實證健康照護於臨床轉譯之應用──以跨專業合作經驗為例

Application of Evidence-Based Healthcare in Clinical Translation: An Interdisciplinary Collaboration Experience

本文旨在闡述實證健康照護於臨床轉譯之跨專業合作經驗。承襲1992年英國國家衛生服務部於牛津大學成立Cochrane Center所揭示之實證醫學精神，本機構以護理專業為核心驅動力量，透過跨領域協作機制、系統化教育訓練與知識轉譯策略，將最佳研究證據整合至臨床決策與品質改進流程中，深化實證導向之臨床健康照護應用。於臨床照護層面，護理團隊主導多項以病人安全與照護品質提升為目標之實證專案，包括跌倒預防、感染控制、鼻胃管滑脫預防、低體溫措施改善創傷性腦損傷病人神經功能、術後姿勢調整、急性期COVID-19肺部復健，以及加護病房家屬介入以降低譫妄發生率等。相關措施多以系統性文獻回顧與成效評估為基礎，結果顯示不良事件發生率明顯下降，病人功能恢復與生活品質顯著改善。護理人員於評估工具建構、照護流程設計、成效監測與持續品質回饋中發揮整合與主導角色，彰顯其於臨床實證應用之專業自主性。在指引發展方面，護理部門主導癌症症狀照護及肝癌治癒後續追蹤指引之建構，倡議以全人照護為核心之整合模式，並協同醫師、藥師與營養師等專業共同制定跨領域照護標準；同時積極輔導專科護理師撰寫進階實證臨床照護指引，強化高階護理實務能力與學術產出。於醫病共享決策與聰明抉擇推動方面，護理人員參與決策輔助工具開發與結構化溝通模式之應用，促進病人價值澄清與參與決策，並提升醫療資源運用之合理性與安全性。整體而言，護理專業於實證臨床體系中兼具照護實踐、研究參與、教育推動與知識轉譯之多重功能，為實證導向臨床照護之永續發展奠定重要基礎。

This article was written to describe the authors’interprofessional collaboration experience with regard to the clinical translation of evidence-based healthcare. Building upon the spirit of evidence-based medicine invoked at the founding of the Cochrane Centre at Oxford University under the United Kingdom’s National Health Service in 1992, our institution recognizes nursing as the core driving force supporting the translation of evidence-based healthcare in clinical settings. Using interdisciplinary collaboration mechanisms, systematic education and training, and knowledge translation strategies, the best research evidence is integrated into clinical decision-making and improving care quality, thus deepening the application of evidence-based clinical healthcare. In clinical care, nursing teams have led multiple evidence-based initiatives targeting patient safety and care quality improvement. Issues addressed have included fall prevention, infection control, nasogastric tube dislodgement prevention, hypothermia interventions to improve neurological outcomes in patients with traumatic brain injury, post-operative positioning adjustments, acute-phase COVID-19 pulmonary rehabilitation, and family-centered interventions in intensive care units to reduce the incidence of delirium. These initiatives have been significantly grounded in the findings of systematic literature reviews and outcome evaluations, with results demonstrating a notable reduction in adverse event rates and significant improvements in functional recovery and quality of life in patients. Nursing personnel play an integrative and leading role in assessment-tool development, care process design, outcome monitoring, and the continuous provision of quality feedback, reflecting their professional autonomy in the clinical application of evidence-based practice. In terms of guideline development, the nursing department has taken the lead in constructing guidelines for cancer symptom management and post-curative follow-up care for patients with liver cancer, advocating for an integrated model centered on holistic care, and collaborating with physicians, pharmacists, and dietitians to jointly establish interdisciplinary care standards. Also, the department has actively mentored advanced practice nurses in writing evidence-based clinical care guidelines at an advanced level, strengthening advanced nursing practice competencies and academic output. With regard to shared decision-making and Choosing Wisely initiatives, nursing staff participate in the development of decision support tools and the application of structured communication models to facilitate patient value clarification and engagement in decision-making, while concurrently enhancing healthcare resource-utilization appropriateness and safety. Overall, within the evidence-based clinical system, the nursing profession fulfills multiple functions in the realms of care practice, research participation, education promotion, and knowledge translation, laying a strong foundation for the sustainable development of evidence-based clinical care.