深耕於社區的護理專業

Nurses Deliver Quality Care in the Community

醫療服務的版圖逐漸發生移位現象，由於人口老化及少子化的趨勢，醫療費用的限制情況下，許多國家逐漸以預防保健照護、出院後社區的次級後續照護(sub-acute care)及長期照護等服務模式面對挑戰。對社區人員和患者來說，護理人員能夠幫助他們統籌保健需要，與民眾合作並提供支持，張等專家指出未來台灣護理發展的趨勢將從醫院趨向社區（張、余、陳、田，2005）；但不斷發展的社會變遷（例如新移民的增加）及新增的健康問題與需求（例如慢性病與不良生活型態）錯綜複雜，以目前國內公衛護士素質與學養，能否單獨承當挑戰？並有一定程度的專業知識和技能執行行動？余玉眉教授(2005)建議應將「公衛護士／護理師」的角色定位於「促進健康」(promoting health)和「預防疾病」(preventing illness)為主，依其領域的需求，強化其執業能力，回歸專業責任的本質，佐以適切的職前訓練與持續的在職進修。而幾次的政府行政改組，使公共衛生護理人員角色與功能更面臨新舊業務轉型的衝擊；雖有上述種種政策的限制與現實執行上的困難，台灣社區護理工作者仍孜孜不倦努力在各職場發揮自己的光芒；透過公衛體系的預防把關，長期照護的持續護理，產後機構的母嬰協助、居家護理的個案管理、學校衛生護理的理念灌輸與職場護理的管理監控。台灣的社區護理專業人員呈現多元發展與深化耕耘的精神，為各階層民眾提供質優的照護。

In Taiwan, responsibility for administering healthcare services is being gradually moved out of hospitals and into the community. As such, nurses are increasingly required to address new problems and meet the specific healthcare needs of important subgroups such as Taiwan's growing elderly population and young adult immigrants. Because policies have lagged behind such developments, nurses are expected to provide leadership in addressing these new challenges. Their status within the medical system, however, continues to reflect earlier, more 'traditional’ stereotypes and gives inadequate credit for current responsibilities, which include providing long term healthcare and public health nursing, in addition to homecare responsibilities. In the face of these challenges, Taiwan community nurses have continued to develop new ways to provide care and demonstrated innovation, commitment and flexibility in their roles. If nurses are to continue to take a leading role in developing community healthcare services, they require professional recognition as well as appropriate policy support from regulatory and local government authorities.