專科護理師(簡稱專師)是台灣護理界唯一具有國家證照之進階護理師,與醫師共同提供病人醫療及護理照護。從護理師轉換為專師的過程中,需積極跨越醫護間角色及觀點上的差異,臨床推理是專師最具關鍵性的專業照護能力,但邏輯性的推論思考能力並非與生俱來,除了須透過教育訓練重新建構思考模式外,亦須不斷地累積臨床經驗方能與團隊成員建立彼此平行的合作關係。本文描述專師在歷經角色轉換過程中所面臨的問題,說明臨床推理知能訓練對專師展現照護能力的重要性,進而以臨床實習前、實習中及具備證照後繼續教育三階段分別提出推理教學策略的應用建議。文末陳述如何應用事後回饋技巧促發學習者的自我反思,期待專師經由推理訓練內化臨床專業實力,進而提升病人照護品質以奠定專師的角色地位。
A nurse practitioner (NP) is an advanced nurse in Taiwan who has a national license and work with physicians to provide patient care. A NP needs to cross the differences in roles and perspectives between healthcare providers in the role conversion process. Clinical reasoning is the most critical professional care ability of a NP. However, the logic inferential thinking ability is not innate. In addition to reconstructing thinking mode through education and training, a NP needs to accumulate clinical experience continuously in order to establish parallel partnerships with inter-professional members. This article introduces the problems faced by the NP in the process of role transition, the importance of clinical reasoning training, and illustrates the application of reasoning teaching strategies according to three learning stages. Finally, the article discusses how to apply the skill of debriefing to promote learners' self-reflection. Hopefully, the NP is able to internalize the clinical professional strength through reasoning training to improve the quality of patient care and establish the professional status.