可信賴專業活動在新進臨床護理師培訓期的應用

背景：近年來臨床醫學教育的訓練轉移到能力導向的教育模式，掀起了一股以「勝任能力」為導向的醫學教育，而可信賴專業活動（entrustable professional activities, EPAs）的導入與發展，使得臨床醫事人員培訓計畫，能夠更全面性與整合性的評值培訓期學員的專業能力，本文介紹EPAs基本內涵，並提出EPAs建置、規劃及臨床評量的初步應用經驗。方法：以名義團體法及問卷調查進行EPAs任務建置，並以EPA品質評量工具Equal（Queen's EPA Quality Rubric, Equal）檢核「住院病人給藥」EPA的效度，再以評分者間一致性建置評量的信度。結果：以名義團體法與問卷調查共建置8個EPAs任務，其中以「住院病人給藥」為例所建置的EPA內容與訓練評估表單運用於臨床評量22位新進三個月護理師，並評定信賴程度監督等級。經過總結式評量結果顯示有21位（95.5%）學員於滿第三個月培訓期達到可獨立執行監督等級level4程度，其中有一位介入輔導仍無法勝任給藥任務。結論：本文以新進人員三個月培訓期EPA發展為例，分享其在臨床護理培訓的應用，並提出初步應用後的反思與建議，作為後續EPAs應用於護理教育上的參考。

關鍵字

可信賴專業活動；臨床護理師培訓計畫；新進人員

並列摘要

Background: The current trend of medical educational has been transformed to competency-based model. The introduction and development of entrustable professional activities (EPAs) enable the evaluation of postgraduate year program more comprehensive and integrative. This paper introduced the elements and principle of EPAs. We also shared our preliminary experiences in the development and implementation of EPAs for new nurses' postgraduate year training. Methods: We used nominal group technique and questionnaire survey to develop EPAs. Equal (Queen's EPA Quality Rubric) was used to test the validity of ＂drug administration to hospitalized patients＂ EPA, and inter-rater reliability was used to ensure the consistency of assessment. Results: There were eight EPAs developed through the nominal group technique and questionnaire survey. The ＂drug administration to hospitalized patients＂ EPA was implemented with 22 new nurses at the end of the third month of training, and their levels of supervision were evaluated. The summative assessment reveals that 21 (95%) new nurses reached the level 4 of supervision as allowed to perform the activity unsupervised. One new nurse was unable to be competent with the drug administration task even by given guidance. Conclusion: We developed nursing EPA for the first three months training period. We also proposed our reflection and further suggestions addressed from the preliminary experiences. Hopefully our experiences of EPAs can provide as a reference for clinical nursing education.

並列關鍵字

entrustable professional activities ； nursing postgraduate year training ； new nurses

參考文獻

周致丞 (2016)˙ 運用「里程碑」邁向勝任能力導向訓練 ˙ 醫療品質雜誌，10(1)，25-30。[Chou, C. C. (2016). Using milestones for designing competency-based training. Journal of Medical Quality, 10(1), 25-30.] https://doi:10.30160/JHQ

陳建宇、唐功培、林峰盛、程毅君、戴裕庭、周致丞 (2018)˙ 臺灣麻醉專科導入可信賴專業活動於里程碑計畫 ˙ 台灣醫學，22 (1)，62-70。[Chen, C. Y., Tang, K. P., Lin, F. S., Cherng, Y. G., Tai, Y. T.,& Chou, C. C. (2018). Implementation of competency-based medical education with a local context in a Taiwan emergency medicine residency training program. Formosan Journal Medicine, 22(1), 62-70.]https://doi:10.6320/FJM.201801_22(1).0007

陳玉枝 (2010)˙ 護理人員應具備的專業核心能力 ˙ 護理雜誌，57(5)，12-17。[Chen, Y. C. (2010). Essential professional core competencies for nurses. The Journal of Nursing, 57(5), 12-17.]https://doi:doi:10.6224/JN.57.5.12

陳祖裕 (2017)˙ 可信賴專業活動的疑惑與理解˙彰化醫學，15(2)，104-113。[Chan, C. Y. (2017). Entrustable professional activities -Doubts and understanding. The Changhua Journal of Medicine, 15(2), 104-113.]https://doi:10.6501/CJM.1502.007

黃國明、溫舒瑜、黃子婕、杜昭遠、林煒柔、楊志偉 (2020)˙ 醫事放射治療領域可信賴專業活動之建置與推廣 ˙ 臺大醫院經驗分享˙ 醫療品質雜誌，14(2)，52-57。[ Huang, K. M., Wen, S. Y., Huang, T. J., Tu, C. Y., Lin, W. J., & Yang, C. W. (2020). Validation and implementation of entrustable professional activities (EPAs) in radiation therapist training: Experiences at National Taiwan University. Hospital Journal of Healthcare Quality. 14(2), 52-57.]https://doi:10.3966/199457952020031402010

被引用紀錄

王靜慧、洪珮瑜、陳瑞珍、林曼玲、林麗華、張智涵、陳右尚（2023）。發展癌症臨床照護之可信賴專業活動（EPAs）歷程。榮總護理，40(4)，427-435。https://doi.org/10.6142/VGHN.202312_40(4).0011

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可信賴專業活動在新進臨床護理師培訓期的應用

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