Mối quan hệ giữa hành vi của bác sĩ với sự tin tưởng, hài lòng và lòng trung thành của bệnh nhân một nghiên cứu tại các bệnh viện tỉnh lâm đồng

IC il f4I

«

KINH Tf

MOl QUAN HE GIITA H A N H VI CUA BAC Sl V d l SU* TIN TU^dNG,

HAI LONG VA LONG TRUNG THANH CUA BENH NHAN MOT NGHIEN ClTU TAI CAC BENH VIEN TINH LAM DONG
Nguyen Thuy Quynh Loan'
Le Quang Vinh'

Ngay nhan bai: 25/ll.'2014
Ngay nhan lai: 09/01/2015
Ngay duySt dang: 19/05/2015

Long triing thanh ciia benh nhan chlnh la muc tieu cho moi hoat dong ma nhieu benh vien
huang tai. Muc tieu ciia bai bdo nay nham xdc dinh vd do luang mice do dnh huang cua cdc yeu
td hdnh vl ciia bde sT (su ldng nghe, sugldi thich vd nghiip vu chuy'en mon) den long lining thdnh
thong qua yeu to niem lin vd sir hdi long cua benh nhdn. De fdi da khdo sal 24 7 bdng cdu hoi vol
doi tuang khdo sal la cdc benh nhdn tqi cdc benh vien tinh Ldm Ddng. Ket qud cho thdy cdc yiu
to dnh hudng den su hdi long cua benh nhan la su tin tirdng (P = 0.582), ke den su ldng nghe
(P = 0.370) vd gidi thich cita bde sT (P = 0.384); co 3 yeu td tdc dong den su tin tuang cda benh
nhdn trong do tdc dong mgnh nhdt la yeu to nghiep vu chuyen mdn (fi = 0.482); su tin tudng
(fi = 0.404) vd su hdi long (fi = 0.388) deu co tdc dong ddng ki den long trung thdnh cua binh
nhdn. Tir dd de tdi da dua ra mot so hdm }' cho nhd qudn ly benh vien Irong viec qudn ly doi ngii
bde sT nhdm ndng cao su tin tuffng. hdi long cho binh nhdn de ho ngdy cdng trung thdnh han.

Patients' loyalty Is a goal for all activities ofthe hospitals. The objective of this paper vas
lo identify and measure the physician s behavior (listening, explanation and competence)
Impacting on loyalty through confidence and satisfaction of patients. The research surveyed 247

questionnaires from patients al the hospitals In Lam Dong province. The results showed that the
factors affecting patients' satisfaction were trust (f3 = 0.582). listening (fi = 0.370) and
explanation (P = 0.384) of Ihe physicians: there were 3 factors impacting on the trust of patients
in which the strongest factor was competence (P = 0.482); confidence (P = 0.404) and
satisfaction (P=0388) had significant impacts on patients' loyalty. This paper then suggested
the mangerlal implications for hospital managers In managing their physicians to enhance
patient's trust and satisfaction so that they become more loyal.
1. GiAi thieu
Slic khoe luon la m6i quan tatn hang diu
cua xa hoi va la diSu quy gia nhdt cua con
nguoi. Mot Ak nuac ma vin ii siic khoe
khong diroc quan tam, phin Itjn dan s6 la
nhiing nguoi benh tat, 6m yiu thi chic chin
khong tranh khoi mot nln kinh tg cung 6m ySu
va kem phat triSn. Do do, sir giau ngheo cua
mot quoc gia phu thuoc phin lon vao chit

lugng y te, trong do chu yeu la chit lugng dpi
ngu y - Bac sT. Vi vay, viec diu tu cho he
th6ng y t i noi chung. doi ngu y - Bac si noi
rieng la dau tu cho tuong lai, cho ca mot su
phat trien lau dai va ben virng. Trong b6i canh
m6i trucmg y te ngay cang co tinh canh tranh
cao do nguoi dan cham Io den sue khoe ciia
minh nhigu hon. tlii viec cac benh vien can tap
trung nang cao chit lugng doi ngu y - bac sT la

^ TS, Traong Dai hoc Bach Khoa - Bai hoc Qudc Gia TP HCM
-Tnidng Dai hgc Bach Khoa - Bai hoc Ouflc Gia TP w r u

