提升急診新進護理人員臨床照護技能正確率

Project of Enhancing the Correct Rate of Clinical Care Skills for New Emergency Nurses

在醫院中，急診的工作一向是急迫且繁忙，而病人也都有高且複雜的疾病嚴重度，急診護理人員需具備快速且正確臨床照護技能的執行能力，才能有效維持病人的生命安全。因2014年本院急診照護異常事件共有53件，其中新進護理人員就佔有42件（79.2%），故成立本專案小組。於2015年3月8日至3月30日，以自訂之「急診新進護理人員臨床照護認知試卷」及「急診新進護理人員臨床照護技能正確性查核表」，針對55位急診新進護理人員進行調查及分析，結果發現造成新進人員臨床照護正確率低的原因為：（1）未實際操作過臨床照護技能；（2）缺乏臨床照護技能指導手冊；（3）未接受過相關照護技能訓練；（4）班別不同教學無法連續性；（5）臨床技能流程不熟悉；以及（6）臨床教師指導方式不一。經本組討論後提出之改善措施為：（1）舉辦臨床照護技能模擬訓練；（2）舉辦臨床照護技能課室教學；（3）製作急診臨床照護技能操作指引；（4）製作臨床照護技能學習光碟等四項對策。本專案自2015年5月1日至9月4日，分計劃、執行和評值三階段執行，結果顯示：臨床照護技能認知正確率由75.4%提升至95.7%，照護技能正確率由70.4%提升至95%，確實提升了急診新進護理人員對臨床照護技能的認知程度及執行正確性，成效顯著。本專案結果可提供臨床急診單位提升新進護理人員臨床照護技能執行正確性之參考。 Emergency room (ER) is a place characterized by urgent and busy work with extreme severe diseases. ER nurses need to implement clinical care skills quickly and correctly to maintain patient safety. In 2014, among 53 emergency room incident reports, 42 (79.2%) were performed by new nurses. To understand the causes for the highe incident rate, we used the ＂Recognition Test of Clinical Care Skills for New Emergency Nurses＂ and the ＂Checklist of Performance Correctness on Clinical Care Skills for Emergency Care for New Emergency Nurses＂ to survey 55 new emergency nurses from March 8 to March 30, 2015. The reasons for the low accuracy of clinical care skills among new nurses included no experiences in practicing clinical care skills, lack of guiding manual for clinical care skills, no trainings of clinical care skills, clinical mentors having different shift rotations, interruption of teaching, not familiar with procedures of clinical care skills, and clinical mentors having different teaching styles. After data analysis and discussion, we developed improvement measures as the followings: conducting clinical care skills simulation training, conducting clinical care skills classroom lecturing, providing guidelines for the development of clinical care skills, and producing training disc of clinical care skills. The project was divided into three phases from May 1st to September 4th, 2015: planning, implementation, and evaluation. The results showed that the recognition rate of clinical care skills increased from 75.4% to 95.7%, and the performance of clinical care skills increased from 70.4% to 95%. This project improved the correctness and awareness of clinical care skills of new emergency nurses. The project had achieved remarkable results and provided a reference for other clinical units to enhance clinical care skills of new nurses.