某教學醫院護理人員之臨床護理能力及其相關因素之探討

Nursing Clinical Competence and Related Factors of Nurses in a Teaching Hospital

本研究主要目的為瞭解各層級護理人員（護士一級至四級）之臨床護理能力，及比較不同層級護理人員之臨床護理能力與其相關的影響因素。研究對象為某教學醫院各層級護理人員，於92年1月30日至92年4月30日採分層隨機抽樣法，共選取304人。研究者以自擬之臨床護理能力評估問卷為研究工具，以10分法計分，經效信度測試後，採因素分析極度轉軸法(Varimax Rotation)，取得臨床照護、教學輔導、計劃評值及研究能力四因素，再測信度以內在等級相關(Intraclass Correlation Coefficient, ICC)檢定達.81。結果顯示：1) 護理人員自評臨床護理能力總平均為7.46分。其中以臨床照護能力最高7.93分，依序為計劃評值能力（7.66分）、研究能力（6.83分）及教學輔導能力（6.75分）。2) 護士一級至四級間臨床護理能力差異檢定顯示，臨床照護能力以三級優於一級及二級、四級優於一級，且達顯著差異；教學輔導能力以三級優於二級與一級、四級優於一級；計劃評值能力及研究能力均是三級優於一級及二級，其差異均達顯著差異(F=8.62～47.42, p<.001)；護理人員職稱、教學輔導能力及平均總臨床護理能力有顯著差異(t=-7.43 & -9.31, p<.05 & .001 )，表示副護理長之教學輔導能力及平均總護理能力高於護理人員，且具顯著差異。3)護理人員之年齡、本院工作年資、參加N3共通在職訓練時數及研習會時數與臨床照護能力、教學輔導能力、計劃評值能力及研究能力均有顯著正相關(r= .13～ .45, p<.05 & .01)。此研究結果，期能作為日後臨床護理照護及在職教育訓練規劃之參考。

The purposes of this study were to understand and compare the competence of nurses at each level on the clinical ladder and factors associated with it. The sample of this study included 304 nurses from all levels of the clinical ladder selected by stratified random sampling between January and April 2004 in a teaching hospital. Using factor analysis with varimax rotation method, the instrument measuring clinical nursing competence included four factors, namely, clinical nursing care, teaching and consulting, planning and evaluation, and nursing research. Each question was measured on the Likert 10-point scale. The test-retest reliability of the instruments measured by intraclass correlation coefficient (ICC) was .81. The results showed that: 1) the average score of total nursing clinical competence was 7.46. The highest score was for clinical nursing care competence (7.93), followed by planning and evaluation competence (7.66), teaching and consulting competence (6.95), and nursing research competence (6.83). 2)There were significant differences in scores for the four competences between nurses of different levels on the clinical ladders (F 8.62~47.42, p .001). The assistant head nurse (AHN) had significant higher scores in teaching and consultant competence and total average of the nursing clinical competence. 3) Age, working experiences, core-course training attendance, and symposium attendance were positively correlated with the four competences (r .13~ .45, p .05 & .01). In conclusions, the results of this study provided references for nursing care and in-service training plans in clinical practice.