運用德菲法建構腦中風急性後期照顧護理人員應具備之核心能力

A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients

背景：國內醫療照護逐漸重視腦中風病人的急性後期照護（post-acute care, PAC），為政府建置連續性照護的必然趨勢。目的：本研究目的為運用德菲研究法確認提供腦中風PAC服務的護理人員需具備核心能力，做為教育訓練的依據，以提升照護品質。方法：採「修正式德菲法」邀請18位專家，針對「急性後期照護護理人員應具備之核心能力」議題，使用自擬核心能力調查表，進行專家匿名調查。核心能力計29項，分屬「個案照護」（包含照顧、溝通、教學、諮商、家庭評估照護等能力）與「照護管理」（包含跨專業團隊合作、管理、與資源整合等能力）二面向。請專家就各項重要性與可行性以7分等級評分。結果：PAC核心能力的重要性：經由二回合專家共識確認所列項目皆為重要；在可行性方面，進行三回合調查達成共識，唯家庭照護評估、照護管理等能力部分項目呈現護理、醫療、衛政等不同背景的專家之間有評價落差。結論／實務應用：比對現有PAC教育訓練內涵顯示不足以培訓人員必要具備的核心能力，尤以照護管理層面較為缺乏。結果有助未來發展PAC服務護理人員職前與在職教育課程規劃參考。

Background: Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. Purpose: In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. Methods: We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. Results: The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. Conclusions/Implications for practice: The PAC in-job training program in its current form inadequately cultivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.