Abstract
Due to the change of the times, the medical environment in Taiwan has adapted the mainstream of ¡§patient-centered¡¨ concept. It seems to become a slogan for all medical practitioners. However, little has really changed despite lip service paid to the process of medical improvement. The author has been treating patients with kidney failure for almost twenty years. As being a nephrologist, he realizes that the quality of medical care, the quality of life and the mortality rate are highly related to the length of going on hemodialysis for uremic patients. It means the longer a uremic patient goes on hemodialysis, the lower uremic toxin level and the better quality of life a patient can receive. However, due to the
limitation of arranging schedule for all of the medical staff at hospitals, many uremic patients can not have enough delivered dialysis doses they need. By re-scheduling hospital staff¡¦s working hours, uremic patients¡¦needs can be easily met in order to achieve the truly ¡§one-by-one¡¨customized service. It seems to move a step closer to the concept of¡§patient-centered¡¨ service.
In Taiwan, the current health insurance system, the total payment clause, and the increasing medical cost seem to play a crucial part in running hospitals. We can avoid causing medical accidence by providing sensible working hours and duties to hospital staff. After carrying out the customized working schedule, the hospital management has successfully reduced the working hours of all staff. It definitely creates a win-win situation for the hospital management and employees.
This study is mainly observative, descriptive, cross-sectional, observing the connection and influence of personal and environmental factors on (1) the satisfactory degree of uremic patients, (2) the criterion of the quality of medical treatment¡X(A) the mortality rate of uremic patients (B) the index of KT/V and Albumin, HCT (C) the infection rate (D) the possibility of unpredictable in-hospital accidents¡X(3) potential uremic patients; CKD the chronic uremic patients¡¦ satisfaction (4) the satisfactory degree of nurses.
This is a retrospective study, comparing the difference between before and after executing the customized schedule. It focus on the two periods¡X(1) From Jan. to April, 2001 (2) From Jan. to April, 2007 to find out the difference by looking at four variances¡X(A) Nursing hours (B) Mortality rate (C) Accidental rate (D) Job-quitting rate of nurses.
To verify the workability and result of this system, we compare the difference between Kaohsiung Armed Forces General Hospital and a private dialysis clinic in Kaohsiung by analyzing the result of questionnaires. The finding shows that there has been a significant improvement on patients¡¦ satisfaction and the quality of medical treatment after carrying out the customized schedule. It¡¦s an undeniable social responsibility to all doctors and nurses to prevent even cure diseases. Taiwan has already had the highest rate of kidney failure around the world; therefore, the customized schedule can save time and manpower to provide better care to chronic kidney disease patients. Moreover, it can also make uremic patients suffer less while going on dialysis or delay the timing for patients going on dialysis.
Key word¡G¡§one-by-one¡¨customized service¡Bhemodialysis¡Bpatient-centered
| Identifer | oai:union.ndltd.org:NSYSU/oai:NSYSU:etd-0815107-120132 |
| Date | 15 August 2007 |
| Creators | Shiang, Jeng-Chuan |
| Contributors | Chi-Cheng Wu, Cher-Min Fong, Jen-Jsung Huang, Tsuang Kuo |
| Publisher | NSYSU |
| Source Sets | NSYSU Electronic Thesis and Dissertation Archive |
| Language | Cholon |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.lib.nsysu.edu.tw/ETD-db/ETD-search/view_etd?URN=etd-0815107-120132 |
| Rights | not_available, Copyright information available at source archive |
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