建構並驗證臺灣護理碩士生領導力整合教育及其成效

Developing and Evaluating the Effectiveness of a Leadership Integrated Educational Program for Master's Nursing Students in Taiwan

10.6224/JN.202210_69(5).08

張友駿(Yu-Chun CHANG)；謝立韋(Li-Wei HSIEH)；陳姿君(Tzu-Chun CHEN)；顏妙芬(Miaofen YEN)

領導能力 ； 教育 ； 碩士 ； 進階護理師 ； leadership competency ； education program ； master ； advanced practice nurse

護理雜誌

69卷5期（2022 / 10 / 01）

56 - 67

繁體中文

背景：護理碩士生為醫療團隊之未來領導者，完整的護理碩士生領導力整合教育可強化進階護理師的領導能力、建構正向護理執業環境。目的：建構並初步驗證護理碩士生領導力整合教育，以培養護理碩士生之領導能力。方法：第一階段採修正式德菲法確立領導力整合教育之教學目標及策略，共14位護理產學界專家參與。第二階段將共識之教學目標及策略融入某國立大學護理碩士班之9堂必修課程，每堂課程皆有對應之領導能力核心要素，且各課程之目標能呼應領導力整合教育之教學目標。課程導入一學年，採類實驗研究設計、單組前後測方式驗證成效，以自擬共十題、四大核心要素之「護理碩士班學生領導能力量表」由學生自評領導能力，以成對樣本t檢定分析介入前後領導能力分數之差異。結果：德菲法於第一回合達到共識，此領導力整合教育總目標為：「運用自我領導特質與能力帶領所屬照護團隊，展現進階護理實務能力，提升護理照護品質。」並對於領導能力項下四大核心要素（個人特質、人員帶領、事務管理及願景構築）分別提出教學目標。共48位碩士生參與領導力整合教育，其結果顯示自評領導能力總分平均為42.33 ± 12.16（潛在分數範圍：10至70分），代表碩士生於接受領導力整合教育前自評僅具備中等程度之領導能力。經過一學年的領導力整合教育介入後，自評領導能力總分平均為51.27 ± 9.74，代表碩士生自評其領導能力仍為中等程度，但後測較前測有顯著提升8.94分（p ＜ .01）。四大核心要素之個人特質、人員帶領、事務管理及願景構築分別由13.52、12.65、8.15及8.02分上升至15.71、15.35、10.31及9.90分，達統計上顯著差異（p ＜ .01）。結論／實務應用：本研究推動碩士級護理領導教育改革，由產學界護理專家共識之領導力整合教育，可增加學生領導能力；研究結果可供國內碩士班發展領導力整合教育之參考。

