本文選題：養(yǎng)老機(jī)構(gòu)　切入點(diǎn)：服務(wù)質(zhì)量評價(jià)　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的我國的老齡化呈現(xiàn)高速、高齡、高齡,基數(shù)大、差異大,社區(qū)養(yǎng)老水平低、自我養(yǎng)老和機(jī)構(gòu)養(yǎng)老意識(shí)低的特點(diǎn),成為我國經(jīng)濟(jì)社會(huì)發(fā)展的嚴(yán)峻問題,于此同時(shí)我國現(xiàn)有的衛(wèi)生評價(jià)內(nèi)容基本針對城市醫(yī)療服務(wù),并沒有針對養(yǎng)老機(jī)構(gòu)的服務(wù)質(zhì)量評價(jià)體系。因此本文針對"醫(yī)養(yǎng)結(jié)合"模式下的養(yǎng)老機(jī)構(gòu)的特殊性嘗試開發(fā)一套評價(jià)量表,能夠兼顧醫(yī)療的特殊性與養(yǎng)老的服務(wù)性,且具有良好的信度與效度,并對該量表進(jìn)行初步應(yīng)用。研究結(jié)果通過國內(nèi)外的文獻(xiàn)回顧,標(biāo)準(zhǔn)和政策梳理,建立了原始項(xiàng)目池。經(jīng)過幾次的專題小組討論和一次專家咨詢,得到初始量表,其量表有37個(gè)條目,根據(jù)具體內(nèi)容采用李克特五分制對選項(xiàng)區(qū)分,個(gè)別只有三個(gè)選項(xiàng)的采用1,3,5計(jì)分。使用預(yù)調(diào)研的數(shù)據(jù),153份有效問卷,檢驗(yàn)其信度Cronbach α系數(shù)0.937、CITC系數(shù)均0.5,信度良好。KMO值達(dá)到0.7060.7,說明適合做因子分析。Bartlett的球形檢定值為5540.91,顯著性0.0000.05,同樣說明做因子分析。在探索性因子分析階段,應(yīng)用主成分分析,提取出8個(gè)公共因子,但由于第一個(gè)因子的特征根極大,且相應(yīng)的載荷過大,后面的因子趨于平緩,因此采用方差極大旋轉(zhuǎn)法,計(jì)算因子載荷和交叉載荷,在單個(gè)因子的載荷0.5和交叉載荷0.4的條件下,剔除不符合要求的條目。得到29個(gè)條目。由于后三個(gè)因子解釋力度不夠,因此剔除后三個(gè),將剩余的5個(gè)因子命名為:硬件設(shè)施及環(huán)境運(yùn)營管理安全防護(hù)人文關(guān)懷基本健康。即為正式量表。正式調(diào)研階段,共收到有效問卷501份,使用斯皮爾曼布朗系數(shù)進(jìn)行檢驗(yàn)發(fā)現(xiàn)結(jié)果為0.830,說明量表等值性狀況良好;再使用α系數(shù)做內(nèi)部一致性檢驗(yàn)得到結(jié)果為0.918,結(jié)論說明量表內(nèi)部一致性較高。此外,量表的校正的項(xiàng)總體相關(guān)性(CITC系數(shù))值也都大于0.5,表明量表信度較高,適合進(jìn)行試驗(yàn)。χ2/df=3.542,RMSEA=0.038,CFI=0.94,NNFI=0.91,說明本研究路徑模型的擬合度較高,潛變量與觀測變量的關(guān)系顯著且穩(wěn)固。過計(jì)算α系數(shù)發(fā)現(xiàn)量表中29個(gè)條目均大于0.90,效度可靠。其次,檢測量表的結(jié)構(gòu)效度。運(yùn)用SPSS 22.0軟件計(jì)算每個(gè)維度下各項(xiàng)目間的相關(guān)系數(shù)矩陣(皮爾森相關(guān)系數(shù)),雖然個(gè)別相關(guān)系數(shù)較小,但絕大多數(shù)相關(guān)系數(shù)都在0.60左右,表明量表的結(jié)構(gòu)效度較好,適合推廣。研究結(jié)論1.正式量表具有良好的信度和效度,適宜推廣。2.實(shí)地走訪的九家養(yǎng)老機(jī)構(gòu)大多存在護(hù)工數(shù)量不足,醫(yī)療操作不規(guī)范,收費(fèi)報(bào)銷比例不統(tǒng)一,員工培訓(xùn)沒有體系,個(gè)性化服務(wù)罕有,人文心理關(guān)懷欠缺等諸多問題;問卷顯示的結(jié)果雖然有一部分的趨利性,但是有些比如防火防災(zāi)基本措施,幾乎沒有養(yǎng)老院可以做到,很多基本規(guī)章制度也不齊全,醫(yī)療聯(lián)合的力度不夠。原始量表中曾有一個(gè)選項(xiàng)是對于老年人的禁錮和束縛,筆者在查閱資料的時(shí)候發(fā)現(xiàn)國外和臺(tái)灣早就講捆綁老人視作一種盡量避免進(jìn)行的措施,而預(yù)調(diào)研的結(jié)果讓人很失望,幾乎每一家機(jī)構(gòu)都會(huì)實(shí)行束縛和禁錮,由于各種原因,這還是一個(gè)非常常見和普適的手段。因此我國的養(yǎng)老機(jī)構(gòu)還存在各種各樣的問題,硬性制度規(guī)章不規(guī)范,缺乏審核監(jiān)督和改正措施,服務(wù)質(zhì)量也有很大的提升空間。
[Abstract]:Objective to study the aging of our country present age, age, high speed, large base, large differences in community endowment low level of self care and institutional care consciousness is low, has become a serious problem in China's economic and social development, at the same time the health evaluation of China's basic content for City Medical service, and no the service quality evaluation system for pension institutions. Therefore, in view of the particularity of medical raising combined with the pension agency under the mode of the attempt to develop a set of evaluation scale, can take into account the particularity of the service and pension care, and has good reliability and validity, and the scale of the preliminary application results. Through the domestic and foreign literature review, standards and policy review, established the original item pool. After several panel discussions and an expert consultation, to obtain the initial scale, the scale has 37 items, according to the specific content Using Likert scale to distinguish individual options, only three options by 1,3,5 score. Using the pre survey data of 153 effective questionnaires, test the reliability coefficient