TAP CHl KHOA HOC TRUONG DAI HOC MO TP.HCM -SO 3 (42) 2015

KO^^

dieu can thiet. Boi theo Youssel & Bovaird
(1996), cac benh vien cung cap nhieu dich vu
giong nhau nhung khac nhau ro ret \k chdt
luang dich vu cham soc sire khoe. Kotler
(1991) cho rang chat lugng dich vu la yiu t6
quan trong dong gop thanh cong cho chien
Iugc cong ty va giup cong ty tfin tai trong moi
truofng canh t r ^ h khde liet. Vi vay, mpt trong
nhB-ng ly do nham thu hut, giir chan benh nhan
va giam tinh trang benh nhSn vugt tuySn vln
dang con gia tang nhu hien nay a Viet Nam la
chat Iugng dich vu dugc cung cSp nhu thi nko
tir ca sa y te do. va dpi ngu y - Bac sT chinh la
luc lugng nong cot quy§t dinh phin lon d^n
chat lugng dich vu kham chira benh va tao nen
danh tieng cho cac benh vien.
Hau het cac chii de da va dang dugc
nghien cuu nhieu tren the gicri va a Viet Nam
chu yeu tap trung vao cac yeu to chat lugng
tao nen su hai long cua khach hang doi vai
dich vu, dien hinh nhu cac nghien ciiu dua
theo mo hinh nam thanh phan cua Parasuraman
& ctg. (1988), hoac hai thanh phan thuoc tinh
dich vu la thuoc tinh ky thuat va thuoc tinh
churc nang (Gronroos, 1984). Nham tim ra

huong tiep can mai, nghien cuu nay ke thira
mo hinh nghien cuu cua Gaur & ctg. (2011)
tap trung den cac nguon luc tuang tac ma cu
the la cac yeu to hanh vi: su lang nghe, giai
thich va nghiep vu chuyen mon cua Bac sT doi
vai long trung thanh cua benh nhan thong qua
sir tin tuong, hai long ciia hg trong qua trinh
kham chua benh. Viec xay dvmg long trung
thanh cua benh nhan cung chinh la phuang
phap giiJ chan benh nhan dong hanh ciing voi
mgi sir thay doi ciia benh vien.
Lieu day co phai la huang ma cac nha
cung cip dich vu trong ITnh vuc y te can quan
tam dk lam gia tang va duy tri long trung thanh
cua nguai benh hay khong? Do do. muc tieu
nghiSn cun nay nham lam ro. Moi quan he
giira hdnh vi cua bde si vdi su tin tudng, hdi
long vd long trung thdnh cua ngudi benh lgi
cdc binh vien tinh Ldm Ddng.
2. Ca s& (y thuyet va mo hinh nghien cihi
2.1. Dich vu vd dich vu y te
Dich vu la qua trinh bao gom cac hoat
dgng, hanh vi tuang tac giira nha cung cap
dich vu va khach hang nham thoa man nhu
cku, mong dgi ciia khach hang, cung nhu tao
ra gia tri cho khach hang (Zeithaml & Bitner,

35

2000). Nhu vay, gia tri dich vu thuc su dugc

tao ra khi khach hang su dung va tieu dCing no,
gia tri nay se tilp tuc dugc tao ra giua nha
cung cdp va khach hang trong suot qua trinh
thu huang cua khach hang.
Dich vu y te la toan bo cac boat dgng
cham soc sue khoe cho cgng dong, con nguoi
nhim thoa man kip thai va co hieu qua hon cac
nhu ciu ngay cang gia tang ve cham soc sue
khoe (Eg Y T I - T6 chirc y ti thi giai. 2001).
2.2. Hanh vi cua Bac sf frong kham
chS-a benh
Hanh vi cua Bac si trong kham chua
benh la ling nghe, luu tam den nhiing cau hoi,
lo lang cua benh nhan khi doi mat vai benh tat
va viec chiia tri; giai thich, cung cap thong tin,
chia se vai benh nhan va gia dinh hg cac giai
doan cua viec chira tri. tranh cac tir phirc tap
va chuyen mon: nghiep vu chuyen mon. quan
sat cac trieu chimg ctia benh nhan (kiem tra
lam sang), chan doan de cuoi ciing dua ra
phuang thuc chiia trj thich hgp (Pham Nggc
Thanh, 2012).
2.3. Sur tin tu&ng, hai long va long
trung thanh cda benh nhan
Su tin tuang la nhijng mong muon cua
nguai tieu diing ma nha cung cap dua vao de
cung cap dich vu nhu da hua (Sirdeshmukh &
ctg., 2002). Berry & ctg. (2008) cong nhan
rang cam ket cua benh nhan ve moi quan he
cua ho vai Bac sT co Hen quan den nhan thirc

