精神科專科護理師執業範圍的展望

The Prospects of Scopes of Practice among Psychiatric Nurse Practitioners

全世界超過五十多個國家已發展專科護理師的制度，其中精神科專科護理師為精神科病人照護不可或缺的重要角色，國內精神科專科護理師已有國家證照，其執業範疇與專科護理師的執業範疇母法一致，亦即精神科專科護理師得於醫師監督下執行醫療業務。未來發展精神科專科護理師的執業範疇可針對民眾的精神及心理健康問題之照護及處置項目進行；並參考美國精神科專科護理師的教育方式，精進精神專科處置技能，至少須接受兩項心理治療模式的臨床訓練，例如：(1)支持性心理治療(2) 家庭治療(3) 生理回饋治療之評估、計劃及執行(4) 行為治療評估、計劃、執行(5) 活動治療、娛樂治療及(6) 精神社會生活功能評估(7) 深度精神健康諮詢等，以提供病人及家屬合宜的個人化照護。但是精神科專科護理師的職業範圍很難與護理師及醫師的職業範圍分層，亦是目前修法的困境之一。同時，精神科專科護理師的養成須朝向精神科專科護理師碩士級及以上的專業培訓，以提升專業素養及技能。目前國內尚缺專屬精神科專科護理師的碩士班，冀望產、官、學界共同討論早日催生，期許精神科專科護理師的學習更具專業化。建議近期內以碩士班研究所或學位學程方式推展，或醫院與大學院校產學合作，甚至產學聯盟的方向進行；更積極擴展病人及家屬對精神科專科護理師的接受度，及計劃性、策略性行銷專科護理師的角色及功能，主動參加各項座談會、公聽會、說明會並具體表達看法。同時加速發展本土化精神科專科護理師的預立醫療流程及照護指引，亦進一步檢測其實用性，以提升病人及家屬的照護品質，並保障專科護理師執業安全及福利。專科護理師職業範疇之施行辦法預計於104 年12 月底頒佈，105 年3 月將再檢討施行狀況及必要的修正。再者，宜進行精神科專科護理師的各種照護成效及人力比率之研究，並建立精神科專科護理師以實證科學依據改善精神科病人臨床照護的現況。

More than 50 countries in the world have developed nurse practitioners for health care. Psychiatric nurse practitioners play a critical role in providing mental health care for psychiatric patients. Psychiatric nurse practitioners follow the same regulation as nurse practitioners in which they provide medical care under the supervision of physician. Future professional development of psychiatric nurse practitioners can focus on mental healthcare therapy and intervention development. It can also emulate the American healthcare system in its education of a psychiatric mental-health nurse practitioner (PMHNP) where emphasis is placed on providing clinical training for mental health care consisting of at least two psychiatric therapies in the following areas: 1) supportive psychotherapy 2) family therapy 3) biofeedback therapy assessment 4) behavioral modification assessment and planning 5) activity therapy, cinema psychotherapy 6) psychiatric social function assessment, and 7) in-depth mental health consultation. However, itis difficult to define the scopes of practice among the psychiatrists, nurses or psychiatric nurse practitioners. Also, psychiatric nurse practitioners can further their professional rankings or secondary education with national medical certificates, master’s and PhD degree programs. Currently, Taiwan a master’s program for psychiatric nurse practitioners is still lacking. Strategic alliances between hospitals, academia, and the government are needed to provide advanced secondary education for psychiatric nurse practitioners. Cooperation between schools and hospitals will allow for academic credits toward short-term medical certificate programs. Their cooperation can also include hosting of health seminars, workshops, public hearing to promote and educate patients on the role of the psychiatric nurse practitioners. Such developments are influential factors to increasing patient and their families’ recognition of the medical services provided by a psychiatric nurse practitioner. Moreover, the quality of care provided by psychiatric nurse practitioners will enhance through programs that addresses the growing diversity of the mental health and psychiatric patients’ needs in Taiwan. Furthermore, development of advance medical care planning and clinical guidelines can help protect the safety and rights of a psychiatric nurse practitioner. The law of scope practice for nurse practitioners will be officially announced on the end of 2015, and will be re-evaluated after three months practice. Additional research is needed to evaluate the effects of care provided by psychiatric nurse practitioners in establishing case studies and determining strategies to improve current healthcare conditions for psychiatric patients and family.