᜕ ந ௡ ෞ ᝥ Ă Հ ΐ ૻ ࿅ ඀ ᄃ ඕ ڍ ࢬ ̝ ෞ ८ĂੵϤঽˠ׶᜕நˠࣶ۞ຏצֽࢎؠݡኳ޽

ᇾĂ֭ૻአঽˠщБăຏߖგט̈́޺ᜈّ໰᜕

޽ᇾ۞ෞ८(̞Ă2005)Ą҃έ៉ၟҌϫ݈ࠎͤĂ

ౌ՟ѣৌϒਕෞณ᜕நݡኳ۞޽ᇾĂЯѩࣃ଀

൴ण˘इ׍ୂຏّ۞᜕நݡኳ޽ᇾĂүࠎෞࣃ

᜕நݡኳᄃ໰᜕јώ۞̍׍Ăͽ೩چ᜕ந૞ຽ

ͪ໤Ą

˘ă᜕நݡኳĈ౅࿅᜕நˠࣶ۞ܑனٙӔ ன΍ගˠ۞˘჌ຏᛇĂ׎̚Β߁᜕ந۞ඕၹă

᜕ந࿅඀׶᜕நନ߉ޢٙӔன۞ඕڍჍ̝Ą

˟ă᜕நݡኳ޽ᇾΞ̶ࠎˬ჌Ĉ

Ğ˘ğඕၹࢬ޽ᇾ(structural indicators)ߏ޽

ෞҤ௡ᖐߏӎ׍౯·֖۞᜕நˠ˧ăᆇጡăన ౯׶щБᒖဩඈ̰टĄ

Ğ˟ğ࿅඀ࢬ޽ᇾ(process indicators)ߏ޽ઍ

ീ᜕ந߹඀ă᜕ந߿જనࢍă໰᜕ᇾ໤׶᜕ந ఢထଐԛඈ̰टĄ

Ğˬğඕڍࢬ޽ᇾ(outcome indicators)ߏ޽ീ

ณତצ໰᜕߿જޢĂٙ൴Ϡ࿰ഇّٕܧ࿰ഇّ

۞ְІ൴Ϡᐛதඈ̰टĄ

ώࡁտߏ˘ೡّࢗăፖᕝّࡁտనࢍĂଳ ϡ൏ᕇဥវळኘڱ(focus group)׶ᇇႬහࡁտڱ (delphi technique)ĄࢵАຉะ઼̰γᗁᒚݡኳ޽

ᇾีϫĂ֭ଂ̚ม٩פᄃ᜕நྵۡତ࠹ᙯ۞޽

ᇾีϫĂВຉፋ΍42ีĄѣ˞ૄώ۞޽ᇾีϫ ޢĂᔛኛ7Ҝ᜕ந૞छ(1Ҝᗁጯ͕̚͹Їă1Ҝઘ

͹Їă1Ҝ༛ጱć2Ҝડાᗁੰ᜕நొ͹Їć1Ҝ

׍ѣᖳಱᓜԖགྷរ۞ԫఙጯੰ७ܜ׶1Ҝ᜕૞७ ܜ)ซҖळኘĂ֭၆᜕நݡኳ޽ᇾีϫ೩΍ຍ֍

ϹೱĂд૞छ྿јВᙊޢᄦј᜕நݡኳ޽ᇾય סĂͽซҖDelphi techniqueĄDelphi૞छϤळኘ

ົ۞૞छଯᖧĂͽႋౠ஧͞ёኛՏҜ૞छЧଯ ᖧ10ҜᓜԖ˯ଂְᄃ᜕நݡኳѣᙯ̝ྤஎ᜕ந ˠࣶĂљੵࢦᖬЩಏޢĂВᔛኛז50ҜDelphi૞

छĂ׎̚29Ҝֽҋᗁጯ͕̚ă21Ҝֽҋડાᗁ

ੰćֶ׎ᗁੰ۞ٙдг̶ĈΔొ39Ҝă̚ొ4 Ҝăݑొ5Ҝăڌొ2ҜĄЯࠎజଯਧ۞૞छஉ ᄏ˞Δă̚ăݑ׶ڌొαડĂЯѩቁؠˠᏴĄ