Background: Nursing students with master degrees have the strong potential to serve as future leaders in medical teams. Implementing a well-developed and integrated educational program for nursing leadership at the master's level can strengthen the leadership of advanced practice nurses and promote a positive nursing practice environment. Purpose: To develop a leadership integrated educational program for master's nursing students and conduct a preliminary evaluation of the effectiveness of this program in cultivating leadership competencies in these students. Methods: Phase 1: A modified Delphi survey conducted on 14 experts with clinical or academic backgrounds was used to identify the teaching objectives and strategies of the leadership integrated educational program. Phase 2: These teaching objectives and strategies were embedded into nine compulsory courses within a current training program for master's nursing students at a national university. The core elements of the leadership integrated educational program were incorporated into each compulsory course. The objectives of each compulsory course directly reflected the objectives of the integrated program. The leadership integrated educational program was implemented for one academic year, and its effectiveness was evaluated using a quasi-experimental test with a single group pre- and post-test design. A self-developed, 10-item ＂Master Nursing Student's Leadership Competence Scale＂ covering four core elements was applied to measure the self-reported leadership competencies of the participants. A paired sample t-test was applied to analyze the differences in leadership competencies between pre- and post-intervention. Results: A consensus on the teaching objectives and strategies of the leadership integrated educational program was achieved in the first round of the Delphi survey. The overarching teaching objective of the leadership integrated educational program was to ＂lead the healthcare team with the leadership and competencies, and demonstrate the advanced nursing practice skills for improving quality of care.＂ In addition, the four core elements under the overarching goal, i.e., personal characteristics, leading people, business management, and vision building, were proposed. Forty-eight master's nursing students participated in this study. The results showed the average total score of leadership competency was 42.33 ± 12.16 (potential range: 10 - 70), indicating that the participants had a middle level of leadership competency prior to program participation. After participating in the Leadership Integrated Educational Program for one academic year, the average total score for leadership competency increased to 51.27 ± 9.74, indicating that the participants still had a middle level of leadership competency. Nevertheless, the 8.94 increase in the post-intervention score was statistically significant (p ＜ .01). Moreover, the scores for each subscale (personal characteristics, leading people, business management, and vision building) had all increased significantly increased from 13.52 to 15.71, 12.65 to 15.35, 8.15 to 10.31, and 8.02 to 9.90, respectively (p ＜ .01). Conclusions/Implications for Practice: This study offers proactive recommendations for reforming master's degree programs in nursing. The proposed multidisciplinary-expert-informed leadership integrated educational program may be used to strengthen leadership competencies in this student population. Furthermore, the findings provide a benchmark for developing an effective nursing leadership integrated educational program that may be incorporated into domestic master's degree programs.