niem tin ciia hg. Niem tin co dugc khi benh
nhan cam nhan ye Bac sT la chan thanh, dang
tin cay va nhan tir (Doney & Cannon. 1997).
Zeithaml & Bitaer (2000) dinh nghTa su
hai long la danh gia ciia khach hang ve san
pham hay dich vu dap img nhu cau va mong
dgi ciia hp. Su hai long dupc coi la ket qua cua
moi quan he giua nguai mua - nguai ban trong
ITnh vuc dich vu (Smith, 1998; Huang, 2008;
n-ich Gaur & ctg., 2011), va no chiu tac dpng
dang ke ciia moi quan he nay (Weng, 2008).
Long trung thanh bao gom cac hanh vi
\h y djnh mua Iai, san sang giai thieu hoac
truy§n mieng tich cue (Zeithaml & Bitner.
2000). Long trung thanh ciia khach hang dupc
xem la ket qua cuoi ciing trong moi quan he va
la sire manh thuc su ciia m6i quan he
(Reichheld, 1993).
2.4. Moi quan he giua hdnh vi cua Bac
si v&i sir tin tu&ng, hdi long cua benh nhan


36

KINH TE'

mit di niim tin cua benh nhan. Moi quan he
tdt giija Bac sT - benh nhan lam gia tang sir hai
long va cirng co sy tin tudng cua benh nhan,
ciing nhu dgng Iuc va each nhin tich cue \i

tinh trang sire khde ciia hp (Skea & ctg., 2004).
Tir nhung phan tich tren, gia thuyet dat ra:
H3: Cd mdi quan he tich cue giita sir gidi
thich cua Bac sT vd su hdi long cua benh nhdn.
H4: Co mdi quan hi tich cyrc giira su gidi
thich cua Bac sTvd su tin tirdng cua benh nhdn.
Nghiep vu chuyen mdn cua Bde sT: la
mirc dp ma benh nhan tin tudng vao kj? nang
va kien thuc can thiet cua bac sT de cung cap
cho nhu cau cham sdc sue khde ciia hg (Berry
& ctg., 2008). Trong mot nghien ciru \i su hai
long cua benh nhan, DiMatteo & Hays (1980)
phat hien bang chung thuyet phuc ring niu
benh nhan cam thay Bac sT cua hp la nhirng
ngudi giao tiep tot, thi hg ciing xem do la
nghiep vu chuyen mdn ve ky thuat va thich
hgp cho viec cham sdc hieu qua (trich Gaur &
ctg., 2011). Chandon & ctg. (1997) cung xac
HI: Co moi quan he tich cue giira su ldng dinh nghiep vu chuyen mdn la mpt trong cac
nghe cua Bde $T vd su hdi long ciia benh nhdn
yeu to ddng gdp de danh gia ve tuang tac dich
H2: Cd mdi quan he tich circ giira sir ldng vu han la hieu qua dich vu. Do do, gia thuylt
nghe cda Bac sTvd su tin tuang cda binh nhdn.
dugc phat bidu:
Sir gidi thich cua Bac sT: de cap den
H5: Cd mdi quan he tich cue giira
nhan thuc ciia benh nhan ve kha nang cung cSp nghiep vu chuyen mdn cua bac sT vd su hdi
thong tin cua Bac si lien quan din tinh hinh long cua binh nhdn.
Slic khoe, dugc pham, cham soc, yeu cau thii
H6: Cd moi quan hi tich cue giiia nghiip