ௐ˘аЪયס᜕̝நݡኳ޽ᇾีϫВ 36

ีĈඕၹࢬ12ᗟć࿅඀ࢬ12ᗟćඕڍࢬ12ᗟĂ

Տᗟͽࢦࢋّ׶ΞҖّ˟࣎ШޘෞؠĂ̶Ҿͽ1

ů10̶ࢍĄ֭ͽઠЩ͞ё౅࿅ˬѨͅᖬೈᒖય

סќะྤफ़Ąௐ˘аЪયסአߤĂВ൴΍ 50

ЊĂаќ43ЊĂаќத྿86ƦĄௐ˟аЪયס

(4)

አߤĂВ൴΍43ЊĂаќ40ЊĂаќத྿93.0 ƦĄௐˬаЪયסአߤĂВ൴΍40ЊĂаќ37 ЊĂаќத྿92.5ƦĄ

Տ˘аЪаќྤफ़ౌซҖበཱིĂГֶᛌቅ ᘨซҖᛌቅ׶በቅޢᏮˢ࿪ཝĂͽSPSS 13.0ۍ ซ Җ ྤ फ़ ̶ ژ Ă ૄ ώ ྤ फ़ ͽ ࣎ ᇴ ă Ѻ ̶ ͧ ௚

ࢍĂ᜕நݡኳ޽ᇾีϫͽπӮᇴ׶ᇾ໤मซҖ

௚ࢍĄϤٺௐ˟аЪ׶ௐˬаЪ۞ࢦࢋّπӮ ࣃĂགྷ௚ࢍᑭؠޢ൴ன՟ѣमளĂͷඕၹă࿅

඀׶ඕڍˬ͞ࢬ޽ᇾีϫ۞Cronbach’s αࣃౌд .86ͽ˯ĂܑϯDelphi૞छ۞ຍ֍̏྿˘࡭ّĂЯ ѩซҖќᑦĄ౵ޢͽௐˬаЪ۞ඕڍซҖ௚ࢍ

׶ᄲځĄ

ώࡁտDelphi૞छᛳّĈБౌࠎّ̃ćѐ᛬

ͽ46-50໐౵к(40.6Ʀ)ćିֈ඀ޘͽჇ̀౵к (83.8Ʀ)ćڇચѐྤͽ21-25ѐ౵к(32.4Ʀ)ćᖚ Ⴭͽ༛ጱࠎ౵к(37.9Ʀ)ă׎Ѩࠎ᜕நొ͹Ї (29.7Ʀ)ĄϤٺέ៉۞շ᜕ّநˠࣶ۞൴णॡม

ྵ୎ĂЯѩ᜕நˠࣶ̪ͽّ̃ࠎ͹Ă͍׎̍ү ѐྤྵ˳ăᖚჍࠎ༛ጱ(ӣ)ͽ˯۞˵̂ౌࠎ̃

ّĂٙͽ̖ົౄјώࡁտ̝Delphi૞छౌࠎ̃

ّĄ

ώࡁտགྷ࿅ˬаЪ۞Dephi૞छຍ֍አߤ ޢĂ྿ј˘࡭ඕڍĂВޙၹ΍᜕நݡኳ޽ᇾ29

ีĂ̶ҾࠎĈ

˘ăඕၹࢬ

᜕நݡኳ޽ᇾВޙၹ΍10ี(ࢦࢋّଂ10.0- 9.5̶)Ă׎̰टࠎĈĞ˘ğ᜕நˠࣶ௑Ъેຽྤ

ॾĄĞ˟ğࢎѣᘽۏ̈́౫ዕᘽგநᏱڱĄĞˬğ నѣЧᙷΞҖ᜕̝ந໰᜕߹඀ᇾ໤͘Ί׶үຽ ఢቑĂͷؠഇՀາĄĞαğঽٗᒖဩщБ(Βӣ ۏநă̼ጯăϠ̼)ĄĞ̣ğາซˠࣶତצ֖ૉ

