界定醫學中心內外科病房之重症情境：以德爾菲預測法探討

Identifying Critically Ill Situations in Medical Surgical Wards in Medical Centers-A Delphi Study

張嘉蘋(Jia-Ping Chang) ； 張瑩如(Ying-Ju Chang) ； 周傳姜(Chuan-Chiang Chou)

《醫護科技期刊》 12卷2期 (2010/06) Pp. 109-119

https://doi.org/10.6563/TJHS.2010.12(2).4

摘要

背景：醫院常因加護病房床位不夠用，而使得在一般病房住有重症、危急、需密切觀察之病人。台灣護理學會護理人員能力進階制度中，要求N2以上層級需具照護重症及困難病人能力，據此學會雖然陳述了重症及困難病人定義，然而在何種情境會需要密切觀察，並沒有進一步說明，以致於各醫院在認定護理人員重症護理能力上會有所不同。目的：界定醫學中心一般內外科病房之重症情境，以利制定其護理人員照護重症病人之相關照護執業能力。方法：本研究採德爾菲預測法，調查11家醫學中心共37位內外科護理專家，對一般內外科病房重症情境之看法。所有專家均具備內外科臨床年資5年以上及大學以上學歷。研究資料以眾數、平均數、標準差、四分位差呈現專家對問題看法差異的程度。結果：經三回合問卷統計，共25項臨床重症情境獲得專家共識。結論：本研究之結果可做爲各醫學中心護理部在安排在職教育課程，及各級護理學校在規劃學習課程時，設計臨床情境的參考。

關鍵字

重症情境 ； 德爾菲預測法 ； 一般內外科病房

並列摘要

Background: Because of insufficient beds in the intensive care units of medical centers, patients with critical illness are admitted to general medical-surgical wards. Nurses thus face a stressful situation arising from their lack of abilities and experiences in caring for crucially ill patients. The Taiwan Nurses Association has established the clinical ladder system and emphasizes that the N2 level of nurse should have the competency in caring for critically ill patients. However, clinical situations requiring intensive observation and care have not yet been identified. Purpose: This study aimed to identify clinical situations of patients requiring intensive care in general medical-surgical wards. Method: This study applied the Delphi Technique with a three-round questionnaire survey. Thirty-seven nurse experts with at least five-years of working experience in medical-surgical wards or critical care units were recruited from 11 medical centers. Data analysis was performed using descriptive statistics, including mode, median, mean, SD, and quartile deviation. Results: After a three-round questionnaire survey, 25 critically ill situations were identified. Conclusions: Study results provide information of designing an in-service training program that nurses can use to care for critically ill patients in medical-surgical wards.

並列關鍵字

Critically ill situations ； delphi technique ； medical-surgical ward

參考文獻

台灣護理學會 （2009年12月22日）醫院基層護理人員臨床專業能力進階制度規劃指引‧取自　http://www.twna.org.tw/home.htm

American Association of Critical-Care Nurses (2009). Definition of a critically ill patient. Retrieved October 26, 2004, from http://www.aacn.org/WD/PressRoom/Content/aboutcriticalcarenursing.pcms?pid=1&&menu=

Intensive Care Society Standards (2002). Level of critical care for adult patients. Retrieved October 26, 2004, from http://www.sussexcritcare.nhs.uk/aboutus/documents/levels.pdf

Intensive Care Society Standards (2009). Level of critical care for adult patients. Retrieved Octo ber 15, 2009, from http://www.sicsag.scot.nhs.uk/Levels_of_Care_Intensive_Care_Society_2009.pdf

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