護理人員實證護理能力之探究及其在臨床上之應用

A Study of the Evidence-Based Nursing Practice Competence of Nurses and Its Clinical Applications

背景：為了因應臨床實務需求，培養護理人員有足夠的實證護理能力，經由發現問題、搜尋資料、研讀與整合文獻，將最佳證據應用在病人身上，做最妥善的醫療照護，以提升護理照護品質。因此，臨床實務之需求，有其必要於醫療機構中精進護理人員實證護理能力。目的：本研究目的為評估基礎實證護理種子培訓課程介入，對於提升護理人員實證護理知識、實證護理實務自我效能、實證照護預期結果以及實證護理應用阻礙之改變。方法　本研究為類實驗性單組前後測研究設計，採方便取樣，以北部某市立醫院的34名護理人員為研究對象；接受2週共8小時基礎實證護理種子培訓課程，並於培訓課程前後填寫研究問卷，研究工具包括：基本屬性問卷、醫護文獻之搜尋與使用經驗、實證護理知識測驗I及II、實證護理實務的自我效能、實證照護預期結果量表、實證護理應用阻礙及學習滿意度。使用paired t test、Wilcoxon SignedRank和McNemar檢定分析資料，以瞭解護理人員參與「實證護理概念與應用」工作坊後，其實證護理知識與行為之改變。結果　護理人員透過「實證護理概念與應用」工作坊介入後，實證護理知識測驗II、實證護理實務的自我效能、實證照護預期結果量表上，後測平均數均比前測高，且皆呈統計上顯著差異；實證護理應用阻礙方面，後測平均低於前測，顯示護理人員在應用上之阻礙較介入前低，惟未達統計顯著差異。結論　實證護理課程對於提升護理人員之實證護理知識、自我效能、預期結果皆有顯著效果，也能降低護理人員對於實證護理的應用阻礙。醫療院所可定期舉辦實證護理課程，提供護理人員在職進修之管道，使護理人員能將實證技能與知識應用於臨床，提升病人照護品質。

Background: Nurses must develop competence in evidence-based nursing in order to provide the best practice medical care to patients. Evidence-based nursing uses issue identification, data mining, and information consolidation from the related medical literature to help nurses find the best evidence. Therefore, for medical institutions to provide quality clinical care, it is necessary for nurses to develop competence in evidence-based nursing. Purpose: This study aims to explore the effect of a fundamental evidence-based nursing course, as a form of educational intervention, on the development of evidence-based nursing knowledge, self-efficacy in evidence-based practice activities, and outcome expectations of evidence-based practice in nurse participants. Further the competence of these nurses in overcoming obstacles in evidence-based nursing practice. Methods: This quasi-experimental study used a pre-post test design with a single group of participants. A convenience sample of 34 nurses from a municipal hospital in northern Taiwan received 8 hours of a fundamental evidence- based nursing course over a two-week period. Participants were asked to complete four questionnaires before and after the intervention. The questionnaires measured the participants' basic demographics, experience in mining the medical literature, evidence-based nursing knowledge, self-efficacy in evidence-based practice activities, outcome expectations of evidence-based practice, competence in overcoming obstacles in evidence-based nursing practice, and learning satisfaction. Collected data was analyzed using paired t, Wilcoxon Signed Rank, and McNemar tests to measure the differences among participants' evidence-based nursing knowledge and practice activities before and after the workshop. Results: The nurses demonstrated significantly higher scores from pre-test to post-test in evidence-based nursing knowledge II, self-efficacy in evidence-based nursing practice activities, and outcome expectations of evidence-based practice. Although the differences did not reach statistical significance, the post-test scores were significantly lower than pre-test scores in terms of the measurement of the nurses' obstacles in evidence-based nursing practice, which indicates significant improvements from pre-test to post-test in terms of the competence of participants in overcoming obstacles in evidence-based nursing practice. Conclusions: The intervention was found to be effective in improving the evidence-based nursing knowledge, self-efficacy in evidence-based nursing practice activities, and outcome expectations of evidence-based practice of participants and effective in reducing their obstacles in evidence-based nursing practice. Medical institutions should provide evidence-based nursing courses on a regular basis as a part of in-service education for nurses in order to help nurses develop the evidence-based nursing knowledge and practical competence required to provide quality clinical care.