• 期刊

護理專業發展之機會與挑戰－臺灣護理精彩一百

本文從我國衛生政策中相關之「護理制度」與世界衛生組織之2011-2015「強化護理及助產服務策略方針」(Strategic Directions for Strengthening Nursing and Midwifery Services, SDNM)，進行臺灣護理專業發展之回顧與前瞻。文獻查證世界衛生組織「強化護理及助產服務策略方針」內涵及「臺灣省政府衛生處」、「行政院衛生署」等國家中央衛生組織之官方資料，分析與論證臺灣護理專業發展之機會與挑戰。適逢建國100年歷史及行政院將於民國101年組織再造：「行政院衛生署轉銜行政院衛生福利部」之際，本文希望記錄臺灣護理精彩100之發展。

• 期刊

轉型中之護理行政管理者－省思與未來展望

醫療照護系統的複雜化，使得護理行政管理者必須不斷的面對新的挑戰，因此，為了能管理組織的資源與確保病人安全及照護品質，具備多元的專業能力與技能是相當重要的。本篇論述的目的旨在透過剖析歷史的觀點，瞭解現今護理行政管理者所可能面臨的問題，進而提出其未來所需的訓練準備與專業能力建言，使其對未來能更具信心與專業能力去完成管理者的角色與功能。

• 期刊

自信肯定的護理行政主管

本文旨在說明自信肯定行為對護理主管的重要，不僅能維護護理同仁的權益，更能展現護理專業的尊嚴。自信肯定行為不同於非自信肯定及攻擊性行為。自信肯定是人際溝通中的一種技巧，其展現方式必須以專業的立場與感受為主，先確定所想要的；在適當的時間和地點清楚表達自己的意見；要以具體事實來說明你所認為的問題，避免被別人錯誤的判斷或解釋；不可受制於權威，以禮貌的態度來要求自己的權利及尊嚴。

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護理行政與管理之變革

面對醫療環境之巨變，護理行政管理者須具有預測及變革管理能力，使組織衝擊程度降到最低。護理領導者須了解變革的過程，引導創新策略改善護理工作環境進而確保病人照護品質。本文旨在介紹當前護理行政與管理面臨之挑戰，護理變革管理的概念與策略，變革的步驟及管理工具。並陳述美國醫學會研究院(Institute of Medicine, IOM)提出的五大核心能力作為改善方向，舉例說明國內外護理行政管理變革的經驗，提供行政及臨床實務管理的參考。

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護理政策與管理的重要研究議題－醫療體系的觀點

本文的目的在探討護理政策管理領域，現階段比較急迫的研究發展議題，而且主要以醫療體系的角度進行討論，分別為人力資源、方案組織、服務提供、管理、經濟支持五個組成。其中護理人力的研究包括人力數量規劃、國家層級的人力供需監測、人力研究方法學、職涯餘命政策規畫四個議題。護理組織與服務的研究包括全責照護計畫與技術混合、任務交付、護理工作內容調查、護理人力結構與運用四個議題。護理政策與社會保險議題則包括醫療機構設置或評鑑標準中有關護理人力標準的訂定，以及健保支付制度對護理專業的衝擊與政策規畫。本文最後並針對護理專業研究議題創新的阻礙與挑戰提出建議。

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預防性抗生素使用對甲狀腺手術部位感染之危險因素探討

Background: Surgical site infection is one of the most common types of nosocomial infection and an important factor in increased mortality and medical costs. The effectiveness of prophylactic antibiotics use on thyroidectomy wound sites merits further examination.Purpose: This study compared the influence of prophylactic antibiotics use or non-use on surgical site infection risk, average hospital stay length and average medical costs in thyroidectomy patients.Methods: This cross-sectional study targeted patients undergoing thyroidectomies at the general surgery ward of a medical center during the period 2007 to 2008. Subjects were divided into two groups. The first comprised patients who received prophylactic antibiotics thirty minutes before receiving a thyroidectomy between January 1, 2007 and October 31, 2007. A retrospective review of patient charts and reports was conducted for this group. The second consisted of patients that did not receive prophylactic antibiotics 30 minutes before receiving a thyroidectomy between November 1, 2007 and October 31, 2008 in line with a new antibiotics policy enforced at the research hospital.Results: A total of 310 subjects were enrolled in the study. All subjects were free of surgical site infection. Fifteen patients (4.8%) received a course in antibiotics after surgery and six (40.0%) of these showed surgical site swelling (x^2=120.33; p＜.01). Statistically significant risk factors of post-surgery antibiotics use included diabetes mellitus (x^2=6.39; p=.03), a surgery duration in excess of 2 hours (x^2=4.40; p=.04), drainage tube remaining in place at the surgical site (x^2=4.58; p=.03) and drainage tube insertion for more than 2 days (x^2=6.24; p=.03). Significant reductions in average hospital stay length (3.65days±1.04; p＜.01) and medical costs (p＜.01) were observed when prophylactic antibiotics were not used before surgery. The cost of post-operative antibiotics increased by $5,851 and medical costs increased from $32,436 to $63,895 when hospital stay length exceeded four days. If hospital stay length was kept within four days and post-operative antibiotics were used, this study found no significant difference in drug or medical costs.Conslusion: Not using prophylactic antibiotics before thyroidectomy does not increase surgical site infection risk.