۞ିֈ੊ቚĄĞ̱ğ᜕ந৭ٙѣᆇጡăన౯̈́

ϡݡ֖ૉͷΑਕϒ૱ĄĞ˛ğ఼ੈᓑᘭր௚ܮ Ӏԣଥͷ̙צઃྖăઃ࿪ᇆᜩĄĞˣğঽٗજ ቢ న ࢍ ዋ ༊ Ą Ğ ˝ ğ ֶ ෞ ᝥ ᇾ ໤ ੨ ཉ ᜕ ந ˠ

˧ĄĞ˩ğనѣ᜕நਕ˧ซลטޘĄ(ྎ֍ܑ˘)

˟ă࿅඀ࢬ

᜕நݡኳ޽ᇾВޙၹ΍11ี(ࢦࢋّଂ9.89- 9.43̶)Ă׎̰टࠎĈĞ˘ğቁ၁ેҖຏߖგט ନ߉ĄĞ˟ğਕѣࢍထ۞ેҖຍγְІ֨ቑନ ߉ĄĞˬğቁ၁ેҖ΍ੰ໤౯ڇચ̍үĄĞαğ ၆ঽଈ̈́छᛳၗޘᏐ̷ĄĞ̣ğਕϒቁેҖCPR ԫఙĄĞ̱ğྎ၁۞᜕ந࿅඀ࡔᐂĄĞ˛ğਕ ϒቁෞҤঽଈ׶छᛳ۞ᅮՐĄĞˣğԆፋ۞᜕

ந߿જેҖࢍထĄĞ˝ğቁ၁ેҖ௑Ъঽˠᅮ

ܑ˘ ඕၹࢬ᜕̝நݡኳ޽ᇾ

̰ट ࢦࢋّ M (SD) ΞҖّ M (SD)

1.᜕நˠࣶ௑Ъેຽྤॾ 10.00( .00) 9.84( .37)

2.ࢎѣᘽۏ̈́౫ዕᘽგநᏱڱ 9.86( .35) 9.61( .55)

3.నѣЧᙷΞҖ᜕̝ந໰᜕߹඀ᇾ໤͘Ί׶үຽఢቑĂͷؠഇՀາ 9.83( .38) 9.43( .70)

4.ঽٗᒖဩщБ(Βӣۏநă̼ጯăϠ̼) 9.78( .42) 8.73( .84)

5.າซˠࣶତצ֖ૉ۞ିֈ੊ቚ 9.78( .42) 8.89( .95)

6.᜕ந৭ٙѣᆇጡăన౯̈́ϡݡ֖ૉͷΑਕϒ૱ 9.76( .43) 8.95(1.18)

7.఼ੈᓑᘭր௚ܮӀԣଥͷ̙צઃྖăઃ࿪ᇆᜩ 9.70( .57) 8.81( .84)

8.ঽٗજቢనࢍዋ༊ 9.64( .54) 8.25( .97)

9.ֶෞᝥᇾ໤੨ཉ᜕நˠ˧ 9.57( .65) 8.16(1.42)

10.నѣ᜕நਕ˧ซลטޘ 9.50( .70) 8.39(1.05)

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Ր ̝ ᜕ ந ࢍ ൪ Ą Ğ ˩ ğ ϒ ቁ ે Җ ˢ ੰ ᜕ ந Ą Ğ˩˘ğؠഇᓝᏱ̈́ણᄃ࣎९ᗁᒚ໰᜕੅ኢົĄ

(ྎ֍ܑ˟)

ˬăඕڍࢬ

᜕நݡኳ޽ᇾВޙၹ΍8ี(ࢦࢋّଂ9.86- 9.62̶)Ă׎̰टࠎĈĞ˘ğ᜕நˠࣶගᘽ᏾ᄱ

൴ϠதĄĞ˟ğঽଈੰ̰ຏߖ൴ϠதĄĞˬğ ঽ ଈ ฀ ࣆ ൴ Ϡ த Ą Ğ α ğ ঽ ଈ ᑅ ስ ൴ Ϡ த Ą Ğ̣ğள૱ְІ൴ϠதĄĞ̱ğঽˠ၆᜕ந۞ڇ ચ ၗ ޘ ႕ ຍ ޘ Ą Ğ ˛ ğ ᜕ ந ࡔ ᐂ ۞ Ԇ ፋ த Ą Ğˣğঽˠ၆᜕ந۞૞ຽਕ˧ܑன႕ຍޘĄ(ྎ֍

