運用模糊德菲法於專科護理師工作內容之研究

專科護理師角色起源於1950後期，美國因二次世界大戰，折損許多基層醫師，因此運用有經驗的資深護理人員去協助執行原本一線醫師的臨床業務，開始專科護理師角色的出現。台灣因為社會人口變遷，人口結構改變，1995年全民健保開辦，增加民眾就醫的可近性，各層級醫療院所廣設，醫療人力需求增加，住院醫師人力不足，專科護理師因而誕生。本研究藉由文獻收集，編訂成專科護理師工作內容適合度問卷，以任職中部某公立醫院中之醫療從業人員，共20位為對象，探討其對於專科護理師工作內容之需求。問卷收集後，透過模糊德菲法進行適合度分析。再輔以焦點團體法，採半開放式問卷，歸納訪談結果，與結果進行再確認。研究結果顯示：（1）專科護理師工作內容應以醫療輔助層面為合適。（2）專科護理師自我工作認同度低，因憂心於法律保障不足與工作部門歸屬混淆。（3）醫療從業人員對於專科護理師臨床需求與現行規範有落差。未來，應將專科護理師定位以協助臨床醫療輔助業務為主要，歸屬於醫療部門，才能在工作中發揮所長，確實彌補醫師缺乏的困境。制定專屬於醫療輔助相關人員的法規，使其合法化，才能確實彌補醫療人力的缺口。以臨床實務需求為依歸，建構適合台灣醫療環境所需人員之養成教育，以培育適切、且具教育訓練的專業人員，才能符合臨床實務上的需求。

關鍵字

專科護理師；工作內容；模糊德菲法

並列摘要

The role of Nurse practitioner originated in late 1950’s. The United States lost a lot of primary physicians during the World War II. Thus, the hospitals used experienced nurses to replace the job of primary physicians. In Taiwan, nurse practitioners appeared because of social demographic structure changes. Moreover, National Health Insurance started in 1995, all levels of hospitals set up and increased the demand of medical staffs. In this study, we complied fitness degree questionnaires of nurse practitioners’ job content by literature collected and selected 20 medical staffs from public hospital in the central Taiwan to discuss the demand of nurse practitioners’ job content. Then, we used Delphi Method to analysis and combined with focus group interview to reconfirm. The result of this study showed: (1) nurse practitioner’s work in medical assistance is suitable; (2) nurse practitioners’ working recognition are low because of worry about less legal protection and confused about working department attribution; (3) There is a gap between the clinical demand of nurse practitioners’ job content in medical staffs and the present provisions. For future, nurse practitioner’s main work should be medical assistance and be attribute to medical department, so that they could do their best in working to cover the shortage of primary physicians. Constructing the suitable medical education; training the educated and professional staffs that be in line with the need of clinical practice.