比較專科護理師自覺重要角色能力與實際執行角色能力之看法：以Q方法探討

Comparison of Role Competencies Between Perceived Importance and Actual Practice in Nurse Practitioners Using Q-Sorts

背景：專科護理師（nurse practitioner, NP）之進階護理角色在臨床期盼上仍有落差，導致NP自身對角色能力期待與發展產生困境。目的：本研究藉由調查NP角色能力之自覺重要性與實際執行現況，來探討理想與實務層面下的差異性及其影響因素。方法：以橫斷性研究設計，利用Q方法進行資料收集。測量工具以「專科護理師角色能力問卷量表」共56題，二個研究問題相隔二週做調查。研究對象共40名，含內科21位（52.5％）與外科19位（47.5％）。結果：NP自覺重要角色能力與實際執行角色能力有顯著差異的結構面有：醫療輔助（t＝-5.62，p＜.001）、臨床研究（t＝4.14，p＜.001）、專業諮商（t＝2.29，p＝.027）及直接照護（t＝2.21，p＝.033）。基本屬性中，在教育程度（t＝-2.17，p＝.036）與是否加入專科護理師學會（t＝-2.36，p＝.017）達顯著差異，顯示學歷愈高或具專科護理師會員者，對重要角色能力抱持高度自我期許。結論：專科護理師在面臨角色期望仍有不符，尤其在實務面極重在醫療輔助上，專科護理師需回歸及落實進階護理的角色與功能，以利護理專業之提升。

Background: The gap between the expectation and the development of role competency is a dilemma that nurse practitioners (NPs) face in clinical settings . Purpose: This study was designed to explore the perceived importance and actual practice of the role competencies of NPs and to compare the differences between the ideal and practical domains as well as related factors. Methods: This cross-sectional design study used Q-sort to collect data. A 56-item “Nurse Practitioner Role Capacity Questionnaire” was used as the research tool. Two questionnaires: Perceptions of Important Role Competencies and Actual Execution of Role Competencies were distributed to NPs twice, at times that were 2 weeks apart. A total of 40 participants were recruited, including 21(52.5%) internal medicine NPs and 19 (47.5%) surgical medicine NPs. Results: The significant differences that were identified in this study between the perceived importance and actual practice of role competencies were, by domain: medical assistance (t = -5.62, p < .001), clinical research (t = 4.14, p < .001), professional consultation (t = 2.29, p = .027), and direct care (t = 2.21, p = .033). The correlative factors for these differences were: education level (t = -2.17, p = .036) and membership in the Nurse Practitioner Association (t = -2.36, p = .017). NPs with higher levels of education and with membership in the Nurse Practitioner Association earned higher scores for self-expectation in important clinical competency. Conclusions: NPs face discrepancies in their role expectations, in important part due to their role as providers of medical assistance in clinical practical settings. NPs need to learn and demonstrate the roles and functions of advanced nursing practice to enhance nursing professionalism profoundly.