ܑˬ)

ֶDonabedian၆ݡኳٙ˭۞ؠཌྷĂෞᆊݡኳ ॡΞͽଂඕၹࢬă࿅඀ࢬ׶ඕڍࢬඈˬ͞ࢬֽ

ซҖĂֶ֭ෞᆊ۞ࢬШࢎؠݡኳ޽ᇾĂЯѩ᜕

நݡኳ޽ᇾ۞ࢬШᑕྍΒ߁Ĉඕၹࢬă࿅඀ࢬ

׶ඕڍࢬĄˬ࣎ࢬШ၆ٺ᜕நݡኳ۞ෞᆊѣ̙

Т۞ຍཌྷĂˬ۰׍ѣ࠹ᅃ࠹ј۞Αड़ĂЯѩౌ

ޝࢦࢋ৿˘̙ΞĄ

ώࡁտдඕၹࢬٙޙၹ۞޽ᇾᄃ࿅Νጯ۰ ޙၹ۞̰टѣֱధ۞मளĂώࡁտඕڍ൴ன᜕

நˠ˧۞੨ཉăିֈ੊ቚ̈́ྤॾߏඕၹࢬ۞᜕

நݡኳ޽ᇾĂᄃKunaviktikulඈˠ(2001)׶Aydin

ܑˬ ඕڍࢬ᜕̝நݡኳ޽ᇾ

1.᜕நˠࣶගᘽ᏾ᄱ൴Ϡத 9.86( .42) 9.32( .71)

2.ঽଈੰ̰ຏߖ൴Ϡத 9.83( .45) 9.08( .77)

3.ঽଈ฀ࣆ൴Ϡத 9.78( .48) 8.86(1.08)

4.ঽଈᑅስ൴Ϡத 9.76( .49) 9.05(1.00)

5.ள૱ְІ൴Ϡத 9.76( .60) 8.97( .93)

6.ঽˠ၆᜕ந۞ڇચၗޘ႕ຍޘ 9.68( .58) 9.32( .75)

7.᜕நࡔᐂ۞Ԇፋத 9.65( .72) 8.95(1.00)

8.ঽˠ၆᜕ந۞૞ຽਕ˧ܑன႕ຍޘ 9.62( .68) 8.97( .80)

ܑ˟ ࿅඀ࢬ᜕̝நݡኳ޽ᇾ

1.ቁ၁ેҖຏߖგטନ߉ 9.89( .39) 9.05( .78)

2.ਕѣࢍထ۞ેҖຍγְІ֨ቑନ߉ 9.81( .46) 8.73( .99)

3.ቁ၁ેҖ΍ੰ໤౯ڇચ̍ү 9.81( .54) 8.43( .96)

4.၆ঽଈ̈́छᛳၗޘᏐ̷ 9.78( .48) 9.11( .77)

5.ਕϒቁેҖCPRԫఙ 9.76( .55) 9.18( .84)

6.ྎ၁۞᜕ந࿅඀ࡔᐂ 9.70( .62) 8.62(1.04)

7.ਕϒቁෞҤঽଈ׶छᛳ۞ᅮՐ 9.65( .59) 8.59( .98)

8.Ԇፋ۞᜕ந߿જેҖࢍထ 9.65( .54) 8.57( .93)

9.ቁ၁ેҖ௑ЪঽˠᅮՐ᜕̝நࢍ൪ 9.62( .55) 8.57( .96)

10.ϒቁેҖˢੰ᜕ந 9.49( .61) 8.68(1.03)

11.ؠഇᓝᏱ̈́ણᄃ࣎९ᗁᒚ໰᜕੅ኢົ 9.43( .65) 8.65( .95)