tuc y ti (Stewart & ctg., 1999). Khi kham chiJa vu chuyen mdn ciia bde si vd su tin tuang ciia
benh, viec thiet yeu la phai tao dupc m6i quan benh nhdn.
he diing, giao tiep hai chieu va giai thich cho
2.5. Moi quan he giita su- tin tu&ng, hdi
benh nhan ro rang, ngin gpn, dilu nay dem lai long va long trung thdnh ciia benh nhan
hieu qua trong mpt phan ngi dung kham chua
Su hai long la mpt yeu td du bao manh
benh. Duffy & ctg. (2004) chi ro benh nhan
ve long trung thanh. khi cac hanh vi tuong tac
mong mu6n duge giao tiep tot vdi Bac sT de hg
ciia Bac si vdi benh nhan dugc cai thien lam
CO th8 cai thi6n m6i quan he va cam thiy dugc
gia tang sir hai long, qua dd ciing gia tang long
hai long hon. Theo kit qua diiu tra cua
trung thanh ciia benh nhan (Bowers & ctg.,
Tongue & ctg. (2005) 75% Bac sT phlu thuat
chinh hinh tin ring hp giao tiip thoa dang vdi 1994). Theo Crosby & ctg. (1990) sir hai long
benh nhan, nhung cbi eo 21% benh nhan hai phu thudc vao tuong tac true tilp giiia cac ca
long trong giao tiip vdi cac Bac sT nay. Khi nhan (trich Gaur & ctg., 2011) nen cam nhan
cac kiem tra y te va viec di^u tri dugc giai ciia khach hang vh tuong tac true tidp vdi nha
thich ro rang, se lam^giam bat cam giac lo lang cung cap dich vu la mdt trong nhimg yiu to
cua benh nhan. Thieu su giai thich diy du va quylt djith long trung thanh (Gronroos, 1994).
s^ dong thuan giua Bac sT - benh nhan cd the Gia thuyet dugc phat bilu:
H7: Benh nhdn cdng hdi long vdi Bac si
dan den thit bai trong dieu tri, hau qua la benh
khong dupc chua het va nhung bien chiing thi hg cdng trung thdnh.
Su tin tudng ctia benh nhan vao Bac si
nghiem trpng cd thi xay ra lam anh huang d8n
moi quan he giua Bac sT - benh nhan vdlam ciing da dugc chung minh rang se dan den su
hai long cua benh nhan (Baker & ctg., 2003).

Su ldng nghe cua Bde sT: de cap den
nhan thuc ciia benh nhan ve viec Bac sT san
long danh thai gian di ling nghe va chii y den
nhirng van de ma hp quan tam (Stewart & ctg.,
1999). Theo Swan & Oliver (1987) ling nghe
la dieu thiet y^u de tiSp can dinh huong khach
hang va co quan h6 tich cue den su hai long
khach hang (trich Gaur & ctg., 20II). Su cham
chu ling nghe, cam thong, va su dung cau hoi
ma lam gia tang su tham gia va gan bo ciia
benh nhan voi viec dieu tri. thiic day moi quan
he than tinh, pha bo tra ngai qua do benh nhan
CO the chia se thong tin can thiet de bae sT chan
doan cbinh xac benh tinh va tuan thii dieu tri
theo quy dinh ciia Bac sT tCr do tao dugc niem
tin cho benh nhan (Tongue & ctg., 2005). Nhan
thuc ciia nguai tieu dimg ve hanh vi lang nghe
cua nhan vien con co tac dpng den viec thiic
day moi quan he Iau dai, xay dung long tin va
du doan cac tuong tac sau do (Ramsey & Sohi,
1997; trich Gaur & ctg., 2011). Vdi nhimg
phan tieh tren, gia thuyet dat ra:


TAP CHf KHOA HOC TRL/ONG DAI HOC MO TP.HCM - SO 3 (42) 2015

.H*

Da cd nhiing phat hien rang su tin tudng trong
cac mdi quan he cd tac ddng tich cue din su

hai long trong cac tuang tac dich vu (Hennig Thurau & ctg., 2002; trich Gaur & ctg., 2011).
Su tin tudng vao mdi quan he se lam giam sir
lo lang va khdng yen tam, dac biet la trong
linh vuc dich vu (Berry & ctg., 2008).
Platonova & ctg. (2008) cung da tim thiy ylu
td niem tin du bao chii ySu cho su hai long va
long trung thanh cua benh nhan. Do do, gia
thuyet duge dat ra la:
H8: Binh nhdn cdng tin tudng vdo Bde
sithi hg cdng hdi long.
H9: Benh nhdn cdng tin tudng vdo Bde
sTthi hg cdng trung thdnh.
TLI cac gia thuyet phat bieu tren, md hinh
nghien cuu dugc thl hien d Hinh I.

Hinh 1. Mo hinh nghien cuu

m^

3. Phircnig phap nghien ciru
Nghien cuu dugc thuc hien qua hai giai
doan: Nghien cmi so bp (nghien ciru dinh tinh
vdi cac thang do ke thira tir nghien cuu cua
Gaur & ctg. (2011), tiln hanh thao luan nhom
vdi 5 tmdng khoa, Bac sT va phong van sau
vdi 5 benh nhan tai cac benh vien Da Khoa I
Lam Ddng (TP. Da L^t), Da Khoa II Lam
Ddng (TP. Bao Ldc) de dieu chinh, bo sung
cac biln nhim cd dugc thang do hoan chinh;
kit qua cd dugc 27 bien quan sat, su dung

thang do Likert 5 dilm vdi "su lang nghe cua
Bac sT - SLN" (5 bien), "su giai thich cua Bac
sT - SGT" (5 biln). "nghiep vu chuyen mdn NVC" (4 bien), "su tin tudng ciia benh nhan STT" (5 biln), "su hai long ciia benh nhan SHL" (4 biln), "long trung thanh cua benh
nhan - LTT" (5 biln). Nghien ciiu chinh thirc
(nghien ciiu dinh Iuang dugc thuc hien theo
phuong phap lay mau thuan tien bang bang
cau hdi, phan tich dir lieu de kiem dinh thang
do va cac gia thiet, sd lieu dugc xir ly bang
phan mim SPSS phien ban 20.0).

