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博碩士論文 etd-0907111-205832 詳細資訊
Title page for etd-0907111-205832
論文名稱
Title
醫院護理人員之臨床專業護理能力及其影響因素 -從人力資本觀點探討
Clinical Competence and its Related Factors among Hospital Nurses -From the Human Capital Perspectives
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
209
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2011-07-26
繳交日期
Date of Submission
2011-09-07
關鍵字
Keywords
人力資本投資、醫院等級、組織資源、護理能力、臨床進階制度、人力資本
nursing clinical ladder system, nursing competence, human capital investment, organizational resources, hospital grading, human capital
統計
Statistics
本論文已被瀏覽 5814 次,被下載 1554
The thesis/dissertation has been browsed 5814 times, has been downloaded 1554 times.
中文摘要
本研究由人力資本的觀點出發,自個人層級探討護理專業人員的人力資本,進階制度投資以及護理能力之關係;並納入組織層級的醫院等級和組織資源等因素,分析與驗證其直接效果與調節作用。
收案樣本來自25家不同等級的教學醫院,共計收案有效樣本2101份。本橫斷性研究,發展「護理能力量表」,經項目分析與探索性和確認性因素分析,萃取出六因素,分別命名為:統整照護計畫、照護措施與溝通、自我成長與專業發展、管理、協調與教學,和學術六能力,修正後護理能力量表共33題項, Cronbach’s α值為0.885∼0.937。本研究發展進階投資評價量表共18題,含三因素,其中個人專業成長與組織資源因素Cronbach’s α值分別為.875及.967。
利用Spss 14及Mplus統計軟體,分別進行多變數及跨層級之統計分析;結果發現「護理進階層級」是很好的人力資本指標,會影響「進階投資評價」與「護理能力」;「進階投資評價」會影響「護理能力」。組織因素具調節作用,「組織資源」會影響「進階投資評價與護理能力」的關係,「醫院等級」對部分護理能力有影響。
護理人力資本值得個人與組織繼續進行投資,以獲取最佳效益。
Abstract
This study by the human capital point of view, discuss on the nursing professional human capital, and its investment and return as well as nursing competence. Effective samples from 25 different level teaching hospitals amounted to 2,101. In this cross-sectional research, development "nursing competence" scale, by items analysis and explorations as well as confirmed factors analysis, extracted into six factors, named for: integrated care plans, care interventions and communication, self-growth and professional development, management, and coordination and teaching competence, modified to 33 questions items, Cronbach ' s alpha value for 0.885~0.937. Developed evaluation scale for clinical ladder system by 18 items, including 2 factors, personal and professional growth and organizational resource factors, Cronbach ' s alpha values was .875 and .967.
Use statistical software Spss 14 and Mplus to test of multivariate and cross-level analysis. The result was that "nursing clinical level" is a very good indicator to the human capital, will affect the "clinical ladder investment evaluation" and "competence"; " Clinical ladder system "will affect the" nursing competence ". Regulation effect of organizational factors, "resource from organization" may affect the relationship of "nursing clinical ladder systems evaluation and nursing competence ". "Hospital grading" has parts of impact on nursing competence.
Nurse is worthy human capital, that individuals and organizations should continue to invest obtain the best value for return.
