以參與式設計研究方法 進行婦女就醫經驗與隱私權探討－空間配置、就醫者隱私與醫療組織倫理(I)

[[abstract]]病人隱私權的維護在醫學倫理領域裡始終是專業人員的核心職能與專業表現評斷，但因為現代醫療的發展，使得機構化的醫療成為當今現代醫學的主流，也由於健保醫療與媒體勃興所帶來的醫療主導權變化，使得就醫時病人隱私的保護一方面仍須由傳統醫療人員的專業倫理來實踐，一方面醫療組織必須擔負更多的組織責任。環境、機構與人三者交錯出複雜的互動關係。因此著重醫師、護士與其他專業人員的專業倫理之外，更應該以機構的角度來探討更高層次的倫理議題。本研究從醫療的專業倫理如：醫學倫理、護理倫理等出發，試圖以結構式與半結構式問卷、人類學田野方法如參與式觀察與深度訪談等方式，藉由醫院的空間設計及軟硬體配置探討置身其中之所有角色與其所在空間的互動關係，帶出醫院經營策略與醫院管 理流程所展現的組織倫理在病人隱私關懷上現行如何作為以及應該如何作為。 第一年：藉由孕婦到院產前檢查利用到的醫院空間與流程，所接觸的環境與人物，除以結構式與半結構式訪談問卷調查之外，以扎根理論(grounded theory)方法進行資料採擷與所有相關人士的深度訪談，建構出基本的輪廓資料，並檢討研究方式與途徑的適合性。並試圖提出現行狀態下，空間內的活動者對於醫院空間設計與配置和孕婦產前檢查隱私權維護之間的對應關係，耙梳出可以改善的流程與人地配置。 第二年：基於第一年的研究運作，擴大研究所涉入整個懷孕、生產與產後的流程與空間，此時孕/產婦之身體與心理狀態和醫療之流程與空間交互作用產生隱私權的內容與敏感度更為複雜，基於管理與成本考量之臨時性設置的空間調度也大大增加，本期研究目標除擴大研究場域與範疇之外，更著重於釐清產科系統活動中，人、時、地、事、物應如何配置對應關係，才能兼顧經營成效與組織倫理。 第三年：基於前二年所形成之知識體系，與參與醫院高階管理團隊討論重新配置與規劃空間及其軟硬體，並導入試作，紀錄醫院成員與病人對於新的空間設計與制度配置的效果、副作用、接受期程、反應類型等組織理論與管理的相關現象，參與觀察並訪談空間內的活動者或空間相關的人員，對於介入的效果與批評做一總結。進一步分析後驗證修正第一、二年工作成果之參考原則，期望能對組織倫理執行與醫務管理摸索出一套新的範型供產官學界參考。 Protecting patient’s privacy is the daily core ethical practice of medical staffs. After the fast development of modern health technology and managed care systems, more and more health care events take place in the huge hospitals. National health insurance and media competitive business models change the medical authority of health care events that happen in the hospitals. Patient’s privacy protection is not only the issue of traditional ethics domain of medical professionals, but also the affair belonging to the administration responsibility of health care organizations. We cooperate with St. Joseph Hospital, a regional teaching hospital in the middle Taiwan, and adopt a series of interdisciplinary studies about the privacy perception of pregnant women who visit the obstetrician outpatient clinic and deliver later. By the structural and semi-structural interviewing questionnaires, grounded theory and other anthropological field studies, we try to find how the people live and bear the privacy roles in the routine medical spaces and procedures. Through the dialogue of medical space design/allocation and institutional arrangement, we try to find what the health care organization has done and ought to be beyond the medical and nursing ethics. In the first year, we focus the first outpatient visits of pregnant women, and the interest fields include the obstetrician OPD, registry area, waiting area, consulting rooms and treatment rooms, and so on. In the second year, we concern the delivery events and extend the study fields to the labor room, delivery room, recovery room, and postpartum care ward. More people of interest wil attend the activities. In the first two years, we learn and develop a set of knowledge of user-centered design about the medical space, which is able to facilitate medical staffs to practice their professional roles of protecting client privacy. Tracing the knowledge context, we will cooperate with the top management team of St. Joseph Hospital to adopt a plan of re-arranging the optimal space design and re-allocating facilities in the third study year. We hope to formulate a package of organizational strategy and ethical practice for later promotion