4. Kit qua nghien ciiu
Co 247 mau dupc chinh thirc sii' dung
lam du' lieu cho nghien ciiu vdi doi tugng la
cac benh nhan din kham chCJa benh hoac dang
nim dilu tri tai cac benh vien Da Khoa I Lam
Ddng, Da Khoa II Lam Dong, Da Khoa Hoan
My (Tp. Da Lat); xet vl do tudi co 61.5%
thuoc nhdm tuoi tir 18 - 35; ve nghe nghiep cd
din 50.7% la ndng dan, cdng nhan, budn ban,
lao dpng tu do; dilu nay cung phii hgp vdi
mirc thu nhap con kha thap ciia ngudi dan d
Lam Ddng chii ylu tir 3 den 6 trieu/thang
(41.3%), dudi 3 trieu/thang (28.3%), tuy cung
CO nhiing ngudi co muc thu nhap cao tren 10
trieu/thang nhung khong nhieu (7.7%), con lai
la 6 - 10 trieu/thang (22.7%).
Kiem djnh thang do
Ket qua phan tich Cronbach's alpha cho
thay he sd cac nhan to cd gia tri trong khoang
0.797 den 0.911, ldn hon 0.6 nen cac thang do

deu dat yeu cau. Ket qua phan tich EFA cho
thay, tat ca cac bien quan sat phan tan thanh 6
nlian td, co 2 bien bi ioai (SGTi, NVC4), con
Iai 25 bien vdi he so tai tir 0.57 den 0.891, ldn
ban 0.5 va chi tai len 1 nhan to; cac he sd
KMO, Eigenvalue va tdng phuong sai trich
(TVE) deu dat yeu cau (Bang 1); nhu vay
thang do dat gla tri hpi tu va gia tri phan biet.
Gia tri cac thang do duac tinh lay trung binh
cac bien quan sat de dai dien cho khai niem can
nghien ciiu trong phan tich hdi qui tiep theo.
Bang 1. Ket qua phan tich nhan to
Nlmn 16

Bign
SLN
SLN3

846

SLN4

794

SLN2

SGT

WC

LTT

787

SLNl

73fi

SLN5

697

SGT4

781

SGT5

756

SGT3

653

SGT2

.570

NVC2

891

NVCI

776

NVC3

703

LTT3

879

LTT2

857

LTTI

824

LTT4

819

SHL

STT

KINH i f
ddng phin ldn den niem tin ciia b?nh nhan
(dilu nay dugc the hien rd hon qua ket qua md
hinh tilp theo).
,846
SHL2
Md hinh hdi qui giiia cdc yeu to hdnh vi
843
SHL4
cua Bde sivd su tin tudng cita benh nhdn:
,783
SHLl
Kit qua hdi qui cd he sd sig. = 0.000 va
,846
STT2
R^dicu chinh = 0-5 chimg td md hinh phu hgp va
829
STTl
giai thich dugc 50% phuang sai su tin tudng
.74!
STT3
ciia binh nhdn. Ckc gia thuyet Hi H4, H^ deu
662
STT4
dugc chip nhan (sig. <0.05), trong do muc dp
123
7 34
1.31
172

