護理人員從事疾病管理照護工作之執業能力共識探討：德懷研究

近二十年來由於醫療費用逐年上升，為減緩其費用上漲之速度，管理式醫療照護 (managed care) 日益受到重視且蓬勃興盛於21 世紀健康照護系統。然而個案管理為管理式醫療照護中所發展出的新名詞之一，在個案管理照護中個案管理師 (case manager) 扮演監督、指導及資源使用控制之重要角色，且影響到管理之成功與否。因護理人員具有醫療及照護專業知識、技巧及熱誠，故被認為最適合擔任個案管理師之職務。本研究主要目的為探究專家群對護理人員從事疾病管理照護工作之執業能力的類項及其重要性的優先順序之共識。研究方法採用修正式德懷術 (modified Delphi technique) 進行探究。在專家的選擇上，共邀請27 位，其領域涵蓋包括：(1) 實務組 10 位，(2) 管理組 7 位，(3) 政策組5 位，以及 (4) 教育組5 位。研究結果顯示，專家所形成共識之執業能力類別與項目，共有三大類33 項，分別為：(1) 可近性 (access) 類8 項，(2) 品質 (quality) 類18 項，以及 (3) 成本 (cost) 7 項。而其重要性部分發現第一類「可近性」為最高，其次為第二類「品質」，而第三類「成本」為最低。期望透過本研究的結果，引發產、官、學各領域專家學者對該主題的關切，並能依據本研究所形成的執業能力共識，作為提供護理人員從事疾病管理照護工作時 (1) 執業能力評價之參考，(2) 培育、職前，以及在職教育課程規劃之參考，(3) 臨床實務甄選及執業內容標準化 (standardization) 之參考，(4) 未來相關規範及制度之參考。

關鍵字

個案管理師；疾病管理；個案管理；德懷術；執業能力

並列摘要

Background. Managed care has evolved over the past 10 to 20 years because of health care costs have risen dramatically. Hence, In the health care delivery system of 21st century emphasis on managed care. Managed care as the basis for case management. Case management is a system of patient care delivery that focuses on improving quality of care, utilizing resources and controlling health costs. The role of the case mangers has placed a key position to successfully implement case management. Nurses make excellent case managers in a disease management program by virtue of their rich clinical skills, knowledge and their interaction with patients and other health care providers. Case management as a new nursing practice in Taiwan, and might lack of preparation and standardization for practicing competencies. To expect this study might develop of practicing competencies of nurse case mangers in a disease management program. Objectives. To explore and identify the priorities of practicing competencies for nurse case mangers in a disease management program. Methods. A modified Delphi technique was used to elicit the priorities of practicing competencies. 27 Delphi experts were selected IV into to 4 representative groups. The participants’ list can be involved practitioners (17), officials (5) and scholars (5). Participants were asked to identify 3 categories of practicing competencies that considered a high priority for case mangers in a disease management program. Results. Both first and second round response rates of 100％were received. A two-round Delphi survey obtained opinions on practicing competencies of nurse case mangers in a disease management program, which comprised 3 categories and 33 items. They were 8 items of the access, 18 items of the quality and 7 items of the cost. The highest ranked priority was category of access, next was category of quality, the last was category of cost. Conclusion. This Delphi study has identified key areas of consensus on practicing competencies of nurse case mangers in a disease management program, which might provide a reference for establishing practice of nurse case mangers. These priorities have helped to provide both direction and focus the development of practicing competencies of nurse case mangers in a disease management program to meet future demands. However the world of health care delivery system is changing, case managers as a new scope of nursing practice might be provided V many opportunity for nurses. It is recommended that future research question should be more address around the issues of case manager in nursing practice scope.