目次 Table of Contents
論文審定書 ………………………………………………………………………… i
致謝…………………………………………………………………………………… ii
中文摘要………………………………………………………………………………iv
英文摘要 ………………………………………………………………………………v
第一章 緒論 1
第一節 背景及重要性 2
第二節 研究目的及假設 8
第二章 文獻探討 15
第一節 人力資本論 15
第二節 「基層護理人員臨床專業能力進階制度」的沿革與內容 21
一、 「基層護理人員臨床專業能力進階制度」的沿革 21
二、 「基層護理人員臨床專業能力進階制度」的內容 26
第三節 護理能力 29
第四節 人力資本、護理臨床進階制度與護理能力 33
第三章 研究方法 39
第一節 概念架構 39
第二節 研究架構 41
第三節 研究對象與抽樣方法 42
第四節 研究工具 45
一、 量表的編制 45
二、 量表的檢定 49
第五節 統計方法 95
第六節 倫理考量 97
第四章 結果 99
第一節 各變項描述性統計與相關分析 99
第二節 不同護理層級在護理能力與評價變異數分析 102
第四節 不同醫院等級在護理能力與進階投資評價變異數分析 133
第五節 多層次迴歸模式分析檢定 148
第五章 結論與討論 - 159 -
第一節 結論 - 159 -
第二節 討論 - 167 -
參考文獻 - 172 -
附錄 - 184 -
圖次…………………………………………………………………………………ix
表次…………………………………………………………………………………x
附件…………………………………………………………………………………xv
參考文獻 References
一 中文部分
于漱、顧乃平(1998)。不同年級護理人員學士學位進修班學生之護 理能力比較與其改變情形。護理研究,6(2), 121-136。
于漱、馬鳳歧(1993)。不同學志應屆畢業護生護理能力之比較與相關因素分析之研究。護理研究,1(1), 35-49。
王梅貴、林淑媛、周傳姜、陳美杏(2010)。護理人員跨科訓練之學習經驗。護理暨健康照護研究,6(2),99-106。
尹裕君、鄒慧韞、張淑容、顧治媚(1999)。醫院基層護理人員臨床專業能力進階制度推展計劃報告。護理雜誌,46(6),5-8。
毛新春(1988)。醫學院護理系畢業生臨床護理能力評量表之設計。醫學研究,9(1), 15-37。
白玉珠、徐南麗、汪蘋(1999)。某醫學中心護理人員自評之護理能力及個人特質相關性研究。護理研究,7(3),209-220。
行政院衛生署(2006)。護理人員法施行細則。2006年5月16日修正公告。
行政院衛生署(2007)。護理人員法。2007年01月29日修正公告。
行政院衛生署(2010)。新制醫院評鑑及新制教學醫院評鑑作業程序。中華民國99月6月28日衛署醫字第0990261733號及台高(二)字第0990104115B號會銜公告修正。
行政院衛生署(2010)。預告訂定「醫事人員執業登記及繼續教育辦法」草案。中華民國99年11月16日,衛署醫字地0990261595號。
考試院(2010)。專門職業及技術人員高等暨普通考試醫事人員考試規則。中華民國99年12月27日考試院考臺組壹一字第09900101031號令修正發布。
余玉眉(2010,6月)。我國護理教育面臨之問題與TNAC評鑑之精神。論文發表於輔英科技大學護理學院護理學系主辦之「護理核心素養臨床教學設計實作研討會」,高雄縣。
汪華斌、舒進(2010)。對臨床護士護理核心能力的見解。品質月刊,46(5),54-56。
呂麗戎、盛夢徽、楊美雪、蘇致遠(2008)。護理人員採用面對面學習與遠距學習於專業能力進階課程之成效與滿意度差異─以高雄某區域醫院為例。安泰醫護雜誌,4(2),73-87。
呂桂雲、陳月枝、王美綺(1998)。護生綜合實習前後護理能力分析。醫學教育,2(2),180-189。
何雪華、劉佩芬、胡曉珍、黃素菲、陳小蓮(2010)。新建護理人員角色轉換與工作適應歷程之質性研究。護理雜誌,57(6),31-41。
李麗傳(2000)。Mintzberg理論的實證,護理管理與實證(pp.289-297)。台北:五南。
林佑聖、葉欣怡(譯)(2005)。林南著。社會資本。臺北:弘智。
林秋芬、盧美秀、康偉玲(2004)。護理能力標準:國際版與台灣版之比較。新臺北護理期刊,6(2),11-22。
林宜蓉、杜玉卿、謝旭玲(2009)。護理專科學生護理能力之探討--護理人員與臨床護理教師之評價。護理與健康照護研究,5(3),220-230。
林鉦棽、彭台光(2006)。多層次管理研究:分析層次的概念、理論和方法。管理學報,12,649-675。
吳姿蓉、鄧慶華、池美華、曾淑梅、袁素娟(2007)。某醫學中心護理人員護理能力及其相關因素之探討。中山醫學雜誌,18,303-316。
吳秉恩、黃良志、黃家齊、溫金豐、廖文志、韓志翔(2010)。人力資源管理-理論與實務。臺北:華泰文化。
吳淑君、黃明宣、宋素真(2008)。南部某醫學中心護理人員延遲下班之分析。榮總護理,25(1),31-37。
徐南麗、李茹萍、李芸茹、賴正芬、彭台珠(2003)。護理人員進階制度實施後主客觀護理能力差異之比較。慈濟護理雜誌,2(1),53-62。
徐南麗、林碧珠、徐曼瑩、楊克平(2002)。比較護理進階制度實施前後護理能力及影響因素分析。慈濟護理雜誌,1(1),76-85。
陳綱華、李選、張綺紋(2005)。護理臨床進階制度的現況與未來發展。慈濟護理雜誌,4(3),14-19。
陳繪竹、李金德、林淑媛(2009)。進階護理人員自評護理能力之探討。醫護科技期刊,11(2),89-97。
陳真慧、陳雅紅、倪碧雲、陶惠如(2007)。提升加護中心護理人員N2能力進階完成率。志為護理,7(3),91-101。
張文亮(1999)。南丁格爾與近代護理。臺北:校園書房。
張火燦、紀乃文、劉嘉雯、林夢倫(2009)。積極人格、社會價值傾向與顧客正義知覺對個人社會資本的影響。台大管理論叢,1(20)。
張承(2005)。管理學魔法書-名詞寶典。台北:鼎茂。
彭台光、林鉦棽(2008)。組織現象和層次議題:非獨立性資料的概念和實徵。組織與管理,1,95-121。
彭美瑛、徐南麗(2003) 。從中西文化特質的差異看現行的護理教育。志為護理,5(1),73-77。
