重整過去展望未來－－談台灣公共衛生護理師的角色與功能

Role and Function of Public Health Nurses in Taiwan: Review of Current Status and Future Perspectives

公共衛生護理是基層健康照護當中最為核心的專業位置。在台灣公共衛生護理師具有兩種不同的角色模式：一是以個人或家庭為對象的基層健康照護服務提供者，另為以群體導向的社區照護者。西方經驗顯示：實務上兩種角色的輕重明顯受到健康照護體系的結構、中央政策與計畫以及保險支付制度的影響。因此，台灣公共衛生護理師角色與功能之調整，應就健康轉型、健康照護體系與政策一併考量。由於實務環境公共衛生護理師人力的不足、慢性病盛行和疾病的多重負擔等因素造成服務輸送的日趨複雜化，因此公共衛生護理師無法再扮演社區統包式服務的角色。相對的，社區衛生護理在精神醫療、長期照護、安寧療護等特殊照護體系、學校與職場、以及醫院的疾病管理等的專業領域應積極發展，並與公共衛生護理互補，讓後者回歸社區，負起「以社區健康為導向的照護者」之責。更重要的是公共衛生護理師應持續與基層醫療建立緊密的夥伴關係，協同合作扮演基層健康照護的服務提供者，發揮示範、支援、協同、服務與監測的功能。

Public health nursing is a core practice of primary health care. Public health nurses (PHNs) in Taiwan act both as individual/family-based primary care providers and as population-based community care providers. Previous studies in Western countries have shown the role preference of PHNs to be highly influenced by the structure of the healthcare system, policies and major programs, and health insurance reimbursement mechanisms. Thus, the impact of the health transition and related changes in the abovementioned systems should be taken into consideration when adjusting the roles and functions of PHNs. The rising prevalence of chronic diseases and the multiple burdens caused by diseases is making healthcare delivery increasingly complicated. With PHNs no longer able to provide ”catch-all” services due to manpower shortages, several potential specialty areas have opened up to participation and development by community nursing. These include psychiatric care, long-term care and palliative care, school/workplace health promotion, and disease management in hospitals. It will be essential that community nurses bridge the gap in service left by PHNs so that PHNs may refocus their job role on the health needs of the community as a whole. PHNs should continue to build partnerships with primary care settings and perform the key functions of demonstration, support, collaboration, service, and surveillance in the community.