臺灣博碩士論文加值系統

實證實務已是當前臨床醫療決策及健康照護的趨勢，廣泛運用於各個健康照護專業領域。臨床護理人員因應業務需求，必須學習如何提出問題、有效率地搜尋資料、檢視證據力，並將知識運用在臨床實務工作中，才能有效提升病人安全及照護品質。因此，本研究旨在提供實證實務訓練，並探討此訓練介入對護理師執行實證實務能力之成效。本研究為兩組重複測量的隨機控制試驗，以北部某區域教學醫院護理師為研究對象，共收案72名，隨機分派至實驗組及對照組；實驗組之介入措施為12小時實證實務訓練，對照組則接受常規在職教育訓練。兩組分別於介入措施前、介入措施後二週、六週以健康科學實證實務問卷(HS-EBP)進行三次測量。
研究資料以SPSS 20.0套裝軟體進行描述性及推論性統計，分析結果顯示實驗組介入實證實務訓練後，於時間及組別之交互作用下，執行實證實務的信念態度於第二週比對照組進步8.15、第六週進步7.89，達統計上之顯著差異(p=.004、p<.001)；科學證據使用行為於第二週比對照組進步12.66、第六週進步13.55，達統計顯著差異(p<.001、p<.001)；專業實踐能力於第二週比對照組進步12.89、第六週進步14.56，達統計顯著差異(p<.001、p<.001)；結果評估能力於第二週比對照組進步6.67、第六週進步6.71，達統計顯著差異(p=.02、p=.001)；執行實證實務的障礙及促進因素於第二週進步5.76，未達統計顯著差異(p=.10)，第六週進步8.47，達統計顯著差異(p=.001)。
本研究結論為介入實證實務訓練措施後，對提升臨床護理人員執行實證實務之信念態度、科學證據使用行為、專業實踐能力、結果評估能力、障礙及促進因素具有成效。因此，建議未來能將本研究結果運用於臨床實務以及護理持續教育，並以此研究為基礎，更深入探討實證實務於臨床實踐之運用，以提升護理專業能力與照護品質。

Evidence-based Practice is an important issue of clinical decision and health care.Nurses must learn how to apply evidence in clinical care.The purpose of this study will be to evaluate the effect on competency of EBP training.This is a randomized controlled trial with repeated measures at three times which are before the intervention (Baseline), clinical practice (posttest 1), and follow-up(posttest 2). Instruments is Health Sciences-Evidence Based Practice (HS-EBP). A total of 72 nurses will be recruited from one hospital. The experimental group received the EBP training. For participants who are in the control group received the general training.
Statistical analyses were performed by SPSS version 20.0. The results of this study is as follows : The outcome of beliefs-attitudes of interaction between the group and time is reached statistical significant difference(p=.004,p<.001). The outcome of results from scientific research of interaction between the group and time is reached statistical significant difference(p<.001,p<.001). The outcome of development of professional practice of interaction between the group and time is reached statistical significant difference(p<.001,p<.001). The outcome of assessment of results of interaction between the group and time is reached statistical significant difference(p=.02,p=.001). The outcome of barriers-facilitators of interaction between the group and time is no significant on 2 weeks(p=.02), and reached statistical significant difference on 6 weeks.(p=.001).
Therefore, this study of EBP training is validated that it can effectively upgrade the nurses’ evidence-base practice competence, as well as to improve the quality of clinical care. It is recommended to continue future research by applying to clinical practice base on this study.

中文摘要…………………………………………………..……………….……….I
英文摘要…………………………………………..……………………….………II
目次 ……………………………………………………………………….………III
表次 …………………………………………………………………….…………V
圖次………………………………………………………………………...………VI
第一章 緒論
第一節 研究動機、重要性及背景…………………………………….…...….1
第二節 研究目的 ………………………………………………………...……3
第三節 研究質疑 …………………………………………………………..….4
第四節 假設檢定………………………………………………………….……4
第二章 文獻查證
第一節 實證實務之臨床現況……………………………………......….…….5
第二節 實證實務推行影響因素之相關研究.……………………….……….10
第三節 實證實務能力培訓成效之相關研究………………………………...16
第三章 研究架構
第一節 研究架構 …………………………………………………………….23
第二節 名詞界定 …………………………………………………………….23
第四章 研究方法
第一節 研究設計 …………………………………………………………….25
第二節 研究地點及研究對象 ……………………………………………….25
第三節 研究工具………………………………………………………..…….26
第四節 倫理考量…………………………………………………………..….28
第五節 研究過程……………………………………………………..……….29
第六節 資料分析 …………………………………………………………….31
第五章 研究結果
第一節 研究對象之屬性分析…………………..…………………………….32
第二節 介入措施對執行實證實務的信念態度之分析 ….…………………36

第三節 介入措施對科學證據使用行為之分析 …………………….……….37
第四節 介入措施對執行實證實務的專業實踐能力之分析 ….…………….38
第五節 介入措施對執行實證實務的結果評估能力之分析 ….…………….40
第六節 介入措施對執行實證實務的障礙及促進因素之分析 …..…………41
第六章 討論
第一節 研究對象之屬性描述…………………………………...………….….43
第二節 介入措施對執行實證實務的信念態度之成效 ….……………...…...44
第三節 介入措施對科學證據使用行為之成效 …………………….……..…46
第四節 介入措施對執行實證實務的專業實踐能力之成效 ….…………..…47
第五節 介入措施對執行實證實務的結果評估能力之成效 ….…………..…48
第六節 介入措施對執行實證實務的障礙及促進因素之成效 …..……….…49
第七章 結論與建議
第一節 結論 ……………………………………….………….…….……….…51
第二節 臨床之運用 ……………………………………….….……….……….51
第三節 建議與限制 …………………………………………..………….…….54
參考文獻
中文部分……………………………..…………………………………….…….55
外文部分……………………………..………….……………………………….58

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