| Summary: | 碩士 === 國立臺灣大學 === 護理學研究所 === 105 === Background and Objective: Taiwan Nurse Practitioner Care Model (NPCM) is the nurse practitioners in collaboration with the auxiliary physician-in-charge to provide continuity and integration of the patient''s medical care. Many hospitals apply this care model to replace the shortage of resident physician. However, at present, there is no related research in Taiwan about whether the quality of medical service of the nurse practitioners meets the expectation of the patients and how the patients feel about the care model. Therefore, the purposes of this study were to: (1) explore the demographic and disease-related characteristics of patients under the NPCM, (2) investigate the patients’expectations of the quality in the NPCM, the perceptions of the actual care provided and measure the gap between patients’expectations and perceptions, and (3) identify the important factors affecting the quality of the NPCM.
Methods: This study adopted a cross-sectional, descriptive correlational design with purposive sampling to collect the data from a medical center in Northern Taiwan. The PZB service quality model was used to develop the modified Service Quality (SERVQUAL) scale. The structured questionnaire included patients’ demographic and disease-related characterisitcs of patients. The survey was conducted from 1st June to 30th November 2016. Finally, 200 patients inculded in this study.The construct validity was examined by exploratory factor analysis, and the data were analyzed by descriptive analysis, independent t-test, paired t-test, one-way ANOVA, Pearson’s correlation, and generalized estimating equations(GEE).
Results: The modified SERVQUAL scale had a good construct validity with 5 factors which could explain 66.76% variances. The scale had the good reliability of internal consistency with Cronbach''s Alpha value 0.969. Major patients were those with stable disease, were male (56.5%) with mean age of 57 years old. Most of them did not understand about the role and position of nurse practitioners. The results of the study showed that patients had overall high expectation (M=6.46) on the quality of medical service in the NPCM, and the average scores of the patients’perceptions (M=5.77) were above the middle level of the scale, which showed that the patients recognized the care by nurse practitioners. Comparing the five medical service quality dimensions, patients had the highest expectation of "Reliability", and the lowest perception in " Responsiveness." Differences between expectations and perceptions among the most of the dimensions were significant (p < 0.001). The largest gap between expectations and perceptions was “Reliability" (M=1.998), following by " Responsiveness "(M=0.828). The smallest gap was "Tangible" (M=0.088). The results revealed that the patients with a higher level of cognition of the role and position of nurse practitioners or admitted from the emergency department had greater gaps in quality of medical care. However, the patients felt the authenticity of the medical care performed by nurse practitioners, the gap in quality of medical care would be smaller regardless of the frequency of the nurse practitioners’ visitings.
Conclusion and recommendation: There is still gap in quality of medical care perceived by the patients, especially in the dimension of reliability. Overall, the results of the study suggest the service quality dimensions of “Reliability”, “Responsiveness” and “Assurance in the nurse practitioners care model should be firstly improved by performing following suggestions: (1) Nurse practitioners should enhance the abilities in assessment and management for major diseases’ sign and symptoms, particularly in fatigue, pain, fever and comorbidities. (2) Nurse practitioners need to explain the details of the disease progression, medical procedure and precautions to the patient or his families before the examination or treatment to reduce the patient''s fear and anxiety. (3). Nurse practitioners should cultivate the patient-centered with evidence-based health care so that the patients will be more trust on nurse practitioners. Then, that will help nurse practitioners to build trust and credibility with patients and improve the continuity and integrated quality of medical care.
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