提升新進護理師交班能力

Improving the Shift Handover Abilities of New Nurses

病人安全年度工作目標第一項「促進醫療人員間團隊合作及有效溝通」，於新進護理師座談會，提及擔心獨立後的交班、無法掌握交班重點、遺漏交班等問題。經現況分析發現新進護理師交班能力偏低原因為：新進人員欠缺對疾病了解程度、電腦操作系統不熟悉、無法掌握病人病情及照護重點；臨床教師無相關交班教學課程、以經驗進行教學、教學不一致、即興教學、接班者態度嚴厲；缺乏回覆示教工具、缺乏專科交班規範、缺乏輔助教學工具。專案期間為2023年1月1日至5月30日，擬定解決策略包含推行新進護理師專科疾病圖卡、推行專科疾病電子書[含ISBAR交班（introduction, situation, background, assessment, recommendation, ISBAR）、資訊化交班操作及專科交、接班重點、教學策略等]、舉辦交班護理作業系統操作課程、舉辦交班實作訓練課程、舉辦臨床教師教學營。執行後新進護理師進行自評交班能力由改善前6.0分提升至8.0分、新進護理師交班完整性由改善前76.4%提升至90.0%、交接班之可信賴專業活動（entrustable professional activities, EPAs）Level程度提升至Level 4，皆達到設定目標，結果可作為日後「規劃新進人員到職訓練課程」之參考。

As stated in the Ministry of Health and Welfare’s Annual Patient Safety Goals in 2022, the first aim is to ''facilitate team cooperation and effective communication among medical professionals.'' Recently, a conference held for new nurses highlighted several issues affecting the efficiency and effectiveness of shift handovers, these included concerns related to working independently, potential for omitted treatment or patient information, and the inability to fully comprehend the key goals of a particular nursing shift. After analyzing these issues and concerns, we have identified multiple factors potentially underlying ineffective shift handovers. In the clinical setting, nurses may suffer from a lack of sufficient disease knowledge, unfamiliarity with computer systems, and the inability to grasp certain patient conditions and related care priorities. Moreover, it has been suggested that during the training and education stages, nursing instructors may lack standard and clear instructions focused particularly on shift handover protocol, while instructors may present a strict and impatient teaching manner. Additionally, instructors have been noted to use inconsistent and improvisational teaching techniques, suffering further from a lack of auxiliary teaching tools, and lack of handover guidelines for medical specialties. Accordingly, a solution strategy was developed, revised, and implemented to assist new nurses from January 1 to May 30 2023, was implemented to assist new nurses. This strategy included providing a specialty disease picture card and e-book [containing ISBAR handover (introduction, situation, background, assessment, recommendation, ISBAR), handover procedure details, noted critical issues concerning various medical specialties, and teaching strategies], and establishing system protocol courses, practical handover training courses, and workshops for clinical instructors. After implementing the strategy, the new nurses' self-evaluation scores improved from 6.0 to 8.0 points, while the shift handover success rate improved from 76.4% to 90.0%, and the Entrustable Professional Activities (EPAs) for shift handover increased to Level 4. The planned objectives of our solution strategy were achieved, and can provide a valuable reference for informing new nurse handover training courses in the future.