臺灣護理照護分級制度之規劃與推動

The Facilitation and Prospects of Schematization of Skill-Mixed Nursing Care Model in Taiwan

臺灣醫療照護體系出現的護理人力短缺問題及護理勞動人力疲憊已嚴重影響醫療照護品質與病人安全。衛生福利部提出護理改革計畫，在護理制度上改革目標以護理業務回歸護理專業為要務，以解決護理業務範圍以及跨專業團隊分工不清的嚴重問題。相關行動方案包括分析護理工作內容、推動技術混合照護模式、增加護理輔助人力、檢討臨床護理進階制度以及釐清護理與醫療專業分工以發展團隊合作模式。本研究團隊比較各國醫療機構的護理照護模式，於全國分區舉辦10場專家學者、護理團體之座談會及說明會，共邀請500位以上的產官學領域之護理學者專家、行政主管及基層人員建立共識，提出團隊合作模式的護理照護分級制度。模式中，在傳統的護理師作為護理照護的核心主力之外，加入護理輔助人力，協助一般技術性之照護工作及一般事務／庶務性之非專業工作。同時，期望藉由推動進階（碩士級）及高階（博士級）護理人力，以協助提供複雜、特殊及困難個案之健康照護，並進行實證分析研究的有效照護計畫，以改善護理人員非專業工作負荷、提升護理照護品質、進而維護病人的安全。

Nursing shortage and overworked nursing workforce have negatively affected the quality of health care and patient’s safety in Taiwan. The Ministry of Health and Welfare proposed the nursing reform program to better define the scope of nursing practices and to clarify the vagueness of inter-professional team-work in order to lead the nursing practice better focusing on the professional tasks. The related action plans include analyzing nursing work content, introducing skill-mixed care model, increasing nursing assistant personnel, re-examining nursing clinical ladder system and clarifying teamwork mode of nursing and medical professionals to develop a cooperative teamwork model. Our research team compared the healthcare models from some countries and held 10 professional forums or seminars or conferences with inviting more than 500 participants such as nursing savants, nursing administrators and nursing staffs, to build the consensus and to initiate a nursing care rating system based on teamwork model. It suggests that the nurse assistants are able to be added to support the nurses, the traditional major nursing manpower, to help the physical care and the non-professional general work. In addition, it also is expected to carried out to introduce the advanced practice nurses (APN) and doctor of nursing practice (DNP) to provide healthcare for the complicated, specific and difficult clients and to complete an effective patient-caring plan with evidence-based practices, in order to alleviate the non-professional loading for the nurses, assure healthcare quality and improve patient safety.