馮月香、李秀珍、方茂守(2009)。精神科急性病房護理人員延遲下班改善案。護理雜誌56(6),47-54。
莊玉嬪(2003) 。基層護理人員臨床專業能力進階制度之探討-以某區域教學醫院為例。未發表的碩士論文,國立雲林科技大學,雲林。
葉秀珍、劉清華(2009)。專科護理畢業生內外科護理能力分析研究。耕莘學報,7,43-54。
臺灣護理學會(2009)。臺灣護理學會基層護理人員臨床專業能力進階制度立場聲明。
劉棻、林梅香、劉雪娥、孫淑惠(2006)。五專應屆畢業護生、單位主管及護理教師對護理能力滿意度之調查。新台北護理期刊,8(2),43-52。
劉敏、黃裕勝、劉克明(2006)。醫學生核心臨床能力的評量方法。高雄醫誌,22, 475-483。
謝佩蓉、曾淑惠(2010)。護理能力評量之現況與展望。領導護理,11(2),02-09。
譚蓉瑩(2000) 。批判性思考─我國護理人員的第七項護理能力。護理雜誌,47(3),52-58。
 
二 英文部份
Aduddell, K. A. & Dorman, G. E. (2009). The development of the next generation of nurse leaders. The Journal of Nursing Education, 4, 1-4.
Becker, G. S. (1962). Investment in Human Capital: A Theoretical Analysis,” Journal of Political Economy, 70(5), pt. 2, 9-49.
Becker, G. S. (1964). Human Capital: A Theoretical and Empirical Analysis, With Special Reference to Education. New York: National Bureau of Economic Research Press.
Becker, G. S. (1993), Human Capital, 3rd Edition, Chicago: University of Chicago Press.
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.
Beier, M. E. & Ackerman, P. L. (2003). Determinants of health knowledge: An investigation of age, gender, abilities, personality, and interests. Journal of Personality and Social Psychology, 84, 439-447.
Bjork, I. T., Hansen, B. S., Samdal, G. B., Torstad, S. & Hamilton, G. A. (2007). Evaluation of clinical ladder participation in Norway. Journal of Nursing Scholarship, 39(1), 88-94.
Black, J., Allen D., and Redfern L.(2008) Competencies in the context of entry-level registered nurse practice: a collaborative project in Canada, International Nursing Review 55, pp. 171–178.
Bliese, P. & Hanges, P. J. (2004). Being too liberal and too conservative: The perils of treating grouped data as though they were independent. Organizational Research Methods, 7, 400-417.
Bobay, K., Gentile, D. L., Hagle, M. (2009). The relationship of Nurses’ professional characteristics to level of clinical nursing expertise. Applied Nursing Research, 22, 48-53.
Bontis, N., & Fitz-enz, J.(2002). Intellectual capital ROI: A causal map of human capital antecedents and consequents. Journal of Intellectual Capital, 3(3), 223-247.
Bradshaw, A. & Merriman, C. (2008). Nursing competence 10 years on: Fit for practice and purpose yet? Journal of Clinical Nursing, 17(10), 1263-1269.
Brief, A.P., & Aldag, R.J.(1977). The Intrinsic Extrinsic Dichotomy Toward Conceptual Clarity. Academy of Management Review, 2(3), 496-500.
Buchan, J. (1999). Evaluating the benefits of a clinical ladder for nursing staffs: An international review. International of Nursing Studies, 36(), 137-144.
Chapman, H. (1999). Some important limitations of competency-based education with respect to nurse education: An Australian perspective. Nurse Education Today, 19(2),129-135.