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家庭照顧者壓力感受與壓力生理指標相關性之探討

Background: Family caregivers (FCGs) of persons with dementia (PWDs) face chronic stress. However, their stress has often been assessed by their distress in the absence of physiological indicators. Studies to date have rarely documented the relationships between distress and various stress biomarkers.Purpose: The aim of this study was to explore the relationships between distress and stress biomarkers in FCGs.Methods: This was a secondary data analysis study that used data collected by two projects funded by the National Science Council. Samples included 113 dyads of PWDs and their FCGs willing to donate blood samples. Original study data sites comprised two teaching hospitals (memory clinics and psychiatric outpatients), two regional hospitals (neurology clinics), and two dementia daycare centers for community-dwelling PWDs in northern Taiwan. FCG distress was assessed using the Chinese Neuropsychological Inventory-Caregiver Distress Scale (CNPI-CD); Stress biomarkers included interleukin (IL)-1β, IL-6, IL-10, cortisol, and C-reactive protein (CRP).Results: Stress biomarker levels did not correlate with overall FCG distress related to PWD neuropsychological problems. However, IL-1ß, IL-6, and IL-10 levels did correlate with specific FCG distress toward specific PWD neuropsychological symptoms.Conclusions: This study found certain stress biomarkers (IL-1ß, IL-6, IL-10) associated with specific PWDs' neuropsychological symptoms (p＜.05). Further longitudinal research is needed to clarify causal relationships between subjective distress and objective stress biomarkers to evaluate FCG stress levels more comprehensively.

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探討兒科護理人員對嬰幼兒發展的認知及發展照護的態度和行為

背景　兒童發展照護強調早期發現早期介入的功效，因此兒科護理人員對嬰幼兒發展的知識和行為是發現特殊兒童的重要能力。目的　探討兒科護理人員對嬰幼兒發展的認知、態度、和行為之影響因素及其相關性。方法　本描述性研究採問卷調查研究法，以中部某醫院兒科護理人員112人為施測對象。以自擬問卷，含嬰幼兒發展的知識、兒童發展照護之態度及行為。資料以平均數、皮爾森檢定、單因子變異數及邏輯式迴歸等方法進行統計分析。結果　顯示兒科護理人員具有嬰幼兒發展知識，對兒童發展照護都持正向態度，但兒童發展照護行為少。其嬰幼兒發展知識和兒童發展照護態度有顯著的正相關。預測兒童發展照護行為的重要因素是參加兒童發展及早療相關課程和子女數。結論　兒童發展相關課程是影響護理人員對兒童發展照護行為的重要因素，建議應舉辦或鼓勵護理人員參加發展及早療相關課程，於護理養成教育中即應涵蓋早療概念和模式的運作。

• 期刊

曾經接受冠狀動脈繞道手術的代謝症候群病患飲食型態之探討

背景　冠心症患者接受冠狀動脈繞道手術後並非一勞永逸，提供心肌血流的血管也可能發生再次狹窄或阻塞，故手術後更需要減少危險因子，如飲食型態，才能維持血管長期的通暢。目的　為探討代謝症候群於冠狀動脈繞道術後病患其飲食習慣。方法　本研究採橫斷式研究方法，以立意取樣，於北部某區域醫院收案共104人進行調查。研究工具包括基本資料問卷與飲食頻率問卷，資料收集後以SPSS 17.0進行統計分析。結果　發現研究對象在手術後所攝取的蔬菜類、奶類之頻率較低，油炸類食品較高；烹調油使用頻率亦偏高。結論　研究對象飲食型態仍應增加蔬菜之攝取，在烹調油及油炸食物的食用頻率應減少，亟需改善飲食型態的攝取頻率以提升較佳之飲食習慣。又研究對象之準備三餐者有半數為配偶，故指導飲食衛教時，更需著重在準備三餐者的飲食觀念與烹調方式；此結果期望可提供醫護人員在術後飲食衛教的參考，讓病患與家人有健康飲食攝取的觀念及落實。

• 期刊

中期照護的護理角色與未來發展－護理新契機

我國政府為因應人口高齡化、住院診斷關連群以及十年長期照顧計畫的政策推動下，中期照護已開始受到關注。中期照護為急性照護與長期照護之間最好的連結之橋樑，它將成為未來醫療領域的另一種新興的服務模式。透過中期照護的服務提供，可使個案在所提供的支持性環境，促進功能回復並返回社區。本文從中期照護之緣起、中期照護之定義、中期照護之服務內涵、中期照護之服務模式以及中期照護之相關研究之國內外相關經驗，提出中期照護之護理角色以及未來台灣中期照護發展的護理意涵。期望未來透過學術界、政府政策以及產業界的攜手合作，中期照護能成為台灣未來護理專業角色延伸及擴展的新契機。