專科護理師自主性之概念分析

Nurse Practitioner Autonomy: A Concept Analysis

自主性是專科護理師臨床工作的基石，缺乏自主會阻礙其角色上的自信心、自尊與限制專業發展。有鑒於目前國內缺乏相關的探討與研究，本文依據Walker及Avant(2011)所提出概念分析步驟，進行國內專科護理師自主性之概念分析。結果指出專科護理師的自主性定義性特徵為：(1)取得專科護理師證書並受聘於醫療機構；(2)可獨立執行規範內之醫療業務；(3)具臨床自信心且對自己的行為負責；(4)具臨床決策能力，可依據自身的知識、技能、批判性思考和判斷，選擇對病人最佳的照護；(5)與醫療團隊合作、共同承擔責任。專科護理師自主性的前置因子包括：(1)護理科系畢業者，應具備護理師證書且工作年資三年以上，或(2)護理研究所畢業者，具備護理師證書且工作年資二年以上，以及(3)正向的執業環境。專科護理師自主性的正向後果為工作滿意度增加、促進團隊合作關係、改善病人照護成果。期望透過概念分析呈現專科護理師自主性之意涵，以提供醫療團隊對專科護理師的自主性有較完整的認識，進而提升專科護理師在醫療職場上的專業性。

The role of nurse practitioners in the medical care system has undergone significant development over the years, with their autonomy serving as the foundation for their clinical work. The absence of nurse practitioner autonomy can hinder their confidence, self-esteem, and professional growth. Surprisingly, there have been no reports addressing this concept in Taiwan. Thus, this paper employs the strategies of conceptual analysis as described by Walker and Avant (2011) to analyze nurse practitioner autonomy. Nurse practitioner autonomy, as characterized in this study, refers to nurse practitioners who: (1) hold the nurse practitioner certificate and are employed by a medical institution, (2) possess the capability to independently perform medical tasks within the scope of regulations, (3) demonstrate clinical confidence and take responsibility for their actions, (4) exhibit clinical decision-making abilities, allowing them to select the best care for patients based on their own knowledge, skills, critical thinking, and judgment, and (5) collaborate with the medical team and share responsibilities. The antecedents of nurse practitioner autonomy include: (1) obtaining a nursing degree from an accredited institution and holding registered nurse certifications, having more than three years of nursing experience with a nursing diploma or bachelor's degree, or (2) having more than two years of nursing experience with a nursing master's degree, and (3) along with a positive working environment. The positive outcomes of nurse practitioner autonomy encompass increased job satisfaction, improved teamwork relationships, and enhanced patient care outcomes. This paper presents novel information on nurse practitioner autonomy, hoping to foster a better understanding of this concept among health professionals. By doing so, it aims to enhance the professionalism of nurse practitioners in the medical workplace, ultimately contributing to improved healthcare delivery and patient outcomes.