營造實證實務組織文化——實證護理與能力進階制度結合之經驗

Building an Evidence-Based Practice Culture: Incorporating Evidence-Based Nursing in the Clinical Ladder System

從提供消費者有效率且高品質的健康服務或從健康政策制定的觀點而言，強調以證據為導向的臨床實務已是醫療照護的趨勢。換言之，傳統解決問題的方法已不符合現今多變的醫療體制，護理人員必須藉由有系統的科學思考模式，來收集、解讀和判斷臨床上各種訊息的意義和重要性，進而做出正確的臨床決策。如何於繁忙的護理工作中讓護理人員認知實證護理之重要性並能學習以實證的步驟來解決臨床問題，營造實證組織文化實是最根本之做法，唯有內化了才能永續。本文針對筆者們所工作之醫學中心，如何將實證護理結合現有的能力進階制度加以說明。主要策略為：一、將實證護理導入新進人員的基礎教育；二、將實證護理能力的展現做為能力進階的評量標準之ㄧ，規劃不同層級實證護理報告；三、建立輔導機制，提供各項輔導方案，包括全院及病房的實證護理研習及個別輔導。期待本文所提出之策略能做為其他有志於推動實證護理文化的教育工作或政策制定者之參考。

Evidence-based practice has become a dominant trend in the healthcare with the objective of providing efficient, high quality health care, and policy making. Traditional problem-solving methods may not adequately address consumer needs in the rapidly changing modern healthcare system. In order to make correct decisions, a systematic and scientific approach to the collection, assessment, and interpretation of clinical information is essential for the health care provider. Creating an evidence-based practice nursing culture is the most fundamental way for nurses to recognize the importance of evidence-based nursing and, subsequently, adapt to solving clinical problems. This paper elaborates the strategy for incorporating evidence-based nursing into the clinical ladder system used at the authors’ affiliated medical center. Three strategies are introduced. These are: (1) including the EBN concept in newcomer in-service training; (2) adopting evidence-based nursing practice competence as a criterion in the clinical ladder system, with various evidence-based, ladder-related reports required for promotion; and (3) providing support to nurses through centralized and decentralized education as well as individual consultation. The proposed strategy is provided as a practical reference for educators and policy makers working to foster evidence-based practice nursing cultures.