| 摘要: | 由於陰道超音波的影像解析度以及檢查的方便性均較腹部超音波佳，因此普遍應用於婦產科的診斷，也使得接受檢查的婦女由裸露肚子轉變成必須暴露私密部位，根據文獻指出，接受陰道超音波檢查的婦女通常會有焦慮反應，且擔心疼痛與不舒服。臨床醫療在建議病人接受檢查時，總以診斷為目的，心理層面的協助較少，傳統的醫療空間與處置流程，多以醫療人員的習慣性與醫院管理者整合人力資源及設備的角度來設計，較少考量就醫者的需求，而這些就醫者必須帶著身心的不適，進入陌生的醫療環境並遷就既有的醫療體系，接受令其更不舒服與不安的檢查。現今的醫療不僅要提供一個乾淨的環境，更講究營造一個藝術化的空間來增進環境的健康因子，文獻指出舒適、藝術化的環境可以消除環境的陌生感，幫助病人緩和其自身與環境引起的壓力。本研究以婦女為中心設計出「人性化檢查服務方案」，給予婦女關懷、尊重，保障婦女隱私權與知的權利，空間的設計以女性為主體之溫馨、居家的佈置，擺設以婦女方便取用並極力維護其安全、舒適、自尊。主要目的為探討提供陰道超音波受檢婦女「人性化檢查服務方案」對於婦女身心感受、服務品質與服務滿意度的成效。
本研究採類實驗研究法，以北部某醫學中心之婦產科超音波檢查室為研究收案場所，研究對象為前來婦產科門診看診且需接受陰道超音波檢查之婦女，對照組提供「常規性的檢查服務」，實驗組提供「人性化檢查服務方案」，研究結果比較對照組與實驗組婦女基本資料對身心感受、服務品質與服務滿意度之差異、人性化檢查服務方案之成效，以及探討身心感受、服務品質與服務滿意度間之線性結構關係。研究工具包括人性化檢查服務方案及研究問卷，研究問卷包括基本資料量表、身心感受量表、服務品質量表與服務滿意度量表。人性化檢查服務方案與基本資料量表採用專家效度進行效度評鑑，身心感受量表、服務品質量表與服務滿意度量表以專家效度、內在一致性信度與建構效度進行信度與效度評鑑，結果顯示信度與效度皆在可接受範圍。
以卡方檢定分析顯示兩組個案具有同質性，由描述統計中可得知，婦女接受陰道超音波檢查最普遍存在的感覺有以下9項：全身緊繃感、感覺緊張、感覺尷尬、感覺害羞、感覺難為情、擔心不舒服、擔心會疼痛、擔心會感染及下腹部悶脹感；兩組個案感受服務品質最高的構面為關懷性，最低為有形性，兩組個案對檢查服務之滿意程度最高的構面為人員服務態度，最低為檢查環境與等候時間。以獨立樣本T檢定分析顯示實驗組個案之身心感受、服務品質與服務滿意度得分均顯著高於對照組，此研究結果顯示人性化檢查服務方案對身心感受、服務品質與服務滿意度是有成效的，其可減輕婦女接受陰道超音波檢查時負向的身心感受，並提升陰道超音波檢查服務的服務品質與滿意度。以結構方程模式分析身心感受、服務品質與服務滿意度三者間的線性結構關係，結果顯示服務品質與身心感受及服務滿意度間有顯著正相關，且服務品質也會透過身心感受對服務滿意度產生一個間接效果，身心感受也與服務滿意度間有顯著正相關，表示當服務品質提高時，可影響婦女之身心感受趨於正向，並提高服務滿意度，而婦女較為正向的身心感受也會提高其對檢查服務的滿意度。
本研究所設計之身心感受量表可應用於其他暴露會陰區檢查之婦女身心感受的評估，如子宮頸抹片檢查、陰道鏡檢查等等。「人性化檢查服務方案」除了可提供陰道超音波受檢婦女更優質的檢查服務，亦可用於以女性為主的婦產科相關檢查，對於其他科別也能應用此概念，提供更卓越的醫療服務。
Owing to its image resolutions and its convenience in diagnosis, both better than abdominal ultrasound, transvaginal ultrasound is nowadays widely applied in diagnosing practice in obstetrics and gynecology. As a result, female examinees who undergo these check-up procedures have to expose their private parts, instead of their abdomens like the old days. According to the literature, women who receive transvaginal ultrasound check-ups normally have anxiety reactions, and worry about pain and discomfort. In clinical practice, when giving advice to the examinees to go through this check-up, more than often the diagnosis itself is its sole purpose, and little psychological assistance is offered. Traditional clinical space and disposal process tend to be designed to serve the purposes of conforming to the customs of medical staff and to the integrity of human resources and facilities in the hospital managers’ minds, and less frequently tend to take the needs of patients into consideration. Consequently these patients are forced to enter strange medical environments and accommodate to the existent medical systems, with physical and psychological discomforts, to suffer from even more uncomfortable and anxiety-causing check-ups. Current medical service is required to not only provide a clean environment, but also give attention to creating an artistic space to increase healthy factors to the environment. The literature points out that a comfortable and artistic space can eliminate environmental strangeness, and help patients to soothe their pressures caused by their own and by the environment.
