可信賴專業活動在新進臨床護理師培訓期的應用

Implications of Entrustable Professional Activities on New Nurses Postgraduate Year Training

背景：近年來臨床醫學教育的訓練轉移到能力導向的教育模式，掀起了一股以「勝任能力」為導向的醫學教育，而可信賴專業活動（entrustable professional activities, EPAs）的導入與發展，使得臨床醫事人員培訓計畫，能夠更全面性與整合性的評值培訓期學員的專業能力，本文介紹EPAs基本內涵，並提出EPAs建置、規劃及臨床評量的初步應用經驗。方法：以名義團體法及問卷調查進行EPAs任務建置，並以EPA品質評量工具EQual（Queen's EPA Quality Rubric, EQual）檢核「住院病人給藥」EPA的效度，再以評分者間一致性建置評量的信度。結果：以名義團體法與問卷調查共建置8個EPAs任務，其中以「住院病人給藥」為例所建置的EPA內容與訓練評估表單運用於臨床評量22位新進三個月護理師，並評定信賴程度監督等級。經過總結式評量結果顯示有21位（95.5％）學員於滿第三個月培訓期達到可獨立執行監督等級level4程度，其中有一位介入輔導仍無法勝任給藥任務。結論：本文以新進人員三個月培訓期EPA發展為例，分享其在臨床護理培訓的應用，並提出初步應用後的反思與建議，作為後續EPAs應用於護理教育上的參考。

Background: The current trend of medical educational has been transformed to competency-based model. The introduction and development of entrustable professional activities (EPAs) enable the evaluation of postgraduate year program more comprehensive and integrative. This paper introduced the elements and principle of EPAs. We also shared our preliminary experiences in the development and implementation of EPAs for new nurses’ postgraduate year training. Methods: We used nominal group technique and questionnaire survey to develop EPAs. Equal (Queen's EPA Quality Rubric) was used to test the validity of “drug administration to hospitalized patients” EPA, and inter-rater reliability was used to ensure the consistency of assessment. Results: There were eight EPAs developed through the nominal group technique and questionnaire survey. The “drug administration to hospitalized patients” EPA was implemented with 22 new nurses at the end of the third month of training, and their levels of supervision were evaluated. The summative assessment reveals that 21 (95%) new nurses reached the level 4 of supervision as allowed to perform the activity unsupervised. One new nurse was unable to be competent with the drug administration task even by given guidance. Conclusion: We developed nursing EPA for the first three months training period. We also proposed our reflection and further suggestions addressed from the preliminary experiences. Hopefully our experiences of EPAs can provide as a reference for clinical nursing education.