129
5 37
tac dpng cua yeu td nghiep vu chuyen mdn (P =
value
0.482) manh nhat, ke den la su gidi thich cua
917
KMO
857
bde SI (P = 0.208) va su lang nghe cua Bde si
68 92%
60,1%
TVE
( P - 0 . 1 9 6 ) (Bang 2).
Phep trich- Principle Axis Faclormg: Phep quay Promax
Ket qua nay cho thSy niem tin ciia benh
Kilm dinh md hinh va thao luan
Md hinh hdi qui giira cdc yiu to hdnh vi nhdn chu yeu dua vao yeu td nghiep vu chuyen
mon cua Bde sT, nghiep vu chuyen mdn cang
cua bde sTvd su hdi long cua binh nhdn:
Kit qua hdi qui cd tri so thdng ke sig. = cao thi benh nhan cang tin tudng. Tuy nhien,
0.000, R^difiu chinh " 0.55 cho thiy md hinh hdi qua dii lieu khao sat, muc dp danh gia nghiep
qui da xay dung phii hgp va giai thich dugc vu chuyen mdn chi dat muc trung binh (mean
55% phuang sai sir hdi long ciia benh nhdn. = 3.28) chiing td benh nhan chua thda man vl
Cac gia thuylt Hi, H3, H5 deu dugc chap nhan nang luc, trinh dp chuyen mdn cua Bac sT. Do
(sig. < 0.05). trong do yeu td su ldng nghe cua do, dieu quan trgng la tang cudng dao tao,
Bde sT (p = 0.370) va s{r gidi thich cua Bde sT huan luyen dpi ngu Bac sT ngay cang vung vang
(P = 0.384) tac ddng gin tuong duong nhau ve chuyen mdn, dap iing nhu cau dugc kham
den sir hdi long cua benh nhdn va manh hon chu'a benh vdi chat lugng cao, hieu qua, tao
yeu td nghiep vu chuyen mon cua Bde sT (p = dung dugc niem tin vihig chac cho benh nhan.
0.154) (Bang 2).

Ben canh dd, viec lang nghe, giai thieh ciia Bac
DiSu nay cd the dugc ly giai rang, su hai sT ciing gop phan giiip b§nh nhan cam thiy an
long se de cd dugc tbdng qua thai dp giao tiep tam, hieu ro va cd y thuc hem trong viec tuan
giiia Bac sT vdi benh nhan vi nhimg khia canh theo che dp dieu tri, dem lai kit qua dilu tri
quan trgng nhat cua su hai long la cam xiic cua hieu qua, lam gia tang niem tin.
benh nhan thuc su dugc cham sdc, quan tam tir
Qua ket qua hai md hinh hdi qui, ta thay
Bac sT khi Bac sT danh thdi gian giai thich, cd mpt su khac biet ro ret dd la d md hinh thu
lang nghe, chia se benh tinh, giup hp xda tan di nhat, su hdi long cua benh nhdn bi tac dpng
nhung io lirig, cang thing hay nhung dau ddn true tiep phan ldn bdi yeu td sir ldng nghe va
ve the xac. 0 day, benli nlian danh gia miic do gidi thich cua Bde sT; cdn d md hinh thii hai,
hai Idng vdi mirc kha (mean = 3.492), nhu vay SIT tin tuang eua benh nhdn lai bi tac ddng chu
cam nhan ciia benh nhan hien nay la kha hai yeu la do nghiep vu chuyen mdn cua Bac sT.
long, tuy nhien vin cdn tinh trang thudng Nhu vay, niem tin ciia bfnh nhSn co dugc xuat
xuyen qua tai, Bac sT khdng co dii thdi gian
phat tir nang lire, trinh dp chuyen mdn cua Bac
ling nghe, giai thich, trin an tinh thin hoac tra
sT nhieu hon la tir thai dd, cii chi giao tiep cua
ldi hit cac thac mic cua benh nhan, ddi khi
bac sT, va nguge lai.
cdn cd thai dp khd chiu vdi benh nhan. Mat
Md hinh hdi qui giira su tin tuang vd su
khac, ciing cdn cd mpt sd Bac si lam viec tic
hdi long cua benh nhdn:
trach, thilu nhiet tinh, td thai do ban an, tu lgi
Ket qua hoi qui cd sig. = 0.000 va R^dieu
ca nhan,^ tao du luan khdng tdt vl hlnh anh
ngudi thiy thudc trong benh vien. Vdi ylu to chmii = 0.34 cho thiy md hinh phii hgp va giai
nghiep vu chuyen mon thi thien vl khia canh thich dugc 34% phuang sai su tin tudng cda
ky thuat, chuyen mon nen it anh hudng din su benh nhdn. Tuy nhien, d day ta nhan thay, bien

hai long ciia benh nhan ma nd chu ylu tac thien su hdi long dugc giai thich gian tilp
thong qua ylu td trung gian su tin tudng ciia
LTT5