This women-centered study designs a “humanized service program”, to give women care and respect, and protect women's privacy and their rights to know; the space design is women-concerned, warm and homelike-layout; its furnishings are well-designed in order to facilitate access for women to use, and give every effort to maintain women’s safety, comfort and self-esteem. The main purpose of this space is to provide the women who receive transvaginal ultrasound “the human-based check-up service program”, in order to see how it affects the physical and psychological experiences of these women, its service quality and service satisfaction.
This study adopts a quasi-experimental research method and takes the ultrasound examination rooms of the obstetrics and gynecology department of a medical center in northern Taiwan as the sites of collecting case data. The studied targets are the women who came to the obstetrics and gynecology clinic as outpatients and were required to undergo transvaginal ultrasound. The women in the control-group were offered with “the routine service”, and the experimental group, the “humanized service program”. The study results compare differences between the control group and the experimental group with regard to their respective basic information concerning their physical and psychological experiences, their opinions on its service quality and service satisfaction, discuss about the effectiveness of this program, and explore the inter-relationships among the physical and psychological experiences, service quality and service satisfaction. The research tools include the humanized service programs and the research questionnaires. The research questionnaires include a basic information scale, a physical and psychological experiences scale, a service quality scale and a service satisfaction scale. Scales of humanized service programs and basic information adopt expert validity for validity evaluation; the physical and psychological experiences scale, the service quality scale and the service satisfaction scale adopt expert validity and internal consistency reliability and construct validity for reliability and validity evaluation. The results show that its reliability and validity both fall within acceptable ranges.
Chi-square test analysis reveals that the cases in the two groups have homogeneity. From the descriptive statistics, it can be learned that the 9 most common existing feelings the women had who received transvaginal ultrasound are the following: sense of tension over the whole body, feeling nervous, feeling awkward , feeling shy, feeling embarrassed, worrying about discomfort, worrying about pain, fear of infection and lower abdominal fullness feeling. The outpatients in the two groups perceived the service quality dimensions as such: the highest dimension is the Empathy, and the lowest is the Tangibles. The highest dimension of the two groups concerning the check-up service satisfaction is the Staff’s Attitude, and the lowest is the environment and the Waiting Time for Check-Up. Independent-samples T test analysis shows that the points of the cases in the experimental group are significantly higher than the ones of the control group in these three aspects: physical and psychological experience, service quality and service satisfaction. This study results demonstrats that the human-based check-up service program is effective for physical and psychological experiences, service qualities and satisfaction. It lessens the physical and psychological negative feelings of the women when they underwent transvaginal ultrasound, and at the same time improves the transvaginal ultrasound service quality and satisfaction. Structural Equation Modeling (SEM) analysis of the relationships among the three, physical and psychological experience, service quality and service satisfaction, shows that there is a significant positive correlation between service quality and physical and psychological experiences, also between service quality and service satisfaction. Moreover, the service quality produces an indirect effect on service satisfaction through the physical and psychological experience. There is also a significant positive correlation between physical and mental feelings and service satisfaction; this indicates that increase in service quality may affect the physical and psychological experience of women to tend to be positive, and enlarge service satisfaction; when women have more positive physical and mental feelings, it will also increase their satisfaction with the services.
The physical and psychological experience scale designed in this study can be applied to other assessments of women's physical and psychological feelings under the situations of necessary perineal area exposures, such as Pap smear, colposcopy and so on. “The humanized service program” can offer the transvaginal ultrasound examinees better service; besides, it can be used in various female-based obstetrics and gynecology-related check-ups. Within other medical divisions, this concept can also be applied in order to provide more superior medical service and care. |
