發展一個理論指導專科護理師完成培訓

我國醫療在健保總額的制度下醫療成本的提高，醫療人力因負荷過重流失，為降低成本提高照護品質，仿照國外醫療模式孕育出「專科護理師」已解除燃眉之急，然而訓練醫院的培訓課程品質參差不齊。目前研究尚缺發展一個理論指導專科護理師完成培訓。因此，本研究旨在發展一個理論指導專科護理師完成培訓。本研究採用質性研究的茁根理論，採理論性抽樣以南部某區域教學醫院已完成專科護理師培訓通過口試半年內的專科護理師為研究對象，共訪談17位個案直到資料飽和，資料收集的時間為2018年01月至2019年03月。資料分析使用開放編碼、主軸編碼、和選擇編碼和質性的NVivo 11電腦軟體輔助分析。本研究結果發展出一個理論指導專科護理師完成培訓。整個培訓過程的核心類別為『精進護理專業能力以展翅高飛』。其它重要類別和次類別連接著核心類別是：一、思考能力提升：批判性思考能力提升、鑑別診斷能力提升；二、臨床照護能力提升：臨床評估技巧的提升、整體溝通能力提升；三、積極學習：多元學習、反覆練習、自我淬煉。本研究結果能提供相關培訓專科護理師機構參考，以提供更適宜專科護理師培訓課程，進而協助培訓人員通過專科護理師甄審，培育出優秀的專科護理師。

關鍵字

專科護理師；培訓課程；茁根理論

並列摘要

In Taiwan, medical care expenses have been increasing under the current system of universal health-care, and excessive workload has resulted in loss of medical professionals. To reduce the cost and improve the quality of care, the position of “nurse practitioner” has been created to relieve the urgent medical burden, following foreign medical system models. However, the quality of training courses in training hospitals is varied, and at present there is still a lack of theory guidance for nurse practitioners in the training program. This study aimed to develop a study guide to aid nurse practitioners in completing the training program. Seventeen nurse practitioners in a regional teaching hospital in southern Taiwan who passed the oral test within the previous six months were selected as interview subjects. Data were collected from January 2018 and March 2019, and well analyzed using open, axial, and selective coding as well as qualitative assisted analysis in NVivo 11. Results were employed to develop a theory guide for nurse practitioners to accomplish training program. The core category of the training process is “Professional ability to improve nursing quality and excel”. Other important categories and sub-categories connected to the core categories were: 1. Improvement of thinking ability: improvement of critical thinking ability and differential diagnosis; 2. Improvement of clinical care ability: improvement of clinical assessment skills and overall communication skills; 3. Active learning: multi-method learning, repeated practice, self-refining. The results of this study provide reference material for nursing training institutes to provide more suitable training programs for nurse practitioners, and to assist the trainers in examining practitioners with the aim of cultivating excellent nursing professionals.