內外科專科護理師值班經驗之探討

目前台灣對於專科護理師執業範圍並不明確，但因應醫療環境的需求，專科護理師需接受值班的業務。然而，國內尚無針對專科護理師值班經驗探討之相關研究。本研究旨探討內外科專科護理師值班經驗。採質性研究法，以立意取樣中部某地區醫院，取得內科或外科專科護理師執照、以專科護理師職稱受聘於醫療院所機構、執行專科護理師工作內容，且值班年資大於一年的專科護理師。以一對一、半結構式訪談收集資料，採現象學研究法進行資料分析。共訪談10位個案，研究結果呈現三個主題及九個次主題：（一）萬般無奈、說不出的苦：面對政策的無所適從、人為因素及紛紛擾擾、文化因素之醫生是神；（二）風雨過後的彩虹：不堪負荷的身體、錯綜複雜的情緒、自我實現的滿足；（三）突破重圍、積極面對：心念一轉、正向思考；補充能量、繼續迎戰；支持鼓勵、有愛無礙。本研究結果顯示專科護理師於值班過程中常會面臨一些困境，於值班後的身體、精神狀態和靈性都受影響；面對不得不值班的情況，專科護理師透過轉念、正向思考、物質補償及家人和同儕的支持下，產生積極面對的態度。期盼本研究結果，可提供臨床實務或日後相關研究之參考。

關鍵字

專科護理師；值班；執業範圍；經驗

並列摘要

The current scope of practice among Taiwanese nurse practitioners is ambiguous. Most of them are required to work in on duty shifts to meet various health care needs. However, related domestic studies have not explored the on duty shift work experience of nurse practitioners. This study investigated the on duty shift work experience of specialist nurse practitioners working in internal medicine and surgical department. A qualitative research method was adopted, with purposive sampling to collect data regarding the scope of practice of specialist nurse practitioners who have worked at least 1 year in medical institutions. Semi structured, one-to-one interviews were executed to ten interviewees, and the phenomenological research method was used to conduct data analysis. The results revealed three main themes and nine subthemes: (1) a sense of helplessness, with unspeakable hardship: being at a loss to follow unclear policies, faced with various interpersonal predicaments, and forced to fulfill the cultural expectation that physician are omnipotent; (2) a rainbow after the storm: experiencing unbearable physiological burden, complex emotional feelings, yet a sense of satisfaction and self-fulfillment; (3) a breakthrough to confront difficulty: having a change of heart to develop positive thinking; revitalizing oneself to face challenges persistently; and providing support and encouragement, using love and concern to overcome obstacles. The findings indicate that specialist nurse practitioners often face various difficulties, and their physical, mental, and spiritual well-being are affected by working in on duty shifts. When shift work is mandatory, specialist nurse practitioners adopt different perspectives and positive thinking to face challenges at work, and demonstrate an active attitude through material compensation and peer and family support. The findings of this study can serve as a reference for future clinical practice and relevant research