美國與臺灣學校衛生護理的跨文化比較初探

Cross-Cultural Comparison of School Nursing between the United States and Taiwan

早在1902年，Lillian Wald已經在紐約市證實，護理人員投入學校可降低50％因病導致的缺席(Lynch, 1977)，美國學校衛生護理的歷史起源如此之早，發展迄今，也有將近百年的歷史，由於美國幅員廣闊，各州政府主權自治，加上各學區(school district)對人員的聘用及健康服務體系之採用有相當大的決策權，因此發展出各式各樣健康照護計劃，相關的健康服務型態與計畫不勝枚舉，學校護理服務也經常列在美國各式各樣的健康服務計畫中，例如：以學校為基礎的診療單位(school-based clinic)、與學校結合的健康服務計畫(school-linked program)、整合型健康服務機構網絡(integrated services network)、完整健康服務學校(full-service school)、中小學初級健康服務計畫(elementary and secondary primary care program)、移民健康(migrant health)、特殊教育(special education)、早期介入(early intervention)、青少女懷孕與育兒計畫(teen pregnancy and parenting program)、雇員健康服務計畫(employee health services)…等等(Lordi & Schneider, 1996)。時至今日，美國學校衛生護理人員已是學校衛生工作的重要一環，根據美國Department of Health and Human Services的報告顯示，公立學校聘有四萬七千多名RN任學校護士，並有十四州立法規定提供學校衛生護理服務(NASN, 2000)。

School nurses play a key role in school health system. This article introduces the education backgrounds, qualifications, roles, functions, standards of practice, and services in the United States. The authors also compare the similarities and differences of school nursing system between the United States and Taiwan. According to the analysis of comparison, authors propose some recommendations as follows: 1.The qualification of school nurses in Taiwan needs to be upgraded by providing a serial of planned continue education. 2.The manpower standards in Taiwan have not been updated for twenty years and need to update it immediately to decrease the nurse/student ratio. 3.A negative feedback in terms of quality of service and numbers of school nurses has been existed for more than twenty years and needs immediate attention to make any change. 4.In regular education system, master and higher degrees must be established soon to provide the channels of pursing advanced knowledge. This article also gives realistic suggestions to Taiwanese school nurses, government authorities, and the association of school nurses. To stop the negative feedback, the nurse/student ratio should be decreased from 1:2485 to 1:750. In addition, school nurses should be encouraged to attend continuing education (including academic degree) by the education authorities. The self-awareness of school nurses should be raised and encouraged. More school nursing education programs is needed and should be approved by the education authorities. In order to increase and ensure the quality of health service provided by school nurses, a ladder system for school nurses should be authorized to the Association of Taiwan School Nurses by the government. More research focusing on the establishment of practice standards and nursing models should be specially encouraged and funded.