Cohen, S., Underwood, L.G., & Gottlib, B.H.(2000). Social support measurement and intervention: A guide for health and social scientists. London: Oxford.
Coleman, J. S. (1991). Parental involvement in education. Policy perspectives series. (ERIC Document Reproduction Service No. ED334028).
Cowan, D. T., Norman, I. & Coopamah, V. P. (2005). Competence in nursing practice: A controversial concept--A focused review of literature. Nurse Education Today, 25(5), 355-362.
Davenport, T. O. (1999). Human Capital: What It Is and Why People Invest It. San Francisco: Jossey-Bass.
Deci, E.L.(1976). The hidden costs of rewards. Organizational Dynamics, 4(3), 61-72.

Deci, E.L., and Ryan, R.M.(1985). Intrinsic motivation and self- Determination in human behavior, New York: plenum Press.
Espeland, V. & Indrehus, O. (2003). Evaluation of students' satisfaction with nursing education in Norway. Journal of Advanced Nursing, 42(3), 226-236.
Feng, R., Chen, M., Chen, M. & Pai, Y. (2010). Critical thinking competence and disposition of clinical nurses in a medical center. Journal of Nursing Research, 18(2), 77-86.
Hackman, J.R., & Oldham, G.R.(1976). Motivation through the design of work: Test of a theory. Organizational Behavior and Human Performance, 16, 250-279.
Hambrick, D. C. (2003). Why are some people more knowledge¬able than others? A longitudinal study of knowledge acquisition. Memory & Cognition, 31, 902-917.
Halstead, J. A., Rains, J.W., Boland, D.L., &May, F.E. (1996). Reconceptualizing baccalaureate nursing education: Outcomes and competencies for practice in the 21st century. Journal of Nursing Education, 35(9), 413-416
Hofmann, D. A. (1997). An overview of the logic and rationale of HLM. Journal of Management, 23(6), 723-744.
Homans, G. (1958). Human Behavior as Exchange. American Journal of Sociology, 63(6), 597-606.
Horvat, E. M., Weininger, E. B. & Lareau, A. (2003). From social ties to social capital: Class differences in the relations between schools and parent networks. American Educational Research Journal, 40(2), 319-350.
Ironside, P. M. (2008). Safeguarding patients through continuing competency. Journal of Continuing Education in Nursing, 39(2), 92-94.
Kenny, D. A. & Judd, C. M. (1986). Consequences of violating the interdependence assumption in analysis of variance. Psychological Bulletin, 99, 422-431.
Klein, K. J. & Kozlowski, S. W. (2000). Multilevel theory, research, and methods in organizations: Foundations, extensions, and new directions. San Francisco: Jossey-Bass.
Lawler, E.E. (1969). Job design and employee motivation. Personnel Psychology, 22, 426-435.
Lang, Y. C. (2010). A clinical ladder for occupational health nurses. AAOHNJ, 58(6), 239-44.
Lepak, D. P. & Snell, S. A. (1999). The human resource architecture: Toward a theory of human capital allocation and development. Academy of Management Review, 24(1), 31-48.
Lin, N. (1999). Social networks and status attainment. Annual Review of Sociology, 25, 467-487.
Luthans, F., Luthans, K. W., & Luthans, B. C.(2004). Positive psychological capital: Beyond human and social capital. Business Horizons, 47(1), 45-50.
McBride, A. B. (1999). Breakthroughs in nursing education: Looking back, looking forward. Nursing Outlook, 47(3), 114-119.
Meretoja, R., Leino-Kilpi, H. & Eeiksson, E.(2002). Indicators for competent nursing practice. Journal of Nursing Management, 10, 95-102.
Meretoja, R., Leino-Kilpi, H. & Kaira, A.M. (2004). Comparison of nurse competence in different hospital work environments. Journal of Nursing Management, 12(5), 329-336.
Noe, R. A., Hollenbeck, J. R., Gerhart, B. & Wright, P. M. (2003). Human resource management: gaining a competitive advantage. New York: Mc-Graw-Hill.
Noe, R. A., Hollenbeck, J. R., Gerhart, B. & Wright, P. M. (2007). Fundamentals of human resource management. Taipei: Mc-Graw-Hill.
Olson, M. (1965). The logic of collective action: Public goods and the theory of groups. Cambridge, Massachusetts: Harvard University Press.
