以修正型德菲法建立台灣愛滋個管師角色與愛滋護理照顧之核心能力

Applying the Modified Delphi Technique to Develop the Role of HIV Case Managers and Essential Nursing Competencies in HIV Care

背景：台灣疾病管制署於2005年始，於指定醫院推行愛滋個管計畫，提供整合性服務及降低風險諮詢。面對臨床照護的日漸複雜性及需要高度專業性，發展以愛滋護理照顧核心能力為基礎的專業教育刻不容緩。目的：建立台灣愛滋個案管理師角色與愛滋護理照顧之核心能力。方法　本研究參考加拿大、英國及非洲的愛滋照顧核心能力，草擬台灣「愛滋個管師角色與愛滋護理照顧之核心能力」架構，包含七個角色及27項能力，以修正型德菲法邀請15位專家共同評定。結果　第一回合共識決策有三項目未達成共識，經整合並修改後，第二回合整體專家共識收斂度達97.06%。定稿的「愛滋個管師角色與愛滋護理照顧之核心能力」為：愛滋病照護專家-9項能力、溝通者-1項能力、合作者-4項能力、領航員-2項能力、管理者-4項能力、代言人-2項能力、專業人員-5項能力。結論／實務應用透過愛滋護理核心照顧能力指標的建立，未來可發展、培育進階愛滋病護理師的核心能力，並應用於長期監測進階護理師提供的愛滋個案管理之照顧品質。

Background: Since 2005, the Taiwan Centers for Disease Control (Taiwan CDC) initiated an HIV case management program in AIDS-designated hospitals to provide integrative services and risk-reduction counseling for HIV-infected individuals. In light of the increasingly complex and highly specialized nature of clinical care, expanding and improving competency-based professional education is important to enhance the quality of HIV/AIDS care. Purpose: The aim of this study was to develop the essential competency framework for HIV care for HIV case managers in Taiwan. Methods: We reviewed essential competencies of HIV care from Canada, the United Kingdom, and several African countries and devised descriptions of the roles of case managers and of the associated core competencies for HIV care in Taiwan. The modified Delphi technique was used to evaluate the draft framework of these roles and core competencies. A total of 15 HIV care experts were invited to join the expert panel to review and rank the draft framework. Results: The final framework consisted of 7 roles and 27 competencies for HIV case managers. In Round 1, only 3 items did not receive consensus approval from the experts. After modification based on opinions of the experts, 7 roles and 27 competencies received 97.06% consensus approval in Round 2 and were organized into the final framework for HIV case managers. These roles and associated core competencies were: HIV Care Expert (9 competencies), Communicator (1 competency), Collaborator (4 competencies), Navigator (2 competencies), Manager (4 competencies), Advocate (2 competencies), and Professional (5 competencies). Conclusion/Implications for Practice: The authors developed an essential competency framework for HIV care using the consensus of a multidisciplinary expert panel. Curriculum developers and advanced nurses and practitioners may use this framework to support developments and to ensure a high quality of HIV care.