| 摘要: | 在病患照護過程中，臨床護理人員需靠豐富的專業知識和經驗，才能根據護理評估做出對病患最合適的護理診斷。在醫護人員短缺的情況下，如何以有效率的方式縮短護理人員決定正確的護理診斷，不但可讓護理人員快速瞭解病患護理健康問題，更將能提高護理照護品質。雖然台灣已有護理診斷系統相關研究，但大多是建置在單一科別的護理診斷系統；然而，許多年紀較大或病情較複雜的病患，常是同時罹患多種疾病，所以較不適用在單一科別的護理診斷系統。因此如何發展出不分科的關鍵字護理診斷搜尋系統，在臨床護理上是非常實用且重要的。此外，護理診斷關鍵字的蒐集和統計，也將有助於瞭解護理診斷的相關研究發展。
本研究希望能夠建構一個以關鍵字搜尋護理診斷的決策支援系統，提升照護品質。首先藉由臨床護理人員先從文獻蒐集相關之臨床護理診斷，經過資料篩選和整理後，將相關的護理診斷架構於雲端資料庫；同時，本研究在網路伺服器建構一個以關鍵字來做搜尋護理診斷的護理決策支援系統，並由臨床護理人員在網站上輸入關鍵字，本研究的決策支援系統會將與關鍵字相關的護理診斷列出，接著讓護理人員選擇合適的決策支援系統，並根據臨床護理人員搜尋的關鍵詞與護理診斷的結果，進一步統計並進行護理診斷相關研究；最後，在系統中也進行問卷以瞭解護理人員對護理診斷的看法，以提升本系統的正確性。
本研究結果顯示，臨床護理人員透過關鍵字在所建構之護理診斷決策支援系統中，可由系統提出與關鍵字相關之護理診斷，更有效率做出正確的護理診斷。本研究進一步統計和研究護理人員在系統中勾選的護理診斷，發現活動、舒適和營養這三類的護理診斷是比例最高的，而國外相關護理診斷系統的前三類則是活動、心理和溝通，也說明了本系統與國外相關系統的差異，由此可見國內護理診斷心理層面的照護是較缺乏的。最後也透過問卷分析結果，說明本不同護理職級及不同醫院單位對於護理診斷決策支援系統的觀點及差異。研究所建構的關鍵字做搜尋之護理診斷決策支援系統，實際運用到臨床，將可幫助臨床護理人員更有效率的決定正確的護理診斷。
Clinical nursing staff usually requires abundant knowledge and experience to determine correct and appropriate nursing diagnoses in patient care. However, under the shortage of medical staff, the ways to efficiently make correct nursing diagnoses and increase patient care quality are highly desirable in the hospitals. Several related work in Taiwan has also developed similar decision support systems for nursing diagnoses, and most of them focused on constructing decision support systems for a specific division. However, many elder or seriously ill patients may suffer from complicated diseases, which may not be suitable if only one nursing decision support system from a specific division is applied. Therefore, developing a general keyword based nursing decision support system is very important and practical. Finally, organizing and analyzing user-specified nursing diagnoses from the decision support system can help researchers better understand the focuses of nursing diagnoses from different medical units in a hospital.
The aim of this study is to develop a nursing decision support system that can propose appropriate nursing diagnoses based on keyword search to increase patient care quality. First, clinical nursing staff collects nursing diagnoses from literature and construct a database on the internet after filtering and organization. After that, we develop an online decision support system that can identify relevant nursing diagnoses based on keyword search. Given a keyword submitted by a user, our system is able to propose several relevant nursing diagnoses for the nursing staff to select. Based on the selected nursing diagnoses, our study also analyzes data and compares the nursing diagnoses made be different nursing ranks in various medical units in a hospital. Finally, we also incorporate a questionnaire in our system to further investigate the importance of our decision support system for nursing diagnoses.
Experimental results demonstrate that nursing staff can more efficiently identify correct nursing diagnoses using keyword search on our decision support system. We further analyze the selected nursing diagnoses in our system and find that “activity,” “comfort,” and “nutrition” rank top three in overall nursing diagnoses, compared to “activity,” “psychosocial,” and “communication” proposed by a related study abroad. This indicates that nursing diagnoses in Taiwan can improve the psychological level of patient care instead of just emphasizing on the physical level. Moreover, our study also shows that nursing staff in different medical units tends to make different nursing diagnoses. In summary, our proposed decision support system based on keyword search can improve the efficiency for nursing staff to identify correct nursing diagnoses if it is applied to clinical patient care in hospitals. |