Parkes, J., Hyde, C., Deeks, J. & Milne, R. (2001). Teaching critical appraisal skills in health care settings. Cochrane Database Systematic Reviews, 3, CD001270. doi:10.1002/14651858.CD001270
Ployhart, R. E. & Moliterno, T. P. (2011). Emergence of the human capital resource: a multilevel model. Academy of Management Review, 36(1), p127-150.
Ployhart, R. E., Van Iddekinge, C. H. & Mackenzie Jr., W. I. (2011). Acquiring and developing human capital in service contexts: The interconnectedness of human capital resources. Academy of Management Journal, 2(54), 353-368.
Ployhart, R. E., Weekley, J. A. & Ramsey, J. (2009). The consequences of human resource stocks and flows: A longitudinal examination of unit service orientation and unit effectiveness. Academy of Management Journal, 52(5), 996-1015.
Portes, A. (1998). Social capital: Its origins and applications in modern sociology. Annual review of sociology of education, 71, 24-43.
Ramphal, M. (1968). Needed: A career ladder. American Journal of Nursing, 68(6), 1234-1237.
Reid M(1994). A descriptive study of the characteristics of participants and non-participants in a clinical nursing ladder program. Kentucky Nurse, 42(2), 13.
Riley, J. K., Rolband, D. H., James, D. & Norton, H. J. (2009). Clinical ladder: Nurses’ perceptions and satisfiers. The Journal of Nursing Administration, 39(4), 182-188.
Roos, J., Roos, R., Edvinsson, L., & Dragonetti, N.(1998). Intellectual capital: Navigating in the new business landscape. New York: New York University Press.


Schneider, B. (2000). Social systems and norms: A Coleman approach. In M. T. Hallinan (Ed.), Handbook of sociology of education (pp. 365-385). NY: Kluwer Academic/Plenum Publishers.
Schmidt, F. L. & Hunter, J. E. (1998). The validity and utility of selection methods in personnel psychology: Practical and theoretical implications of 85 years of research find¬ings. Psychological Bulletin, 124, 262-274.
Schmidt, L., Nelson, D. & Godfrey, L. (2003). A Clinical Ladder Program Based on Carper’s Fundamental Patterns of Knowing in Nursing. Journal of Nursing Administration, 33(3), 146-152.
Schultz, T. W. (1961). Investment in Human Capital. The American Economic Review, 51(1), 1-17.
Schultz, T. W. (1962). Reflections on Investment in Man. The Journal of Political Economy, 70, 1-8.
Schwirian, P.M. (1978) Evaluating the performance of nurses: A multidimensional approach. Nursing Research, 27(6), 347-351.
Stewart, T. A. (1997). Intellectual Capital: The New Wealth of Organizations. New York: Bantam Doubleday Dell Publishing Group, Inc.
Taylor, K. (2000). Tackling the issue of nurse competency. Nursing Management, 31(9), 34-37, quiz 37-38.
Tzeng, H. M. (2003). Demand and supply for nursing competencies in Taiwan’s hospital industry. Nursing Economic, 21(3), 130-139.
Utley-Smith, Q. (2004). 5 competencies needed by new baccalaureate graduates. Nursing Education Perspectives, 25(4), 166-170.


Wright, P. M. & Boswell, W. R. (2002). Desegregating HRM: A review and synthesis of micro and macro human re-source management research. Journal of Management, 28, 247-276.
 
三 網站資料
行政院衛生署中央健康保險局(2009)。98年全民健康保險統計。2011年6月,取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=661&WD_ID=689&webdata_id=3413
臺灣護理教育評鑑委員會(2010)。評鑑準則。2010年5月15日,取自http://www.heeact.edu.tw/lp.asp?ctNode=352&Ct Unit=118&BaseDSD=7&mp=5
臺灣護理學會(2009)。基層護理人員臨床專業能力進階制度規劃指引。2011年5月,取自http://www.twna.org.tw/frontend/un10_open/welcome.asp#
Donley, R. & Flaherty, M. J., (2008). Promoting professional development: Three phases of articulation in nursing education and practice. ANA Periodicals OJIN, 13(3). Retrieved June 10, 2011, from http://nursingworld.org/default.aspx
Dreyfus, Stuart E. & Dreyfus, Hubert L. (1980, February). A five-stage model of the mental activities involved in directed skill acquisition. Washington, DC: Storming Media. Retrieved June 13, 2011, from http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA084551&Location=U2&doc=GetTRDoc.pdf.
Wade, M. (2005, September 20). Real options theory-theory used in IS research. Retrieved June 13, 2011, from http://www.istheory.yorku.ca/realoptionstheory.htm

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