中部某醫學中心推動實證護理經驗

An Experience Promoting Evidence-Based Nursing at a Medical Center in Central Taiwan

醫療知識快速更新，醫療給付政策的改變，民眾對品質的要求日遽，使得醫護人員必須在此多變的醫療環境中，學習新方法，做出正確照護決策，以最有效益的方式，提供高品質的照護服務。實證護理（evidence-based nursing, EBN）能有效管理快速更新醫護資訊，介紹新照護技術，重視醫護相關問題，並關心病人的感受及安全，不僅可以提升護理品質更可對面二十一世紀多變醫療環境。本文主要是推動實證護理之經驗分享，為使EBN在本院護理部推展順利，在2002年時擬定EBN之推展策略方案。2002年開始推廣期以來（至2005年12月），舉辦46場次基礎EBN教育訓練，共1,840人參與；58場次EBN進階教育訓練，共約500人參與。共計提出445篇臨床照護問題進行討論；這些臨床照護問題最常見的是有關於導尿管照護、中心靜脈管路照護以及周邊靜脈注射相關議題等。實證護理小組進一步與護理品質委員會合作將抽痰、導尿管照護、鼻餵管灌照護等三項護理技術以EBN準則修訂相關護理指引。推動EBN這幾年經驗中，深覺EBN能幫助護理人員更新知識，降低臨床照護的變異性與改善護理品質。然而，針對EBN推廣成效，仍有待進一步客觀研究證據。

In the 21st Century, evidence-based nursing (EBN) may provide a mechanism by which nurses can manage the explosion in published information in the literature, introduce new techniques, effectively control healthcare costs, and increase attention on nursing quality and health outcomes. The objective of this paper is to share the experience implementing evidence-based nursing. We had applied strategies to implement evidence-based nursing care in our hospital since 2002. Over a more than three-year period (January 2002 to October 2005), we held 46 basic course sessions (around 1,840 attendees) and 58 advanced course sessions (around 500 attendees). There are 445 clinical questions with answered reports, Most questions related to foley care, central vein care and peripheral intravenous injection. Our nursing department revised three guidelines on nursing care skills related to suction and foley and nasal-gastric feeding to meet local conditions. Based on our subjective experience, promotion and implementation of EBN is feasible and helpful to update knowledge and decrease variance in clinical nursing care. However, further outcome research is needed in the future in order to obtain more objective evidence.