某醫學中心專科護理師對工作範疇的看法

The Views of Nurse Practitioners Toward the Scope of their Work in a Medical Center

背景：2000年臺灣立法通過「專科護理師」法定名稱，2006年舉辦專科護理師證照考試，執業範疇在護理人員法第24條業務規範下運作，因醫療輔助行為之工作職責規範不清，造成專科護理師執業的模糊地帶。本研究目的為了解急性照護醫院專科護理師的工作範疇。
方法：於2009年1月至12月進行質性研究，立意取樣具內或外科專科護理師執照的專科護理師共18人，以自擬訪談指引，進行一對一的深度訪談，以內容分析法進行資料分析。
結果：本研究結果將專科護理師對工作範疇的看法歸成三個主題九大類：第一類為現行法規下的工作範疇，包括：(1)住院病人身體理學檢查之初步評估及病情詢問；(2)紀錄住院病人病情及各項檢查、檢驗結果；(3)處理住院病人及其家屬醫學諮詢及病情說明；(4)在醫師指示下，開立檢驗、檢查申請單；(5)在醫師指示下，開立處方。第二類是隨時補足照護團隊的模糊專業界線，包括：(1)醫療業務多於護理業務；(2)認知模糊的角色及工作範疇；(3)於指示下執行侵入性的醫療輔助行為；第三類是被挑戰的專業能力，主要是臨床研究、影像學判讀及鑑別診斷與藥物學的能力。
結論與實務運用：專科護理師的醫療輔助工作範疇超越現行法規的規範。結果可作為規劃專科護理師教育訓練設計的依據及作為制定專科護理師在醫療輔助行為及進階護理臨床照護工作範疇的參考依據。

Background: In 2000, Taiwan’s legislature approved the legal title “nurse practitioner”, and consequently, certification examinations for nurse practitioners began in 2006. The scope of practice is based on Article 24 of the Nursing Personnel Act. However, since the work responsibilities involved in the provision of medical assistance are not clearly established, the professional duties of nurse practitioners often fall into a grey area. The aim of this study is to investigate the scope of work of nurse practitioners in an acute care hospital. Method: Qualitative research was carried out between January to December, 2009. Purposive sampling was used to select 18 nurse practitioners with either surgical or medical nursing practitioner certification. We produced an interview guide to carry out one-on-one in-depth interviews, and used content analysis to analyze the data. Results: The views of nurse practitioners toward the scope of their work were separated into three themes and nine categories. The first category is the scope of work under existing regulations, including: (1) The initial physical examination, asking the patient about his or her illness; (2) Recording the patient’s medical condition and the results of each medical examination and test; (3) Responding to questions from the patient and his or her family, and explaining the patient’s medical condition; (4) Applying for medical tests and examinations under the direction of the physician; and (5) Prescribing medicines under the direction of the physician. The second category is additional assistance given to the care team when needed, which may fall into a professional grey area, including: (1) Medical duties are greater than nursing duties; (2) Lack of clear understanding of the role and scope of work; and (3) Assisting with invasive medical procedures when required. The third category is challenges to the professional competence of nurse practitioners, primarily clinical studies, visual image interpretation, differential diagnosis, and pharmacological capabilities. Conclusions and practical application: The medical assistance provided by nurse practitioners exceeds the scope of existing regulations. The results of this study can be used as a basis for designing training for nurse practitioners, and establishing the scope of medical assistance and advanced clinical nursing care provided by nurse practitioners.