Developing Practical Knowledge Content of Emergency Nursing Professionals

急診護理人員實務知識內涵

10.1097/JNR.0b013e31821aa0eb

朱雯(Wen Chu)；許麗齡(Li-Ling Hsu)

實務知識 ； 現象學 ； 急診護理 ； 急診護理人員 ； practical knowledge ； phenomenology ； emergency room nursing ； emergency room nurses

The Journal of Nursing Research

19卷2期（2011 / 06 / 01）

112 - 118

英文

背景　有關臨床／實務知識內涵的研究相當缺乏，然而，急診護理人員如何習得、發展以及維持急診照護品質以達實務知識水準的需求，亦值得探究。 目的　本研究目的乃經由檢視發生於臨床情境的學習歷程，以探討急診室護理人員的實務知識內涵。 方法　本研究採用現象學研究法與深度訪談法，訪談10位具急診3年以上年資的護理人員。以Moustakas之分析步驟進行文本資料分析。藉由可信度、遷移性、可靠性與驗證性檢驗本研究之嚴謹度。 結果　內容分析顯示，急診護理人員發展實務知識可歸納出4個主題，包括：(1)急診基本處置流程、常規及症狀處理；(2)疾病及藥物機轉、藥效學及治療反應；(3)最新急診處置與技能、藥物治療的討論及最近辨識的疾病；及(a)護理價值的認同，包括護理態度與持續護理。所有的參與者皆可從第一階段至第三階段中發展出實務知識，並結合和應用這些不同型式的知識於護理實務上。但只有少數參與者經驗過第四階段。 結論／實務應用　急診護理人員的臨床／實務知識學習歷程如下：(1)描述性知識：如急診基本處置常規實務應用與操作程序（知道什麼）；(2)程序性知識：包含由管理者、實務練習與訓練人員的教授；(3)情境性知識：在與病人互動的過程中，涉及觀察與處置的知識（知道何時與知道為何）。為了實施綜合評估、確認病人狀況與發展可促進照護品質的有效方法，對護理人員而言，於護理實務中聯結與應用多種型態的知識顯得相當重要。

Background: There is a paucity of published research on clinical or practical nursing knowledge. The ways that nurses acquire, develop, and maintain emergency room (ER) nursing care skills is a research area, in particular, that deserves further investigation. Purpose: This study examined clinical setting learning processes to better understand the practical knowledge content of ER nurses. Methods: This study used a phenomenological approach and in-depth interviews of 10 nurses. Each participant had at least 3 years of ER experience. Researchers used Moustakas' method to analyze interview data. Findings were checked for credibility, transferability, dependability, and confirmability. Results: The authors identified four major practical knowledge themes for ER professionals. These were (a) basic emergency treatment procedure routines and symptom management; (b) disease mechanisms, pharmacodynamics, and treatment responses; (c) newly identified diseases, updated emergency treatments and techniques, and medical treatment discussions; and (d) identifying nursing values including nursing attitudes and continuing patient care. Participants in this study had experience with the first three themes and successfully combined various types of nursing knowledge in their nursing care duties. Only few participants indicated experience with the fourth theme. Conclusions/Implications for Practice: Findings clarify that clinical or practical knowledge in ER nurses evolves first from declarative knowledge (e.g., basic emergency treatment routines and operating procedures) to procedural knowledge (e.g., instructions from supervisors, actual practice, and drills) to conditional knowledge (e.g., observation and treatment involving direct interactions with patients). Nurses should combine and apply the various knowledge types in their nursing practice to assess comprehensively each patient’s condition and administer effective treatment and service.

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