應用德爾菲法評估公共衛生護理人員執業環境之改善方案

Improvement of Positive Public Health Nursing Practice Environment: The Delphi Evaluation

陳美惠(Mei-Huei Chen)

指導教授 ： 陳靜敏

臺北醫學大學/護理學院/護理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00072

摘要

本研究旨在整合產、官、學界專家對公共衛生護理人員執業環境改善具體策略之共識，並提出改善策略之優先順序。透過修正式德爾菲調查法收斂各界專家之意見，瞭解公共衛生護理人員執業環境改善重要及可行之具體策略。研究對象為我國公共衛生護理之產、官、學界專家各25名，研究資料以平均值、標準差、四分位差及因素分析等進行統計分析，共進行三回合的修正式德爾菲專家意見調查並排序，回收率分別為69.74％、73.33％、及73.33％。結果發現：
1、 產、官、學界專家對公共衛生護理人員執業環境改善策略可歸納為實務熟練、教育政策、人員結構/招聘及留任、中階及資深領導者角色、生產力測量及組織溝通之六個層面。
2、 專家意見在三回合問卷即達收斂，可由（1）第三回合各題項標準差顯著低於第二回合分析；（2）四分位差分析顯示在第三回合中已有96.41％策略達成共識；（3）內在一致性檢定α值顯示在六層面是介於 .94~ .98之間顯示專家群對各項指標之看法一致集中達收斂。
3、 經四分位差共識性檢定分析，195項提列之策略中共有188項在產、官、學界專家呈中度（95項）及高度（93項）一致性。
4、 以因素分析法各別分析六層面提列的具體策略，共投入139題項，結果刪除3題項，共保留136項具體策略，再依研究進行方式刪除可行性平均得分在3.5以下之策略，刪除8題，最後共保留128項具體策略，並依平均值與標準差來排列優先順序：
（1）、 實務熟練層面：包括制定公共衛生護理人員的執業範疇標準、規範公共衛生護理人員的能力標準、規劃公共衛生護理人員實務培訓課程、設計提升公共衛生護理人員執業能力的內容與工具及提升公共衛生護理人員緊急救護能力等，共5大規劃16項具體策略。
（2）、 教育政策層面：含明訂公共衛生護理人員養成教育應教導之專業課程內容、及規劃公共衛生護理人員繼續教育與進修之課程內容2項規劃，19項具體策略。
（3）、 人員結構/招聘及留任層面：為明訂公共衛生護理人員招聘與留任，共10項具體策略。
（4）、 中階及資深領導者角色層面：含4大項規劃，明訂公共衛生護理領導者應具備之管理能力與位階、建立公共衛生護理人員完善的升遷管道及業務內容、規劃公共衛生護理領導者的培訓內容、規劃公共衛生護理領導者的培訓方式，共28項具體策略。
（5）、 生產力測量層面：含3大項規劃，設立公共衛生護理人員績效/考核機制、明訂公共衛生護理人員業務成效之運用、明訂公共衛生護理人員業務工作內容與標準，共20項具體策略。
（6）、 組織溝通層面：含4大項規劃，建立公共衛生護理人員行銷策略及通訊管道、建立公共衛生護理人員參與業務內容機制、建立公共衛生護理人員窗口統合制度、建立公共衛生護理人員溝通協商管道機制，共35項具體策略。
彙整本研究結果，最終期望能夠提供政府機關對公共衛生護理人員改善執業環境之政策建議，使其能趨向優越、正向的執業環境，以呼應國際護理協會呼籲全球各會員國重視執業環境與愛惜護理人力資源。
關鍵字：德爾菲法、公共衛生護理、正向執業環境

關鍵字

德爾菲法 ； 公共衛生護理 ； 正向執業環境

並列摘要

This study was designed to integrate experts’ consensus on strategies to improve the positive practice environment for public health nurses. Applying the modified Delphi survey, experts’ opinions representing working field, government and academic arenas can be prioritiezed based on its importance and feasibility. A total of three rounds survey were conducted, with the response rates of 69.74%, 73.33% and 73.33%. The results were as followed:
1. Six strategic domains were converged from the experts’ opinions: clinical proficiency, educational policies, force structure / recruitment and retention, mid-grade and senior leadership roles, productivity measurement, and organizational communication.
2. The modified Delphi survey was completed at the third rounds based on: 1) the standard deviations of items at the third round were significantly lower than that of the second round; 2) 96.41% of the strategies have reached the consensus in the third round applying the quartile deviation analysis; 3) the Cronbach’s α ranged .94- .98 in six domains had indicated reaching the internal consistency.
3. Based on the results of quartile deviation analyses, 188 specific strategies have reached the moderate (95 items) and high (93 items) consensus among the 195 strategies proposed by the participants.
4. Factor analyses were applied for each of these six domains with 139 strategies. Three and eight items were deleted because of low communality and feasibility (<3.5), and finally retained 128 items. Specific strateties in each domain were prioritied according to its importance and feasibility using mean scores.
(1) In clinical proficiency domain, 5 factors were merged including development of standard and scope of public health nursing practice, regulation on competency levels of public health nursing practices, development of public health nursing practice training courses, design tools to enhance of public health nursing practice capacity and enhancement of public health nurses’ emergency preparedness capacity.
(2) Determining public health nursing curriculums in both nursing schools and for continuing education were merged in education policies domain.
(3) There were 10 specific strategies merged to enhance public health nurses’ recruitment and retention.
(4) In mid-grade and senior leadership roles domain, clearly stipulates of public health nursing leaders’ management capacity and bit-order, establish and improve the promotion system, development of public health nursing leadership training plan, and determining mechanism for the training programs were merged.
(5) Establishment of performance and evaluation mechanism, application of effectiveness measures, clear define of content and standards of professional public health nursing tasks were 3 factors merged in the productivity measurement domain.
(6) In organizational communication domain, 4 factors were merged including: establishment of marketing strategies and communication channels for public health nursing, establishing mechanisms for public health nurses involved in decisionmaking, establishment the integration system for public health nursing tasks, and establishment of mechanisms for communication and consultation channels.

並列關鍵字

Delphi ； Public Health Nursing ； Positive Practice Environment

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