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ඈˠ(2004)࠻ڱ˘࡭Ąҭд᜕நˠ˧۞௡ј͞

ࢬĂϤٺ઼᜕̰நˠ˧۞͹˧ࠎᅳѣે໰۞᜕

ந र ٕ ᜕ ̀ Ă ᄃ ࡚ ઼ ᜕ ந ˠ ˧ ѣ ො Ί ᜕ ̀ (Registered Nurse)ăѣે໰۞ᓜԖ᜕̀(Licensed Practical Nurse)̈́ ᜕ ந ҥ ந ࣶ ۞ ௡ Ъ (ANA, 2006a; Gallagber ō Rowell, 2003)ඈ̙ТĂ߇ώ ࡁտϏ૟໰᜕јࣶ۞஄Ъ඀ޘЕࠎݡኳ޽ᇾĂ

҃౵ૻአ᜕நˠࣶ௑ЪેຽྤॾĂӈֶԧ઼᜕

நˠࣶڱ۞ఢؠĂᅳѣ̚රϔ઼᜕நर᜕ٕ̀

ે໰۰଀·༊᜕நर᜕ٕ̀Ą

Ωγ˵ૻአᘽۏ׶౫ዕᘽგநયᗟĂЯࠎ έ៉᜕நˠࣶ൴Ϡᗁᒚ᏾ᄱ९І̚Ăͽගᘽ᏾

ᄱ౵ᚑࢦĄ͍׎έ៉гડд2002ѐ൴Ϡߙᗁੰ

۞౫ዕᘽგந̙༊Ăᑈ׊ވ۞Т˘Дቐ̚ٸཉ

˞҉҇ᗫђ጗׶ᑈ׊۞BݭքۆࠪࡺĂౄј᜕ந ˠࣶχ᏾੫Ă͔੓າϠ׊ 1Ѫ6ࢦ๋۞ၝᆐĄ 2003ѐ˫൴Ϡ˞ߙ෧ٙᄱ૟ࢫҕᎤ጗྅ˢຏ݂

ᘽឫ̚ĂឰѺዶЩঽˠᄱڇᘽ጗Ăౄј1Щᑈ׊

Ϡ׻ݬПĄЯѩĂ኎Ϡ͹გ፟ᙯ૟ϡᘽщБ̈́

გநЕࠎՏѐᗁᒚੰٙ༛ጱ҂८۞ีϫ̝˘Ă ឰ᜕நࠧՀࢦෛᘽݡგநĄ

ТॡĂώࡁտඕڍ˵ࢦෛ᜕ந໰᜕߹඀ᇾ

໤׶үຽఢቑăঽٗᒖဩщБ̈́ିֈ੊ቚĂѩ

˜Ϥٺܕѐֽέ៉ᄃ઼̂̚ౙ̈́͵ࠧЧ઼۞ֽ

ـՀΐฟٸᄃᐛᓄĂЯѩᆧΐ˞ధкତᛈາᎸ

็ߖ়ّঽĂּтSARSă༲߹ຏඈ۞፟ົĂ҃

ЧᗁੰΞਕ၆఺ֱঽˠ۞᜕ந໰᜕߹඀ౌ՟ѣ ޙϲĂឰ᜕நˠࣶ̙ۢтң໰ᜪ఺ֱঽˠĂ˵

ឰ ఺ ֱ ঽ ˠ ౌ ൑ ڱ ଀ ז р ۞ ໰ ᜕ Ă д ࿅ Ν ۞ SARSགྷរ̚౵ࠎځពćϺͅᑕ˞າטᗁੰ᜕ந

௡ෞᝥ၆᜕நݡኳ۞ᇆᜩ(̞Ă2005)ĄJelinekă HaussmannăHegyvary׶Newman(1974)ࠎΐૻ᜕

ந࿅඀Ă֭૟ඕၹ᜕̈́நඕڍᓑЪд˘੓۞ෞ

