建構台灣臨床護理專家制度──混合研究法

Developing a Clinical Nurse Specialist System in Taiwan: A Mixed-Methods Study

背景：因應人口老化與疾病複雜化，臨床護理專家（clinical nurse specialists, CNS）的專業照護需求日益增加，然而台灣尚缺乏完整制度架構，亟需建構CNS制度以提升照護品質。
目的：建構臨床護理專家制度，以強化護理專業能量，進而提升醫療照護品質。
方法：採混合研究法，以國內外相關文獻探討、專家焦點團體訪談、修正式德菲法與全國產官學界共識論壇，初步建構具台灣本土特色的CNS制度。
結果：透過三回合專家焦點團體座談完成的結構式問卷，並由30位Delphi專家學者進行兩回合填答。六章19項條文之可行性與合適性收斂度分別為94%−94.3%與93.6%−95.8%，顯示專家意見高度一致。最終CNS制度架構包含：總則（3條）、任用（6條）、核心能力與工作職責（4條）、甄選（2條）、繼續教育（2條）及工作評核（2條）。
結論／實務應用：本研究建構之CNS制度，有助於拓展護理專業角色並提升照護品質，對台灣護理發展具重要意義。未來推動應強化醫護團隊支持，以提升制度可行性，並建議政府推動法制化認證與資源配置。同時，落實碩士教育培育，以確保CNS實踐品質。

Background: Population aging and increasing disease complexity have increased the demand for specialized care provided by clinical nurse specialists (CNSs). However, Taiwan still lacks a comprehensive institutional framework, highlighting an urgent need to establish a structured CNS system to enhance the quality of care.
Purpose: This study was designed to develop a CNS system to strengthen the nursing profession and improve the overall quality of healthcare delivery.
Methods: A mixed-methods approach combining a literature review, the modified Delphi technique, focus group interviews, and expert consensus forums was used to develop a locally adapted CNS framework for Taiwan.
Results: The CNS framework was developed through a rigorous and systematic process. Initially, three rounds of expert focus group discussions were conducted to identify core components and inform the development of a structured questionnaire. Subsequently, 30 expert panelists participated in two rounds of Delphi surveys to evaluate and refine the proposed framework. The finalized framework comprised 19 articles organized into six chapters and demonstrated a high level of consensus, with convergence rates of 94.0%–94.3% for feasibility and 93.6%–95.8% for appropriateness. The resulting CNS system structure consists of: general principles (3 articles), appointment (6 articles), core competencies and responsibilities (4 articles), selection (2 articles), continuing education (2 articles), and performance evaluation (2 articles).
Conclusions/ Implications for Practice: The CNS system developed in this study contributes substantively to expanding nursing roles and enhancing care quality in Taiwan. Future implementation should focus on strengthening interprofessional support to improve system feasibility in practice. Also, an appropriately funded and supported CNS certification system should be established. Finally, CNS contents must be incorporated into graduate-level nursing education to ensure the quality of CNS practice.