實證護理概念與臨床應用

The Concept and Clinical Application of Evidence-Based Nursing

護理是實踐科學知識的專業，在臨床上需具備能夠應用最新實證知識於提升病人照護品質的能力，因此在醫療新知及研究文獻劇增的時代，護理人員必須學習實證照護概念，並熟悉搜尋及應用實證文獻的方法，以輔助臨床護理決策的參考。本文在介紹實證護理的概念及實證執行5A的步驟，從臨床問題或病人問題的訂定、系統地搜尋研究證據、評析研究證據、整合最佳證據並應用、到執行過程及結果的評值，詳細說明每一個步驟的重點。臨床應用方面，也介紹實證資料應用的7A階段，從對實證知識能注意到、接受、可行、有能力做、開始做、認同、到養成習慣；以及實踐行動的7期：1.找出知識與行動的差異，2.轉化知識到當地環境，3.評估應用知識的阻力或助力，4.選擇、修正、實施介入方式，5.監督知識應用，6.評估結果，7.持續應用知識。並以實例介紹臨床應用實證護理的經驗，以提供臨床護理人員在實踐實證護理的參考。

Nursing is a healthcare profession that involves the application of scientific knowledge to a clinical nursing practice setting; therefore, clinical nurses need to apply their knowledge of evidence-based nursing to promote quality patient care. In a time of increasing innovative healthcare knowledge and research literature, nurses must learn the concept of evidence-based nursing, become familiar with the method of searching and applying evidence-based literature, and use it as a reference tool for decision making. This paper introduces the concept of evidence-based nursing and explains in detail the five main steps of its implementation: identification of clinical or patient-related problems, systematical search of research evidence, review and critique of research evidence, integration and application using the best evidence, and implementation and evaluation of the results. The author also introduces seven phases of implementation: (1) identifying the gap between knowledge and action; (2) transforming knowledge based on the local context; (3) assessing obstacles or facilitators in the application of knowledge; (4) selecting, modifying, and implementing interventions, (5) monitoring the application of knowledge; (6) evaluating outcomes; and (7) sustaining the application of knowledge. The author uses examples to explain the clinical application of evidence-based nursing as a reference for nurses who are implementing evidence-based nursing.