[[alternative]]An Empirical Study on the Using Experiences and Working Efficiency of Nurses for Peritoneal Dialysis Case Management System

[[abstract]]近年來由於國內末期腎衰竭的發生率高居世界第二名，且盛行率位居世界之冠，因此健保署極力推動腹膜透析個案管理，以提升照護品質。當病人接受腹膜透析治療後，醫護人員必須收集各種透析治療相關資訊，進行個案管理及照護品質監測。然而目前腹膜透析個案管理的資料，多以紙本方式呈現，且無法使用醫院的醫療資訊系統，導致個案管理的效能不彰，進而影響腹膜透析的照護品質，因此本研究目的為瞭解護理人員使用腹膜透析個案管理系統的經驗與因應策略，並分析此系統對護理人員工作效能的影響，進而探討推動此系統的成效。本研究採用三角交叉研究法（Triangulation）於北部某醫學中心，以方便取樣方式選取腹膜透析室的護理人員進行資料收集。質性研究則採用一對一訪談方法，以半結構式訪談指引，收集護理人員使用腹膜透析個案管理系統的使用經驗、困難與因應策略。量性研究採取工作取樣法，收集腹膜透析個案管理系統導入前、導入後第三及第六個月，護理人員各項工作花費時間，並以病歷回顧方式收集護理人員紀錄完成率，比較腹膜透析個案管理系統導入前後，對於護理人員的工作效能影響。本研究結果發現：（1）護理人員使用腹膜透析個案管理系統經驗，包括改善工作效能及提升護理品質，在使用系統的困難則有資訊設備不完備、系統功能完備性不佳，及資訊素養不佳，（2）而護理人員產生因應策略包括個人因應模式及尋求支援模式。（3）量性研究結果顯示系統導入後，能增加護理人員直接照護活動時間，24小時內護理紀錄完成率亦有顯著提升。本研究實證結果，能瞭解護理人員使用腹膜透析個案管理系統的經驗，及對其工作效能影響，可做為未來建置其他透析治療資訊系統之參考。[[abstract]]Taiwan ranks first in the prevalence of end-stage renal disease (ESRD) globally. Peritoneal dialysis (PD) is a major renal replacement therapy. The government has promoted the use of PD case management to improve the quality of medical care for patients with ESRD. PD case managers need to collect and record all dialysis-related medical information. However, most medical information is recorded on paper-based medical record and cannot be directly integrated into the hospital information system. Therefore, this study was aimed to understand the PD nurse's user experience and coping strategies of Peritoneal Dialysis Case Management System (PDS), and investigated the work efficacy of PD nurse after this system implementation.The triangulation method was conducted in the study. The PD department nurses were select from a medical center in northern Taiwan through purposive sampling. We utilized a qualitative approach to conduct one-on-one depth interviews for collect using experience and coping strategies of PDS. A quantitative approach was used for work sampling and chart review in order to compare the changes in the work efficacy of PD nurse before, after 3 and 6 months PDS implementation.The results of this study were as follows: (a) Nurses’ positive experiences using PDS included improve work efficiency and enhance the quality of care. The Negative experiences have imperfect information equipment, incomplete system function, and poor information literacy. (b) Nurses coping strategies include personal coping method and external support model. (c) After PDS implementation to increase direct nursing care activity time, and within 24 hours of care records completion rates are also significantly improved. This study empirically result identified the nurse’ using experience and coping strategies of PDS, also evaluated the effectiveness on work efficacy of using PDS. It can be used as system development references model to builds other dialysis information system in the future