臺灣博碩士論文加值系統

背景
專科護理師執行臨床照護與醫療行為，加上工作負荷重、護病比高，亦被充作住院醫師使用，甚至被迫獨立執行醫療行為，致使遊走於觸法邊緣。過往研究顯示專科護理師轉任過程將面對多種困境，亦提到了於臨床的模糊定位，然研究皆在人力充足的中大型醫院執行，「地區醫院專科護理師」鮮少被提及，其角色定位及醫院或醫師期待皆與大型醫院不同，因此本研究探討地區醫院專科護理師的角色轉換經驗為何，做為地區醫院護理師日後轉任專科護理師的參考，亦可提供地區醫院擬定政策或管理專科護理師的依據。
方法
本研究為質性研究，以立意取樣方式招募正或曾於臺灣地區規模屬地區醫院執業之專科護理師，透過半結構訪談指引，於訪談對象指定之受訪地點或藉由視訊方式進行深度訪談，並透過內容分析歸納研究結果。
結果
收案共15名，受訪者女性8位、男性7位，平均年齡為36.6歲(SD=7.5)；教育程度以大學畢業者居多(80%)；平均護理師臨床工作年資為10.2年、專科護理師年資為5.3年。地區醫院專科護理師角色轉換經驗包括決斷、挑戰、替代與順應共四大主題，其中決斷包含「追求理想工作型態」、「實踐自我目標」、「追隨專科護理師角色」三個次主題；挑戰包含「飽受教育機制不完善之苦」、「經歷角色定位困境」、「感受執業能力不足」、「囿困醫療照護複雜關係」、「身處工作風險帶來不安」及「承擔超負荷工作之苦」六個次主題；替代則包含「遞補基層護理角色」、「替代過多醫療業務」及「承擔過多行政文書作業」三個次主題；順應包含「尋找困境之解決方案」、「定錨角色價值」及「維持執業熱忱」三個次主題，闡述了專科護理師角色轉換的歷程。
結論
研究發現，地區醫院專科護理師的教育訓練嚴重不足、執行醫療行為的程度加劇。應規劃良好的訓練機制及在職教育、建立臨床教師制度、完善執業辦法並明定工作指引、建立嚴格的轉任篩選機制、完整預立醫療流程制度，並由專科護理師主導管理。

Background:
Providing clinical care is the responsibility of nurse practitioners. However, oftentimes, owing to heavy workloads and a high nurse to patient ratio, nurse practitioners are required to independently execute medical behavior in lieu of resident physicians, and this practice falls under the gray zone of law. Studies have shown that nurse practitioners face difficulties when they are transferred, where they often feel their roles are fuzzy and not clearly outlined in clinical practice. However, these studies were conducted in medium-large hospitals with sufficient manpower and rarely involved nurse practitioners from district hospitals. In district hospitals, the roles of nurse practitioners and physician expectations from them are different those of large hospitals. Therefore, this study examines the role transfer experience of nurse practitioners in district hospitals to provide a reference when considering future transfer of nurse practitioners to district hospitals and to help district hospitals formulate policies to manage nurse practitioners.
Methods:
In this qualitative study, convenience sampling was used to recruit nurse practitioners who are currently working in or have previously worked in district hospitals. Semi-structured interview guidelines were used to conduct in-depth interviews at a venue designated by the subjects or through video conferencing. Content analysis was used to summarize the study results.
Results:
Of the 15 subjects recruited, 8 were women and 7 were men, and their mean age was 36.6 years (SD:7.5). Most subjects were university graduates (80%) in terms of education level. The mean number of years of clinical experience was 10.2, and the mean number of years of working as a nurse practitioner was 5.3. Four themes were extracted from the interviews regarding the role transfer of nurse practitioners in district hospitals: decision-making, challenges, substitution, and adaptation. Each theme was further divided into sub-themes. Seeking an ideal work pattern, achieving self-goals, and following the role of a nurse practitioner were the three sub-themes identified under the main theme of decision-making. Suffering caused by an imperfect education system, difficulties of role positioning, perceived insufficiency in execution capabilities, feeling trapped in the complex healthcare relationship, unease due to work risks, and the burden of a heavy workload were identified as the six sub-themes under the main theme of challenges. The main theme of substitution could be categorized into three subthemes: working as primary nurses, performing medical tasks, and burdened by additional administrative tasks. The main theme of adaptation had three subthemes: seeking solutions for difficulties, determining the role value, and maintaining enthusiasm for the practice. These themes and subthemes describe the experiences of role transfer in nurse practitioners.
Conclusion:
This study found that in district hospitals, nurse practitioners faced severe lack of training. Besides, they were required to execute medical behaviors, which placed them in a risky gray zone under law. The need is to implement a good training system and on-the-job training, establish a clinical mentorship system, improve practice methods, formulate work guidelines, set up a stringent transfer screening system, and develop an advanced medical procedure system, which should be led and managed by nurse practitioners.

目錄
中文摘要.................................i
Abstract...............................iii
致謝.....................................v
第一章 緒論..............................1
第一節 研究背景及重要性.................1
第二節 研究問題........................3
第二章 文獻查證與概念架構.................4
第一節 國內外醫院分級...................4
第二節 國內外專科護理師發展及執業現況....6
第三節 臺灣專科護理師角色定位...........8
第四節 專科護理師轉任相關研究...........10
第五節 質性研究........................14
第三章 研究方法..........................18
第一節 研究設計........................18
第二節 研究對象與場所...................18
第三節 研究工具........................19
第四節 資料收集過程....................20
第五節 資料分析........................21
第六節 研究嚴謹度......................24
第七節 倫理考量........................26
第四章 研究結果..........................28
第一節 受訪者基本屬性描述...............28
第二節 地區醫院專科護理師角色轉換經驗....29
主題一 決斷..........................34
主題二 挑戰..........................38
主題三 替代..........................49
主題四 順應..........................57
第五章 討論..............................65
第一節 地區醫院專科護理師角色轉換經驗....65
第二節 研究限制........................82
第六章 結論與建議........................83
第一節 研究結論........................83
第二節 建議............................86
參考資料.................................91
中文文獻.................................91
英文文獻.................................95 
附件
附件一、受訪者基本資料表及訪談大綱.........103
附件二、人體試驗委員會審查通過證明書.......104
附件三、受試者招募文宣....................105
附件四、受試者同意書......................106
表次
表4-1、訪談對象基本屬性表..................29
表4-2、專科護理師角色轉換經驗..............31
圖次
圖4-1、地區醫院專科護理師角色轉換經驗.......64

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