1. 黃璉華, L.-H.,陳紀雯, C.-W.,柯乃熒, N.-Y.,張淑紅, S.-H.,王秀紅, H.-H.(2022)。護理領導人才培育成效之分析－混合研究法。護理雜誌，69(2)，55-66。
   連結：
2. 黃璉華, L.-H.,陳紀雯, C.-W.,柯乃熒, N.-Y.,張淑紅, S.-H.,王秀紅, H.-H.(2022)。護理領導人才培育成效之分析－混合研究法。護理雜誌，69(2)，55-66。
   連結：
3. Agnew, Ç.,Flin, R.,Reid, J.(2012).Nurse leadership and patient safety.BMJ,345,Article e4589.
4. American Association of Colleges of Nursing(2021).The essentials: Core competencies for professional nursing education.
5. American Nurses Association. (2014, November 12). Professional role competency: ANA position statement. https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/professional-role-competence/
6. Chang, Y.-C.,Chang, H.-Y.,Feng, J.-Y.(2022).Appraisal and evaluation of the instruments measuring the nursing work environment: A systematic review.Journal of Nursing Management,30(3),670-683.
7. Cummings, G. G.,Lee, S.,Tate, K.,Penconek, T.,Micaroni, S. P. M.,Paananen, T.,Chatterjee, G. E.(2021).The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership.International Journal of Nursing Studies,115,Article 103842.
8. Daly, J.,Jackson, D.,Anders, R.,Davidson, P. M.(2020).Who speaks for nursing? COVID-19 highlighting gaps in leadership.Journal of Clinical Nursing,29(15-16),2751-2752.
9. Fennimore, L.,Wolf, G.(2011).Nurse manager leadership development: Leveraging the evidence and system-level support.The Journal of Nursing Administration,41(5),204-210.
10. Hsieh, L.-W.,Chang, Y.-C.,Yen, M.(2022).Improving leadership competence among undergraduate nursing students: Innovative objectives development, implementation, and evaluation.Nursing Education Perspectives,43(1),24-29.
11. Hughes, R. G.(Ed.)(2008).Patient safety and quality: An evidence-based handbook for nurses.Agency for Healthcare Research and Quality (US).
12. International Council of Nurses. (n.d.-b). ICN nurse practitioner/advanced practice network: Aims and objectives. Retrieved June 5, 2022, from https://international.aanp.org/About/Aims
13. International Council of Nurses. (n.d.-a). ICN mission, vision, constitution and strategic plan. Retrieved December 22, 2021, from https://www.icn.ch/who-we-are/icn-mission-vision-constitution-and-strategic-plan
14. Keeney, S.,McKenna, H.,Hasson, F.(2011).The Delphi technique in nursing and health research.John Wiley & Sons.
15. Kim, H.-O.,Lee, I.,Lee, B.-S.(2022).Nursing leaders’ perceptions of the state of nursing leadership and the need for nursing leadership education reform: A qualitative content analysis from South Korea.Journal of Nursing Management
16. McNamara, M. S.,Fealy, G. M.,Casey, M.,O’Connor, T.,Patton, D.,Doyle, L.,Quinlan, C.(2014).Mentoring, coaching and action learning: Interventions in a national clinical leadership development programme.Journal of Clinical Nursing,23(17-18),2533-2541.
17. Miles, J. M.,Scott, E. S.(2019).A new leadership development model for nursing education.Journal of Professional Nursing,35(1),5-11.
18. Murphy, L. S.,Scott, E. S.,Pawlak, R.(2013).Crossing our quality chasm: Heeding the case for graduate preparation of nurse managers and leaders.The Journal of Nursing Administration,43(9),431-433.
19. Murphy, L. S.,Warshawsky, N. E.,Mills, M. E.(2014).An assessment of the alignment between graduate nursing leadership education and established standards.The Journal of Nursing Administration,44(10),502-506.
20. Scott, E. S.,Miles, J.(2013).Advancing leadership capacity in nursing.Nursing Administration Quarterly,37(1),77-82.
21. Serembus, J. F.,Solecki, S.,Meloy, F.,Olszewski, J.(2011).Preparing tomorrow’s leaders: A leadership course for real-world challenges.Nurse Education,36(3),91-92.
22. Shekleton, M. E.,Preston, J. C.,Good, L. E.(2010).Growing leaders in a professional membership organization.Journal of Nursing Management,18(6),662-668.
23. Varndell, W.,Fry, M.,Lutze, M.,Elliott, D.(2020).Use of the Delphi method to generate guidance in emergency nursing practice: A systematic review.International Emergency Nursing,56,Article 100867.
24. World Health Organization(2020).State of the world’s nursing 2020: Investing in education, jobs and leadership.
25. Yoder-Wise, P. S.,Scott, E. S.,Sullivan, D. T.(2013).Expanding leadership capacity: Educational levels for nurse leaders.The Journal of Nursing Administration,43(6),326-328.
26. 台灣護理學會（2021，7月5日）．台灣護理學會進階護理師認證發展規劃。https://www.twna.org.tw/WebPad/WebPad.aspx?1x8jyHnXeNRZ7af5neRU%2BA%3D%3D [Taiwan Nurses Association. (2021, July 5). Taiwan Nurses Association’s development plan for advanced practice nurse certification. https://www.twna.org.tw/WebPad/WebPad.aspx?1x8jyHnXeNRZ7af5neRU%2BA%3D%3D]
27. 張媚, M.,余玉眉, Y.-M.(2010).護理人力及專科護理師制度：願景與挑戰.國家衛生研究院=Taiwan National Health Research Institute.
28. 教育部（無日期）．110學年度大專校院一覽表。2022年6月4日取自https://ulist.moe.gov.tw/Query/AjaxQuery/Discipline/0913#\ [Ministry of Education, Taiwan, ROC. (n.d.). An overview of universities and colleges: 2022. Retrieved June 4, 2022, from https://ulist.moe.gov.tw/Query/AjaxQuery/Discipline/0913#\]
29. 陳淑齡（2015，10月5日）．技職與高等教育機構在護理碩士班規劃之差異．臺灣護理教育學會。http://www.tane.org.tw/news1.aspx?entry=245 [Chen, S.-L. (2015, October 5). Differences in vocational college and university-level master’s nursing education programs. Taiwan Association of Nursing Education. http://www.tane.org.tw/news1.aspx?entry=245]