SHL3

.670

856


TAP CHI KHOA HOC TRLTONG DAI HOC MO TP.HCM -SO 3 (42) 2015
^^^

benh nhdn (34%) la thap ban so vdi biln thien
sir hdi long da dugc giai thich true tilp phin
^^'^ l^i cac ylu td hanh vi cua Bac sT (55%)
trong md hinh hdi qui diu tien. Trong md hinh
hdi quy nay cd he sd hoi qui chuin hda rit ldn
(p = 0.582) nen gia thuylt Hg duoc chip nhan
(sig. < 0.05) (Bang 2).
Ket qua cho thay, vdi muc tac ddng tren,
neu nhu xem khdng cd su tac dpng ciia cac
yeu td khac thi khi .SM- tin tuang cua benh nhdn
tac ddng len mdt dan vi lam cho su hdi long
tang len 0.582 lan. Dieu nky cho thiy khi nilm
tin ciia benh nhan tang len thi su hai long ddi
vdi Bac sT ciing dupc cai thien. Tuy nhien, dii
cd muc tac ddng cao nhung danh gia cua benh
nhan chi d miic trung bmh (mean = 3.38).

Trong bdi canh nen kinh te nudc ta dang cd
nhiing budc thay ddi tich cue, phat triln theo
CO che thi trudng, su canh tranh dang dien ra
hang ngay, hang gid, ap lire gianh liy thi phin
gitra cac benh vien vdi nhau thi viec co dugc
niem tin ttr benh nhan la dieu vd ciing quan
trgng, bdi qua dd khdng chi lam tang su hai
long ma cdn lam cho benh nhan trung thanh
ban (dieu nay dugc the hien ro ban trong ket
qua md hinh tiep theo).

AUsii,
lii^

Md hinh hdi qui giUa sic tin tudng, hdi
long vd long trung thdnh cua benh nhdn:
Tuang t u nhu kilm dinh cho cac mo
hinh hdi qui tren, ket qua hdi qui cd sig. 0.000, R \ | U chinh = 0.493, chung td ind hinh
phu hgp va giai thich dugc 49.3% bien thien
ldng trung thdnh cua binh nhdn. Cac he so tac
dpng diu duang va tucmg ddi cao, vdi yeu td
su tin tuang (p = 0.404), su hdi long (p =
0.388) nen cac gia thuylt H7, Hg diu dugc
chip n h | n (sig. < 0.05) (Bang 2).

'. ^aj
*.;(i
*
''ll

^-„
0^^
^^•^
i^ .

Kdt qua nay phii hgp vdi thuc te bdi long
trung thanh xuit phat tir su hai long va niem
tin cua benh nhSn. Khi dpi ngu Bac sT chua
thuc su dem iai hai long hoac chua tao dung
dugc nilm tin cho benh nhan thl long trung
thanh khdng t h l tilp tuc dugc duy tri, tham chi
benh nhan se chuyen sang kliam va dieu tri d
benh vien khac, bdi muc dich ciia viec kham
chiia bdnh la lam sao benh tinh cua benh nhan
dugc nhanh ohdng chiia khdi, sue khde sdm
hdi phuc. Theo miic dp danh gia cua benh
nhan cho hai yeu td su hdi long (mean =
3.492) va su tin tudng cua benh nhdn (mean =
3.380) vin chua cao, do do viec danh gia long

^jMifiia^B^'^'

39

trung thdnh ciia benh nhdn chi d miic trung
binli (mean = 3.303). Vdi miic dp trung thanh
nay, benh nhan de bj lung lay va kha nang
chuyln sang chpn benh vien khac la hoan toan
cd the.
N I U cac benli vien dang con nhieu khd

khan, thilu thdn ngudn nhan luc, ca sd vat
chit nhung vdi tinh than phuc vu tan tuy, an
cin, cd trach nhiem va trinh dp chuyen mdn
dugc nang cao cua dpi ngu y bac sy chac chan
se gay dung dugc niem tin va tao su hai ldng
cho benh nhan, tir do thu hiit, giu chan dugc
benh nhan.
Bang 2. K i t qua hoi qui
Hes6
chua chuan hoa
Biin
B

Da lech
chuan

Beta
chuan
hoa

t

Sig.

Mo hinh cac yeu to haiih vi ciia bac si va sir hai long cua benh
nhan
-] 83

068

(Hang s6)

-.433

236

SLN

422

.062

370

6.826

000

SGT

482

.066

.384

7.286

-000

NVC

,184

-056

,154

3,279

-001

Mo hinh cac yeu to hanh vi cua bac si \a su hn tuong cua
benh nhan
(Hang so)

-079

226

349

.728

SLN

.201

059

,196

3 404

001

SGT

236

063

208

3 737

000

NVC

518

.054

482

9.680

.000

Mo hinh giOa su tm tuong % a sir hai long ciia benh nhan
(Hang sS)

