三軍總醫院管理者、員工與病人對健康促進醫院的需求評估研究

Abstract

「健康」一直是民眾關心的議題，有健康的身體才能享受生活的樂趣, 延續事業, 實現夢想。過去一般民眾維持健康的方式，主要是早期診斷及治療。然而，影響健康的因素是相當複雜的，除了個人生活型態之外，環境對我們的健康更是影響深遠，例如：工作壓力、環境的污染、政策的規範、社會經濟狀況、醫療資源分佈等種種因素，都與我們的健康有密不可分的關係（McMichael, 1994）。正因為這些影響健康的危險因子，就潛藏在我們日常生活的場所當中，因此，世界衛生組織開始不斷提倡場所性的健康促進，期望藉由建立健康的支持性環境，讓我們得以改善環境中的健康影響因子，進而提昇我們的健康。醫療場所平日肩負維持大眾健康的責任，即自然負擔起健康促進的功能，並將醫院員工、病人、家屬以及鄰近社區居民列為對象（Mullen et al., 1995）。行政院衛生署為了掌握民眾健康需求的轉變，將健康促進列為重要的施政項目，其衛生政策的走向從注重醫療服務轉向促進健康, 期待發展健康促進醫院，然而, 其內容的規劃卻一廂情願的由上而下。本研究主要是在三軍總醫院, 臺北市內湖、南港、汐止區唯一的醫學中心, 嘗試推動健康促進醫院計畫，並以管理者、員工及病人為中心，由下而上的依自覺健康生活需求、支持性健康環境、健康促進活動三個面向評估他們的需求, 以作為選擇健康議題與策略規劃之參考。經過結構式問卷研究結果顯示: 許多健康促進活動因需求不同, 確應因人而異, 並進一步因人設事。在自覺健康生活需求方面, 七成以上的受訪對象無規律運動習慣，主因為工作太忙及沒有時間; 三成以上的受訪對象反映工作環境有二手菸; 一半以上的受訪對象有失眠的問題; 且研究對象罹患不同類型的慢性疾病; 受訪對象認為需改變生活型態主要為飲食、運動及生活作息。在醫院支持性健康環境需求方面, 五成以上醫院員工健康問題無法有效解決, 並期待醫師能積極主動衛教。員工更期盼管理者做決策時，能多傾聽各種意見, 開誠佈公，化解人際衝突。三總藝文活動, 滿意者低於五成,顯有加強空間。在醫院健康促進活動需求方面, 醫院在九成以上的民意基礎上, 應更積極推展健康促進醫院計畫, 唯宣傳宜再加強, 且應聚焦在養生保健、衝突解決、正面思考及人際關係等知識與技能。人際溝通, 外語學習, 時間管理及深造教育是推動學習的主流。而面對管理者及病人的高度期盼, 身為衛生教育專業人員, 應積極作為, 努力介入。結果並顯示電子及平面媒體在衛生教育中不可偏廢, 且應加強衛生教育宣傳資料的可近性, 並改善健康系列講座的內容。 三軍總醫院將利用此一研究成果, 積極有效的發展切中時弊的健康促進計畫, 並期盡早躋身世界衛生組織健康促進醫院之林, 扮演社區保護者與醫界領航者的角色。“Health” has always been the subject of public concern, in order to have a more enjoyable life you will need a healthy body. In the past, general public maintains their health primarily through early diagnosis and treatment. Although there are complex factors which affect our health and not only to individual life style but the environment have far more reaching effects to our health. For example, polluted environment, etiquette policy, job stress, socio-economic status, and distribution of medical resources etc. They all have very close linkage (McMichael, 1994). These risk factors, which impacts our health, conceals in our everyday life. For this reason, the World Health Organization (WHO) start to promote health promotion settings, to create a supportive environment, and to improve environment’s health factors. The medical institute has the responsibility for the maintenance of health services functions, and targeted hospital staffs, patients and residents of neighboring communities (Mullen et al., 1995). Department of Health gauge the needs of changing public health have addressed health promotion as a major issue, its health policy direct from a focus on medical services to promote public health. However, their policy was basically top down design. This research is based on Tri-Service General Hospital (TSGH) promoting health as a project for hospital. Promoting health is currently based on evaluating patient and staff needs (bottom up) through a structured questionnaire. The results demonstrated that different populations may have different needs. There are more than 70% targeted persons not having regular exercise behavior due to busy life; 30% targeted persons still exposed to second hand smoking. Half of the studied populations have insomnia problem. All of the targeted populations wish to change their life style especially focus on nutrition, exercise, and living activities. Both of the hospital staffs and the patients want to get health education from physician or professional health educator. Furthermore, more than 90% targeted groups support the idea of health promoting hospital, which will make us much easier to promote this action. Based on this research, I will continually develop the strategies to rapidly promote this project, health promoting hospital, in my hospital, and to join the network of WHO HPH as soon as possible.