of Cronbach 0.937, CITC coefficient was 0.5, the reliability is good up to the.KMO value of 0.7060.7, suitable for spherical calibration factor analysis.Bartlett = 5540.91 significant 0.0000.05, also shows that the factor analysis. The exploratory factor analysis, principal component analysis was applied to extract 8 common factors, but due to the characteristics of the first root factor is great, and the corresponding load is too large, the factor tends to be flat, so using the varimax rotation method, calculating the load factor and cross in the condition of load load, single factor and 0.5 cross load 0.4, does not conform to the requirements of the item. 29 entries. Due to three factors after interpretation is not enough, so after excluding three, will be left More than 5 factors named: the hardware facilities and environmental management safety protection of humanistic care in basic health. As a formal questionnaire. The formal investigation phase, 501 valid questionnaires were received, inspection found that the result is 0.830 using the Spielman Brown coefficient, which indicates that the scale of equivalence in good condition; and then use the alpha internal consistency coefficient test results for 0.918, conclusion the scale shows high internal consistency. In addition, the scale correction overall correlation (CITC coefficient) values are greater than 0.5, indicating that the scale has high reliability, suitable for testing. 3.542 x 2/df=, RMSEA=0.038, CFI=0.94, NNFI=0.91, the results show that the path model of high fitting degree the relationship between latent variables and observed variables, significant and stable. The calculation coefficient found scale of 29 items were higher than 0.90, validity and reliable. Secondly, the structure validity of the scale. The use of SPSS 22 software. Calculate the correlation coefficient matrix of each item in each dimension between (Pearson correlation coefficient), while the smaller individual correlation coefficient, but the vast majority of the correlation coefficient is about 0.60, the scale has a better construction validity, suitable for promotion. The conclusion of the study 1. the formal scale has good reliability and validity, suitable for.2. field visits nine pension institutions are less than the number of medical workers, the operation is not standard, the proportion of reimbursement fees are not unified, employee training system, personalized service rare, many problems such as lack of Humanistic Psychological care; questionnaire results although part of the profits, but some basic measures such as fire prevention, nursing homes can hardly so, many of the basic rules and regulations are not complete, the medical association is not enough. The original scale had an option for the elderly is the shackles and the inspection When the data found in Taiwan and abroad early say old woman as a bundle of measures to avoid, and the preliminary research results were disappointing, almost every agency will implement the bound and imprison, due to various reasons, this is a very common and universal means. Therefore pension institutions in China there are a variety of problems, rigid rules and regulations are not standardized, lack of audit supervision and corrective measures, the quality of service also has the very big promotion space.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1;D669.6

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