1 310

,202

STT

,645

058

582

6 502

000

11.19

000

Mo hiiih giila su tin luting, hai long va long trung thanh cua
benh nhan

(Hang sa)

.537

184

2,926

004

SHL

374

.054

-388

6,957

000

STT

432

-060

-404

7,242

000

Mdhinh PATH
PATH dugc diing de danli gia su- tac dong
cua toan bg mo hinh den biln phu thuoc long
trung thdnh cua benh nhdn thong qua he so phu
hgp tong hgp R^jm duo'c tinli theo cong thuc:
RVng= 1 - (1 - R ' I ) (1 - R'2) (1- R'3) (1- R'4).
KSt qua tinh dugc R^o„g= 0.6498, nhu vay mo
hitih nghien citu xay dimg phii hgp va tit ca cac
moi quan he trong mo liinh giai thich dugc
64.98% bien thien long inm<^ tfidnh cna lienli


KINH T£
nhdn. Cac md hinh biln thl PATH ciang dugc
xem xet, kit qua thu duac khang dinh md hinh
gdc ban diu giai thich tdt nhit cho long trung
thdnh ciia benh nhdn.
5. Ket luan
Tir kit qua nghien ciru, co thl ket luan
long trung thanh ciia benh nhan chiu anh
hudng bdi cac ylu td hanh vi cua bac sT thdng
qua niem tin va sir hai long cCia benh nhan. Ket
qua ciing do ludng dugc miic dp tac ddng ciia
cac mdi quan be nay, trorig do yeu td niem tin
cd tac ddng then chdt din su hai long ciing
nhu giir vai tcb quylt dinh den ldng trung
thanh cua benh nhSn, ma niem tin chu ylu
dugc hinh thanh tir nghiep vu chuyen mdn cua
Bac sT. Do dd, cac nha quan ly benh vien can
tap trung quan tam den yeu td nay bang each;

Cd mdt ke hoach huan luyen. dao tao thudng
xuyen, thilt thuc va hieu qua sat vdi yeu cau
thuc tien; xem xet cac hoat ddng nang cao gia
tri ddi sdng vat chat, tinh than ciia dpi ngii Bac
sT de hp cam thay xung dang vdi nhimg nd lire
va cdng sue da ddng gdp; md rdng su hgp tac,
trao ddi chuyen mdn vdi cac benh vien Idn
trong va ngoai nudc, giup nang cao kien tbuc,
kinh ngbiem cua cac Bac si, dem lai nhieu Igi
ich cho benh vien. Ngoai ra, ket qua nghien
cuu ciing cho thay cd hai yeu td quan trpng tac
dpng den su hai long ciia benh nhan dd la su
lang nghe va giai thich cua bac sT, day ciing la
ca sd de eac nha quan ly benh vien can quan

tam dl cai thien sir hai long lam gia tang ldng
trung thanh ciia benh nhan bang each: Nang
cao tinh thin trach nhiem, biet ling nghe, ehia
se. ddng cam vdi benh tinh cua benh nhan, lay
benh nhan lam trung tam trong kham chiia
benh; mat khac, de tranh bi tac ddng tu mat
trai cua nln kinh te thi trudng khien cho dao
due nghl nghiep bi anh hudng xiu, mpt bo
phan thiy thudc, Bac si vd cam trudc ndi dau
cua ngudi benh, lam trai y due gay buc xuc
cho xa hpi, do do cac nha quan Iy benh vien
can phai khdng ngimg giao due, nang eao y
due cho dpi ngu Bac sT, tham nhuan dao ly
"luang y nhu tir mau" va ludn lay y due lam
gdc de cd the trd thanh ngudi thay thudc "sang

ve y due, gidi ve chuyen mdn".
Tuy dat dugc mdt so ket qua nhat dinh,
nghien cuu van con vai han che anh hudng den
tinh khai quat ciia de tai. Thu nhat, tinh dai
dien eua mau ididng cao do phuang phap lay
mau thuan tien, pham vi va doi tugng khao sat
chi tap trung vao benh nhan kham chira benh
tai cac benh vien Lam Ddng, can md rdng
them ddi tugng khao sat d cac tinh khac cua
Viet Nam vdi phuang phap liy miu tdt hon.
Thu hai, sd lugng mau chua dii ldn de so sanh
giita cac benh vien va cac ylu td nhan khiu
hgc khac. Day ciing la hudng triln khai nghien
cijcu tiep theo vdi sd Iugng m i u thu thap du ldn
de cd dugc ket qua danh gia day du nhat.

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^^ji
t^*

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-*

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ftfii*

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