ࣃ͞ڱࠎ౵၁ᅫĄඕၹߏ૞ຽેຽ׶൴ण۞ૄ

Ϯ Ă ՟ ѣ · ֖ ۞ న ౯ Ă ᜕ ந ൑ ڱ · ̶ ൴ ೭ Α ਕĄ՟ѣЪॾ۞᜕நˠࣶĂ᜕ந߿જ൑ڱ྿ז পؠ۞ᇾ໤Ą՟ѣр۞᜕நેຽఢቑٕ͘ΊĂ

᜕நˠࣶ൑ڱдѣᇾ໤۞ଐڶ˭ેຽĂٙͽ᜕

நݡኳ۞ඕၹࢬߏޝࢦࢋ۞Ą

кᇴጯ۰ϺТຍᓑЪ࿅඀ᄃඕڍ۞ݡኳგ טࡁտߏϏֽ൴ण۞ᔌ๕Ą᜕நݡኳ۞࿅඀ࢬ ߏ޽᜕நેҖຽચ࿅඀۞ݡኳĂૻአેҖ۞ଐ ԛĄώࡁտඕڍ̚д࿅඀ࢬ͹ࢋߏૻአ᜕நࢍ

ထ۞ેҖĂΒ߁᜕ந࿅඀۞ٙѣՎូĂӈਕෞ

Ҥঽˠ׶छᛳ۞ᅮՐăࢍထ̰टਕ௑Ъঽˠᅮ ՐăਕֶࢍထેҖ᜕ந߿જăਕྎ၁ᇤᆷ᜕ந

࿅඀ࡔᐂăϒቁેҖCPRĂͷਕેҖˢੰ᜕ந׶

΍ੰ໤౯Ăᄃ઼᜕࡚நםົٺ1996ѐٙ೩΍̝

᜕ந࿅඀޽ᇾĈঽˠ໰᜕ᅮՐ۞ෞҤᄃેҖă

΍ੰࢍထăঽˠ኎ିăቁܲঽˠ۞щБăჯ޺

ϩቲ۞Ԇፋّඈ̈́Kunaviktikulඈˠ(2001)ٙ൴ण

΍ֽ۞঍઼᜕ந޽ᇾ̰ट࿩ТĄੵ˞᜕ந࿅඀

۞ેҖγĂᔘপҾૻአેҖຏߖგטăຍγְ

І֨ቑ׶ણᄃ໰᜕੅ኢົඈĄТॡ˵ᙯ͕ז᜕

நˠࣶдፋ᜕࣎ந࿅඀̚۞ၗޘĂ఺ߏ࿅Ν۞

᜕நݡኳ޽ᇾࡁտ۰ٙϏޙၹ۞̰टĄ఺ᇹ۞

࿅඀ࢬෞᆊ޽ᇾĂೀͼஉᄏ˞᜕நˠࣶՏ͇ે

Җ۞̍ү̝ٙѣ̰உĂΞਕߏЯצזέ៉ᗁඉ

ົᗁੰෞᝥ᜕ந௡ีϫ۞ᇆᜩٙ࡭Ą

ঽଈ۞˘჌ٕᇴ჌ඕڍ͹ࢋߏϤߙ჌ٕᇴ

჌᜕நନ߉ٙጱ࡭ٕᇆᜩ۞ĂΞᏜ̝၆᜕நୂ

ຏ۞ঽଈඕڍ(nursing-sensitive patient outcomes) Ąώࡁտ۞ඕڍࢬᄃ࿅Ν࠹ᙯࡁտඕڍ࠹Т۞

޽ᇾѣĈ฀ࣆ൴Ϡதăᑅስ൴Ϡதăੰ̰ຏߖ

൴ Ϡ த ă ள ૱ ְ І ൴ Ϡ ̈́ ঽ ˠ ڇ ચ ႕ ຍ ޘ ඈ (Aydin et al., 2004; Chow, 1995; Kunaviktikul et al., 2005; Langemo et al., 2002)Ąώࡁտ૞छপҾ ࢦෛĶගᘽ᏾ᄱ൴ϠதķĂΞਕᄃέ៉гડ౵ܕ

