運用德菲法建構腦中風急性後期照顧護理人員應具備之核心能力

A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients

10.6224/JN.62.6.35

紀淑靜(Shu-Ching Chi)；葉莉莉(Lily Yeh)；盧美秀(Meei-Shiow Lu)；林珮宇(Pei-Yu Lin)

急性後期照護 ； 護理人員 ； 核心能力 ； 修正式德菲法 ； post-acute care ； nurses ； core competences ； modified Delphi method

護理雜誌

62卷6期（2015 / 12 / 01）

35 - 47

繁體中文

背景：國內醫療照護逐漸重視腦中風病人的急性後期照護（post-acute care, PAC），為政府建置連續性照護的必然趨勢。目的：本研究目的為運用德菲研究法確認提供腦中風PAC服務的護理人員需具備核心能力，做為教育訓練的依據，以提升照護品質。方法：採「修正式德菲法」邀請18位專家，針對「急性後期照護護理人員應具備之核心能力」議題，使用自擬核心能力調查表，進行專家匿名調查。核心能力計29項，分屬「個案照護」（包含照顧、溝通、教學、諮商、家庭評估照護等能力）與「照護管理」（包含跨專業團隊合作、管理、與資源整合等能力）二面向。請專家就各項重要性與可行性以7分等級評分。結果：PAC核心能力的重要性：經由二回合專家共識確認所列項目皆為重要；在可行性方面，進行三回合調查達成共識，唯家庭照護評估、照護管理等能力部分項目呈現護理、醫療、衛政等不同背景的專家之間有評價落差。結論／實務應用：比對現有PAC教育訓練內涵顯示不足以培訓人員必要具備的核心能力，尤以照護管理層面較為缺乏。結果有助未來發展PAC服務護理人員職前與在職教育課程規劃參考。

Background: Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. Purpose: In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. Methods: We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. Results: The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. Conclusions/Implications for practice: The PAC in-job training program in its current form inadequately cultivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.

1. 吳冠穎, K. Y.,吳肖琪, S. C.,洪燕妮, Y. N.,吳君誠, C. C.,林麗嬋, L. C.,胡漢華, H. H.(2012)。台灣腦中風病人急性後期照護需要之探討。台灣公共衛生雜誌，31(3)，251-262。
   連結：
2. Aday, L. A.,Bgley, C. E.,Lairson, D. R.,Balkrishnan, R.(2004).Evaluating the healthcare system.Washington, DC:Health Administration Press.
3. Gordon, M.(2007).Manual of nursing diagnosis.Sudbury, MA:Jones and Bartlett.
4. Hewner, S.,Seo, J. Y.,Gothard, S. E.,Johnson, B. J.(2014).Aligning population-based care management with chronic disease complexity.Nursing Outlook,62(4),250-258.
5. Lee, W. J.,Chou, M. Y.,Peng, L. N.,Liang, C. K.,Liu, L. K.,Liu, C. L.,VAIC Study Group(2014).Predicting clinical instability of older patients in post-acute care units: A nationwide cohort study.Geriatrics & Gerontology International,14(2),267-272.
6. Linstone, H. A., & Turoff, M. (2002). The Delphi method: Techniques and applications. Retrieved from http://is.njit.edu/pubs/delphibook/
7. Lock, L. R.(2011).Selecting examinable nursing core competencies: A Delphi project.International Nursing Review,58(3),347-353.
8. Nancarrow, S.(2007).The impact of intermediate care services on job satisfaction, skills and career development opportunities.Journal of Clinical Nursing,16(7),1222-1229.
9. Rout, A.,Ashby, S.,Maslin-Prothero, S.,Masterson, A.,Priest, H.,Beach, M.,Sturdy, D.(2011).A literature review of interprofessional working and intermediate care in the UK.Journal of Clinical Nursing,20(5-6),775-783.
10. Tzeng, H. M.,Ketefian, S.(2003).Demand for nursing competencies: An exploratory study in Taiwan’s hospital system.Journal of Clinical Nursing,12(4),509-518.
11. Wiles, R.,Postle, K.,Steiner, A.,Walsh, B.(2003).Nurse-led intermediate care: Patients’ perceptions.International Journal of Nursing Studies,40(1),61-71.
12. 中央健康保險署（2014，1月）．全民健康保險提升急性後期照護品質試辦計畫．取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=712&webdata_id=4477&WD_ID=1069 [National Health Insurance Administration, Taiwan, ROC. (2014, January). Plan to improve the quality of post-acute care under the National Health Insurance system in Taiwan. Retrieved from http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=712&webdata_id=4477&WD_ID=1069]
13. 吳肖琪, S. C.(2008)。急性醫療與慢性照護的橋樑－亞急性與急性後期照護。護理雜誌，55(4)，5-10。
14. 宋文娟, W. C.(2001)。一種質量並重的研究法—德菲法在醫務管理學研究領域之應用。醫務管理期刊，2(2)，11-20。
15. 李孟智, M. C.,廖妙淯, N. Y.(2012)。台灣中期照護的展望。醫學與健康期刊，1(1)，1-7。
16. 李欣慈, H. T.,曾建寧, C. N.,胡文郁, W. Y.(2011)。台灣護理之家提供急性醫療後期照護的挑戰。長期照護雜誌，15(3)，249-258。
17. 李威儒, W. J.,劉謹儀, C. Y.,程遠揚, Y. Y.,劉力幗, L. K.,陳亮恭, L. K.,鄭紹宇, S. Y.(2010)。以周全性老年評估為核心的本土化中期照護社區醫院模式成效。台灣老年醫學暨老年學雜誌，5(4)，248-256。
18. 杜敏世, M. S.(2010)。中期照護創新服務計畫成果初探。長期照護雜誌，14(1)，11-18。
19. 林麗君, L. J.,陳惠紋, H. W.,余麗華, L. H.,周美雲, M. Y.,黃玉珍, Y. C.(2013)。中期照護效益及其相關因素之研究。醫院，46(5)，32-40。
20. 邱淑芬, S. F.,蔡欣玲, S. L.(1996)。德爾菲預測術—一種專家預測的護理研究方法。護理研究，4(1)，92-98。
21. 柯慧青, H. C.,劉彩娥, T. E.,江蕙娟, H. C.,林豐裕, F. Y.,胡月娟, Y. J.(2014)。中期照護模式建置與成效評值。源遠護理，8(3)，40-48。
22. 紀淑靜, S. C.,李志明, C. M.,郭弘昌, H. C.,顏政佑, C. Y.(2012)。,高雄市=Kaohsiung City, Taiwan, ROC:義大醫療財團法人義大醫院護理部=E-Da Hospital, Department of Nursing。
23. 張維容, W. J.,鍾信成, H. C.(2009)。以德菲法建立醫院內部評估社區健康服務成效之指標。澄清醫護管理雜誌，5(1)，45-54。
24. 陳玉枝, Y. C.(2010)。護理人員應具備的專業核心能力。護理雜誌，57(5)，12-17。
25. 陳惠姿, H. T.,李光廷, K. T.(2012)。長期照護專業人員核心能力與培育。護理雜誌，59(6)，12-18。
26. 臺北榮民總醫院=Taipei Veterans General Hospital(2012).中期一生照護您.台北市=Taipei City, Taiwan, ROC:作者=Author.
27. 謝美慧, M. H.,王秀紅, H. H.(2011)。中期照護的護理角色與未來發展－護理新契機。護理雜誌，58(3)，74-79。

1. 戴千淑,鄭朝惠,劉子菁,黃千恩,梁穎,林少瑜(2020)。提升腦中風病人急性後期照護下轉率。榮總護理，37(4)，360-368。