臨床護理人員執行實證實務影響因素之探討

A Study of Factors that Influence Nurse Implementation of Evidence-Based Practice

蔡玉梅(Yu-Mei Tsai) ； 郭倩琳(Chien-Lin Kuo) ； 鄭夙芬(Su-Fen Cheng)

《護理暨健康照護研究》 6卷2期 (2010/06) Pp. 79-88

https://doi.org/10.6225/JNHR.6.2.79

摘要

背景　實證實務的概念自1990年代逐漸由醫學擴展到護理領域，且被認為是促進護理人員發現及解決臨床問題的最佳工具。然而，實證實務在臨床照護的推展卻相當緩慢，影響因素有待探究，亦缺乏有關護理人員執行實證實務所需的知識與技能，以及過程中可能面臨阻礙的本土文獻。
目的　探討影響護理人員執行實證實務的因素，期能根據研究結果提出有效建議，以協助實證護理實務的落實。
方法　採描述性相關性研究設計，以立意取樣方式選取南部某教學醫院之376位護理人員為研究對象，研究工具為中文翻譯之「發展實證實務量表」。
結果　護理人員的實務知識主要來自臨床所學、工作與個案照護經驗，網際網路為其獲取實證資料的主要方式。由於護理人員對評論研究報告缺乏自信及缺乏時間搜尋，因而阻礙其搜尋和評論研究報告；缺乏充足的資源、權力及時間為其運用實證改變實務的阻礙。影響實證實務發展的因素為護理人員的期刊閱讀頻率、職稱、專業職級、工作單位、年資、年齡、進修與否及是否學過實證實務。
結論／實務應用　醫療機構於推動實證護理時，應對護理人員增能賦權，鼓勵其閱讀專業期刊、參加在職進修與精進臨床能力進階，同時要重視資淺人員的教育訓練，以及提供依據實證資訊編制的工作指引。

關鍵字

實證實務 ； 影響因素 ； 護理人員

並列摘要

Background: The concept of evidence-based practice (EBP) was extended from the medical to the nursing field during the 1990s. While EBP is widely considered the best tool for nurses to resolve clinical problems, its development has been slow in nursing clinical care. It is necessary to explore the factors that influence EBP development in the nursing field. Few studies have been conducted in Taiwan related to the knowledge/skills that nurses should have in order to apply evidence-based information effectively or to the obstacles that nurses may encounter during EBP implementation process.
Purpose: Purposes of this study were to investigate the factors that influence the development of EBP in nursing as well as provide guidance to nurses on how to better implement EBP in their professional practice.
Methods: This was a correlational study. Three hundred and seventy-six nursing staffs were purposively selected from a regional teaching hospital in southern Taiwan. The research tool used was a Chinese version of the ”Development of Evidence-Based Practice Scale”.
Results: Participant practical knowledge was obtained mainly from their working experience caring for patients. Participants relied heavily on the Internet to obtain empirical information. Results found that nurses lacked the self-confidence necessary to critique research articles and lacked adequate resources, authority and time to change their clinical practice through the application of evidence-based information. Factors influencing EBP development included journal reading frequency, job title, professional level, working unit, years of work experience, age, continuing education, and EBP awareness.
Conclusions/Implications for practice: The study suggests that medical institutions should empower staff nurses, encourage their reading professional journals, support their attendance of continuing education courses and upgrade their nursing career ladders. Also, institutions should enhance on-the-job training for new staff and provide evidenced-based care guidelines.

並列關鍵字

evidence-based practice ； influence factors ； nurses