൴ϠೀІዩមۤົ۞᜕நˠࣶග᏾ᘽĂͽ̈́έ

៉᜕நˠࣶ۞ຍγְІ̚ͽග᏾ᘽ۞ͧத౵੼

ѣᙯĄΩγ၆ٺঽˠ۞ڇચ႕ຍޘ͞ࢬĂᔵϏ ည઼᜕࡚நםົ૟׎௟ထࠎূ൭఍நăঽˠ኎

ିăঽˠፋវ໰᜕᜕̈́ந໰᜕ඈα࣎޽ᇾֽෞ

८(Gallagber ō Rowell, 2003)Ă҃ߏপҾ૟ڇચ

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ၗޘ׶૞ຽਕ˧ܑன̶ฟֽෞ८ĂΞ֍઼᜕̰

ந ૞ छ ԓ ୕ ੵ ˞ ᑕ ྍ ࢦ ෛ ᜕ ந ˠ ࣶ ۞ ၗ ޘ ̝ γ Ă ˵ ᑕ ྍ ࢦ ෛ ΁ ࣇ ߏ ӎ ׍ ѣ ֖ ૉ ۞ ૞ ຽ ਕ

˧Ăͽࡎព᜕நߏ˘࣎૞ຽĄϤٺ᜕நˠࣶགྷ

૱̙௫ၚ૟ঽˠ۞ଐڶ׶ٙેҖ۞᜕ந߿જซ ҖࡔᐂĂགྷ૱ٺ൴Ϡள૱ְІॡĂ൑ڱᗃ୻ˠ

ࣶม۞యЇĂౄј᜕நˠࣶ۞๋चĂЯѩপҾ

ૻአืࢋѣԆፋّ۞᜕நࡔᐂĄ

ώࡁտٙޙၹ᜕̝நݡኳ޽ᇾВѣ29ีĂ

̶ҾΒ߁Ĉඕၹࢬ11ีă࿅඀ࢬ10ี׶ඕڍࢬ8

ีĄ

˘ăඕၹࢬ

Ξ ̶ ࠎ ˬ ొ Њ Ĉ ˘ ă ᜕ ந ˠ ࣶ ొ ̶ Ă Β ߁Ĉ᜕நˠࣶ௑Ъેຽྤॾăາˠ੊ቚăਕ˧

ซล׶ˠ˧੨ཉĄ˟ă᜕நүຽგטొ̶ĂΒ ߁Ĉᘽۏ׶౫ዕᘽგநᏱڱă᜕ந໰᜕߹඀ᇾ

໤ ͘ Ί ׶ ү ຽ ఢ ቑ Ą ˬ ă న ౯ ඕ ၹ ొ ̶ Ă Β ߁ĈᒖဩщБă఼ੈᓑᘭր௚ăᆇጡన౯Αਕ ϒ૱׶ঽٗજቢనࢍඈĄ

˟ă࿅඀ࢬ

᜕நݡኳ޽ᇾͽ᜕ந࿅඀ࠎ͹Ăஉᄏ˞7

ี Ă ӈ ˢ ੰ ᜕ ந ă ϒ ቁ ෞ Ҥ ঽ ˠ ׶ छ ᛳ ۞ ᅮ Ր ă ௑ Ъ ঽ ˠ ᅮ Ր ۞ ᜕ ந ࢍ ထ ă ે Җ ᜕ ந ࢍ ထăྎ၁۞᜕ந࿅඀ࡔᐂăેҖCPR׶΍ੰ໤౯ ڇચඈĄΩγ3ีࠎĂેҖຏߖგטନ߉ăၗޘ Ꮠ̷׶ણᄃ࣎९ᗁᒚ໰᜕੅ኢົĄ

