提升準專科護理師身體評估完整性之專案

Project for Improving the Integrity of Physical Assessment on Would-Be Nursing Practitioners

10.29494/LN.202003_21(1).0010

林巧惠(Chiao-Hui Lin)；李宇茜(Yu-Chien Lee)；羅元妙(Yuan-Miao Luo)；王妙菁(Miao-Ching Wang)；賴美玉(Mei-Yu Lai)

身體評估 ； 準專科護理師 ； 醫療品質 ； physical assessment ； would-be nurse practitioner ； quality of medical care

領導護理

21卷1期（2020 / 03 / 01）

121 - 135

繁體中文

「身體評估」是醫療業務常規執行相當重要的技能，正確有效率的評估，可以提升醫療判斷及減少病人處於危機狀態。本專案藉由實際稽核準專科護理師身體評估，發現完整性僅43分。經現況分析確立問題為身體評估工具缺乏一致性、缺乏教育訓練、缺乏標準流程與稽核機制、臨床教師授課標準不一致。訂定改善措施，如：統一身體評估工具、舉辦在職教育、制訂規範與稽核制度、舉辦臨床教師共識會。經由專案實施後，準專科護理師身體評估完整性由43分提升至75分，達專案目的。專案實施後有效提升準專科護理師的評估能力，及早發現病人之問題，並提升整體醫療照護品質，建議未來學校將此技術納入教學評估必修課程，以增加學生對於評估流程的概念及完整性。

Physical assessment is the crucial skill for routine execution of medical practices. Accurate and efficient assessments improve medical judgment and also reduce the risk of patient in crisis. This project is based on the physical evaluation of quasi nurse practitioners, and the result showed integrity scores merely around 43 points. After analyzing the current situation, we found the causes include: the inconsistency of physical measuring tool; lack of educational and training; absence of SOP and auditing mechanisms; inconsistent teaching standards in lectures of preceptors. The established solutions were: unifying the physical measuring tool; organize on-job trainings education; develop SOP and auditing mechanisms; organize clinical teacher consensus meeting for preceptors. The integrity scores of physical assessments from those quasi nurse practitioners elevated from 43 points to 75 points after this project implementation, and the objective of this project was achieved. After the implementation of the project, it effectively improve the assessment ability of quasi nurse practitioners, detection of patient problems took place earlier, and enhanced the overall quality of medical care. Physical assessment process is highly recommended to be incorporated as a compulsory curriculum to improve students' understanding of concept and completeness of the assessment process.

1. 藍玉玲,劉彥君,高聖博(2011)。另一種心理師專業能力的評量模式：客觀結構式臨床測驗模式在心理學的應用。中華心理衛生學刊，24(2)，209-245。
   連結：
2. Allen, S. S.,Miller, J.,Ratner, E.,Santilli, J.(2011).The educational and financial impact of using patient educators to teach introductory physical exam skills.Medical Teacher,33(11),911-918.
3. Amanda, H.,Duncan, D. N.,Marion, L. M.,Carol, A. J.,Michelle, K.,Michele, G.,Sabina, K.(2013).An implementation framework for using OSCEs in nursing curricula.Nurse Education Today,33(12),1459-1461.
4. Barbara, B.,盧澤民（譯）(1998).身體檢查與病史詢問指引.台北市:藝軒.
5. Gloria, R. G.,Philip, W.,Natalie, B.,Tricia, M. B.(2013).Comparison of Patient Simulation Methods used in a physical assessment course.American Journal of Pharmaceutical Education,77(4),1-6.
6. Harden, R. M.,Gleeson, F. A.(1979).Assessment of clinical competence using an objective structured clinical examination (OSCE).Medical Education,13(1),41-54.
7. Katrina, F. H.,陳怡行（譯）(2014).OSCE 臨床技術手冊.新北市:合記.
8. Wolfgang, A. B.,Hannes, B.,Roger, V.,Klaus, L.,Antonius, S.(2013).Can near-peer medical students effectively teach a new curriculum in physical examination?.BioMed Central Medical Education,13(1),165.
9. Yoshikiyo, K.,Hiroaki, S.,Yoshito, S.,Ikuo, M,Masao, T.,Syunji, S.,Tetsuo, O.(2012).Standardizing the assessment of the clinical abilities of physical therapists and occupational therapists using OSCE.Journal of Physical Therapy Science,24(10),985-989.
10. 李書芬,郭梅珍(2014)。身體檢查與評估技術影音教學光碟與手冊之製作與應用。耕莘學報，12，5-14。
11. 連恒煇,黃其晟,吳錦桐,秦志輝,陳淑貞,徐尚楓,洪焜隆(2015)。利用系列OSCE及其相關活動促進教學醫院臨床技能教學品質。台灣擬真醫學教育期刊，2(1)，4-10。
12. 陳靜敏(2012)。社區專科護理師發展之國際趨勢與挑戰。護理雜誌，59(2)，11-16。
13. 黃靜宜,廖以誠,曹龍彥(2013)。實證醫學之客觀結構式臨床測驗評量信效度評估初探。彰化醫學，11(2)，103-111。
14. 楊政議,李麗紅,楊惠娟,陳淑齡(2016)。台灣護理專科學校OSCE之發展現況與困境。澄清醫護管理雜誌，12(1)，40-47。
15. 廖淑娟,陳仲達,葉建宏,葉炳強(2011)。以客觀結構式臨床考試來評量七年級醫學生的醫病溝通技能。台灣醫學，15(4)，356-363。
16. 鄧喬鳳,張光喜,吳碧珠,夏珊,張瑛瑛,劉雅絃(2014)。應用客觀結構式測驗課程提升護理臨床教師教學評量之一致性。榮總護理，31(3)，265-275。
17. 盧瑞華,王瑜欣(2014)。客觀結構式臨床測試於護理教育之應用。長庚護理，25(3)，274-282。
18. 韓惠君,許麗齡(2014)。專科護理師參與培訓課程之學習經驗。護理雜誌，61(1)，54-63。
19. 羅惠敏,章淑娟,陳文香(2015)。傳統式教學與客觀結構是臨床考試對學生於護病溝與關懷技能之差異。中州學報，29，109-127。