台灣與美國維吉尼亞州精神衛生照護反思－－地理、歷史、文化與專科護理師

Reflection on the Differences and Similarities of Mental Health Care in Virginia and Taiwan: Geography, History, Culture, and Nurse Practitioners

因教育部學海築夢獎助計畫，筆者帶領10位學生，對美國維吉尼亞州（以下簡稱維州）精神衛生照護體系進行一個月的學習，包含：Catawba州立醫院、Salem榮民醫學中心、Carilion Saint Albans行為健康（New River Valley醫學中心）、Warm Hearth高齡健康社區中心、私立兒童成人與家庭諮商護理師執業診所、New River Valley免費診所、及主動式社區治療自治俱樂部。透過觀察、深度對話與部分實地參與護理活動的珍貴經驗，引發筆者對本土精神衛生照護與專科護理師角色的省思。本文嘗試從巨觀視角比較台灣及維州，包括：地理特質、歷史、文化的異質性、保險制度對民眾求醫行為的主導性影響、以及護理師其他醫療專業人力的競合關係，來反思專科護理師角色，而社會文化脈絡與醫療大環境是過去文獻未曾觸及的面向。期盼透過此跨文化的對照及反思，了解地理、歷史、文化、醫療保險體系等因素，對專科護理師專業角色的形塑及其間的互動，並提供思考護理專業未來的觀點及建議。

Sponsored by the pilot overseas internships project of the Ministry of Education, Taiwan, the authors and ten undergraduate students from Taiwan visited several mental health facilities in Virginia for one month. These facilities included the Catawba State Hospital, Salem Veteran Affairs Medical Center, Carilion Saint Albans Behavioral Health (New River Valley Medical Center), Warm Hearth Village, Adult & Child Family Counseling private outpatient clinic, the Free Clinic of the New River Valley, New Life Clubhouse, and Self-Government Program for Assertive Community Treatment. Indepth dialogue and participation in nursing care under the supervision of registered nurses facilitated the authors’ reflection on mental health care and the roles and functions of Taiwanese nurse practitioners. The present article adopts a macro view in order to compare the related issues between Taiwan and Virginia, including: geographic features, history, culture of health-seeking behavior, healthcare insurance, and the relationships among various professionals. How these issues relate to social-cultural background and how the overall healthcare environment impacts upon the roles of nurse practitioners in Taiwan are rarely discussed in literature. We expect that this cross-cultural contrast and reflection will elicit a better understanding of how these factors have shaped and affected the roles of Taiwanese nurse practitioners. Further, suggestions about how to improve the nursing profession in Taiwan are presented.