ˬăඕڍࢬ

᜕நݡኳ޽ᇾੵ˞᜕நࡔᐂ۞Ԇፋத׶ග ᘽ᏾ᄱ൴Ϡத̝γĂౌͽᇴ჌᜕நନ߉ٙጱ࡭

ٕᇆᜩ۞˘჌ඕڍĂΒ߁ੰ̰ຏߖă฀ࣆăᑅ ስăள૱ְІඈ۞൴ϠதĂΩγᔘѣ੫၆ঽˠ

၆᜕நˠࣶ۞ڇચၗޘ׶૞ຽਕ˧ܑன۞႕ຍ ޘĄώඕڍࢬ۞உᄏࢬޝᇃĂ҃ͷਕஎˢ᜕ந ಏ˘׶ᇴ჌᜕நନ߉ٙጱ࡭ٕᇆᜩ۞ඕڍĄ

ώࡁտצࢨٺॡมᄃགྷ෱۞ࢨטĂֶ่ፂ

͛ᚥߤᙋ᜕̈́ந૞छ۞ຍ֍Ԇј˞᜕நݡኳ޽

ᇾ ี ϫ ۞ ܐ Վ ޙ ၹ Ă إ Ϗ ૟ ఺ ֱ ޽ ᇾ ̟ ͽ ؠ ཌྷăࠧؠࢍზᇾ໤̈́၁ᅫдᗁੰ̰ซҖ᜕நݡ ኳ޽ᇾีϫќะ׶រᙋ̍үĂЯѩд᜕நݡኳ

޽ᇾྻϡ˯۞ΞҖّ̈́ѣड़ّĂϏֽإᅮͽᚑ ᖰᆶຕ۞၁ᙋࡊጯ͞ёֽᑭរĄॲፂώࡁտඕ ڍĂޙᛉޢᜈࡁտΞͽ੫၆Чี᜕ந޽ᇾ̟ͽ ซ˘Վ۞࣒ࢎĂ֭ซҖ޽ᇾؠཌྷ׶ࢍზᇾ໤۞

ଣ੅Ăͽޙၹ᜕நݡኳ޽ᇾВТ۞ᄬ֏Ă྿ј

௚ ˘ ᇾ ໤ ۞ ϫ ۞ Ą ѣ ˞ ௚ ˘ ۞ ؠ ཌྷ ׶ ࢍ ზ ᇾ

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ABSTRACT

The purpose of this study was to develop standardized indicators for measuring the quality of nursing care in acute-care hospitals based on the scientific methods and expert opinions. The research methods employed in this study were focus group discussion and Delphi technique. International as well as domestic literatures, regarding nursing-quality indicators, were first reviewed to draft the preliminary questionnaires. In the next phase 7 nursing experts were invited to attend focus group discussions and to formulate the final questionnaires, scoring 1 to 10 for each item. Finally, in the Delphi study, 50 experts were recommended by aforementioned experts, through 3 successive questionnaire inquiries anonymously to reach a consensus on indicators of nursing-quality. The results of the study provided 29 indicators of nursing-quality. The structural indicators have 10 items: nursing-manpower allocation, qualification of practice, safety of equipments and environments, safety guide, and operational manual, etc. The process indicators have 11 items containing the implementation and process of nursing, attitude of caring, incident prevention, and infection control, etc. The outcome indicators consist of 8 items such as patient falls, pressure ulcers, medication errors, nosocomial infections, adverse events, and patient satisfaction, etc. The study developed core indictors of nursing quality, though more studies are needed to refine the definition of indicators, expand collection and analysis of data on quality of nursing care, in order to promote the future nursing evaluation and professionalism.

Key words: nursing quality indicator.

The Development of Nursing Quality Indicators

Chiou-Fen Lin ĆMeei-Shiow Lu*ĆChun-Chih Chung**

RN, Ph.D, Associate Professor, College of Nursing, Taipei Medical University, *MSN, Chairman Professor, School of Nursing, Taipei Medical University, **MHA, Deputy Director, Department of Nursing, Taipei Medical University Hospital.

Received: March 29, 2006 Revised: September 25, 2006 Accepted: October 2, 2006

Address correspondence to: Chun-Chih Chung, Department of Nursing, Taipei Medical University Hospital, No. 252, Wusing St., Sinyi District, Taipei City 11031, Taiwan (R.O.C.) Tel.: 886-2-27372181 ext. 1220; Fax: 886-2-27372181 ext. 1223; E-mail: chung@

mail.tmch.org.tw