某精神專科醫院護理師身體評估能力之改善專案

A Project of Improving Physical Assessment Competency of Nurses in the Psychiatric Hospital in Taiwan

10.6847/TJPMHN.201812_13(2).05

林惠玉(Hui-Yu Lin)；李依玲(I-Ling Li)；陳瑾樺(Chin-Hua Chen)；李世凱(Shih-Kai Lee)

身體評估 ； 能力 ； 精神科護理師 ； physical assessment ； competency ； psychiatric nurse

精神衛生護理雜誌

13卷2期（2018 / 12 / 01）

39 - 49

繁體中文

背景：精神專科醫院病人慢性疾病盛行率高，護理訓練以精神科專業為主，缺乏內外科照護訓練，臨床照護顯現缺乏專業自信與相關知能。目的：藉由專案介入提升身體評估能力自信度、技能與認知正確率。方法：1.製作精神科護理師身體評估臨床指引；2.提供身體評估學習光碟；3.舉辦身體評估模擬訓練教學；4.擬訂身體評估臨床情境模擬演練。結果：專案實施後身體評估能力自信度由68.5%提升至86.6%，技能與認知正確率由59.7%與67.0%提升至82.8%與89.2%。結論：專案實施後，身體評估自信度、技能與認知均有明顯上升。建議應將訓練課程納入護理進階教育，藉由護理主管推動，增加臨床護理人員學習的動機並提升身體評估與照護能力。

Background: The prevalence of chronic physical diseases has been higher than that of general population in psychiatric hospitals. The nurses' training received from physical assessment of physical condition is relatively insufficient, if compared with their psychiatric expertise. As a result, the clinical care lacks of professional confidence and related knowledge. Purpose: To enhance the nurse's self-confidence, accuracy of skills and cognition through performing physical assessment is the aim of this study. Methods: 1.Establishing a formal Physical Assessment guidelines for psychiatric nurses. 2. Providing nurses with physical assessment learning videos. 3. Holding the aforementioned-training courses of physical assessment for nurses. 4. Establishing clinical situation of physical assessment for practice. Results: The degree of self-confidence for physical assessment ability of nurses was increased from 68.5% to 86.6%; the accuracy of skills was increased from 59.7% to 67.0%; and the accuracy of cognition was increased from 82.8% to 89.2% after performing this project. Conclusion: The project has enhanced self-confidence, the accuracy of skills and cognition. We thus suggest the education program should involve in the advanced nursing education. The program can be promoted by the nursing supervisors to increase the motivation of learning for clinical nurses, and to improve the physical assessment and care ability of nurses.

1. 陳祖裕,李發耀,陳震寰(2009)。有效的教學技能工作坊模式。醫學教育，13(2)，133-139。
   連結：
2. Bardi. J.,Moorley, C. R.(2016).Improving the physical health assessment of people with serious mental illness.Primary Health Care,26(10),28-33.
3. Gulley, S. P.,Rasch, E. K.,Chan, L.(2011).The complex web of health: Relationships among chronic conditions, disability, and health services.Public Health Reports,126(4),495-507.
4. Happell, B.,Platania-Phung, C.,Gray, R.,Hardy, S.,Lambert, T.,Mcallister, M.,Davies, C.(2011).A role for mental health nursing in the physical health care of consumers with severe mental illness.Journal of Psychiatric and Mental Health Nursing,18(8),706-711.
5. Happell, B.,Platania-Phung, C.,Scott, D.(2014).A systematic review of nurse physical healthcare for consumers utilizing mental health services.Journal of Psychiatric and Mental Health Nursing,21(1),11-22.
6. Happell, B.,Scott, D.,Nankivell, J.,Platania-Phung, C.(2013).Nurses’ views on training needs to increase provision of primary care for consumers with serious mental illness.Perspectives in Psychiatric Care,49(3),210-217.
7. Murray, R. M.,Fearon, P.(1999).The developmental’ risk factor’ model of schizophrenia.Journal of Psychiatric Research,33,497-499.
8. Stein-Parbury, J.,Liaschenko, J.(2007).Understanding collaboration between nurses and physicians as knowledge at work.American Journal of Critical Care,16(5),470-477.
9. Terry, J.,Cutter, J.(2013).Does education improve mental health practitioners’ confidence in meeting the physical health needs of mental health service users? A mixed methods pilot study.Issues in Mental Health Nursing,34(4),249-255.
10. 李選,蔡文佩,陳綱華(2004)。臨床精神科護理人員自我潛能、專業承諾與工作滿意度之關係。中山醫學雜誌，15(1)，41-52。
11. 周成蕙,黃慧芬,劉桂芬(2014)。熟能生巧—情境模擬在護理教育的應用。榮總護理，31(3)，226-233。
12. 邱梨淑,李仙惠,張慧貞(2014)。以多媒體教學介入透析病人血管通路穿刺異常之改善專案。臺灣腎臟護理學會雜誌，13(1)，16-29。
13. 邱艷芳(2011).身體評估：護理上之應用.台北:華杏.
14. 張文蕙,謝素英,許麗齡(2014)。運用客觀結構式臨床測驗以評量出院準備護理人員溝通能力之研究。護理雜誌，61(3)，45-57。
15. 莊孟蓉,洪麗娟,何建良(2014)。應用模擬訓練教學設計提升新進護理師水療換藥技能之初探。寶建醫護與管理雜誌，12(1)，25-34。
16. 陳玉枝(2010)。護理人員應具備的專業核心能力。護理雜誌，57(5)，12-17。
17. 陳杰峰,邱文達(2008)。評估及選擇臨床指引。醫療爭議審議報導雙月刊，35，1-8。

1. 郭嘉竹,許瑋玲,侯怡吟,林佳蓉,吳貞蓉(2020).運用情境模擬教學提升加護病房護理人員身體評估之能力.嘉基護理,20(2),17-29.
2. (2023)。運用ADDIE教學模式提升精神科護理人員儀器操作正確率。精神衛生護理雜誌，18(2)，35-42。
3. (2024)。提升精神科急性病房護理團隊急救作業正確率。志為護理-慈濟護理雜誌，23(3)，102-114。