實證健康照護能力納入臺灣基層護理人員臨床專業能力進階制度之現況探討

The Current State of Integrating Evidence-Based Health Care Competence Into Taiwan’s Nursing Clinical Ladder System

背景：有鑑於實證健康照護（evidence-based health care, EBHC）的重要性，臺灣已有醫院將此能力納入護理人員能力進階中，但目前各院在推動方式與要求的現況仍缺乏全面性了解，若各院間在推動上存在差異，恐影響臨床實作、人員晉升公平性及EBHC能力培育的成效。
目的：探討醫院推動EBHC及納入基層護理人員臨床專業能力進階制度之現況及促進與阻礙因素。
方法：採橫斷性研究，於2024年1至3月間以自擬問卷調查台灣護理學會240家會員醫院推動EBHC的現況、是否納入護理人員進階制度及實施方式、促進與阻礙因子等。每家醫院由一位負責規劃與執行相關業務的代表填答。資料以描述性統計分析。
結果：共回收215份有效問卷（回覆率89.6%），其中66.5%醫院已推動EBHC。在已實施進階制度183家的醫院中，68.9%（n = 126）以撰寫實證報告的方式將EBHC納入制度，但此要求僅24.6%（n = 31）納入在所有進階層級中。此外，僅53.2%的醫院要求進階需完成特定的實證教育時數，且各院要求差異大；不同層級的EBHC能力要求與報告標準亦缺乏一致性。主管認同EBHC（73.5%）、組織資源的可近性（69.3%）、教育訓練（68.4%）是主要的促進因素；護理人員英文能力不足（70.2%）、缺乏實證輔導師資（63.7%）為主要的阻礙因素。
結論／實務應用：為促進EBHC能力於進階制度中的推行，建議透過專家共識會議明確各層級EBHC能力要求，並發展分層教育訓練標準與評核方式。護理學校應建立一致的EBHC核心課程。此外，護理專業團體可合作共同發展系統化、數位化的繼續教育模組，促進臨床應用與能力培育。

Background: Given the importance of evidence-based health care (EBHC), some hospitals in Taiwan have incorporated this competency into their clinical ladder systems. However, the details regarding how hospitals implement and integrate EBHC across different ladder levels remain insufficiently understood. Inconsistencies between hospitals may affect clinical practice, staff promotion fairness, and the overall effectiveness of EBHC competency development.
Purpose: This study was designed to explore the current status of the promotion of EBHC in hospitals, how EBHC is being integrated into nursing clinical ladder systems, and the key facilitators and barriers to implementation.
Methods: A cross-sectional survey was conducted between January and March 2024. Representatives from 240 member hospitals of the Taiwan Nurses Association completed a self-developed questionnaire. Questions on the survey examined how the targeted hospitals promoted EBHC, how EBHC was being incorporated into the clinical ladder system, related implementation methods, required educational hours, and perceived facilitators and barriers. Data were analyzed using descriptive statistics.
Results: Of the 215 hospitals that responded (response rate = 89.6%), 66.5% reported having promoted EBHC. Of the 183 hospitals that had implemented a clinical ladder system, 68.9% (n = 126) reported incorporating EBHC competencies by requiring evidence-based reports; however, only 24.6% (n = 31) of these applied this requirement at all ladder levels. In addition, only 53.2% of these 183 hospitals required that nurses complete a specific number of EBHC training hours, with these hours varying substantially across institutions. Moreover, EBHC competency requirements and reporting standards were inconsistent between ladder levels. The key facilitators identified included managerial support for EBHC (73.5%), organizational support (69.2%), and regular training (68.4%). The major barriers identified included limited English proficiency among nurses (70.2%) and a lack of qualified mentors (63.7%).
Conclusion/Implication for Practice: To better integrate EBHC into clinical ladder systems, nursing professional associations should convene expert consensus meetings to define EBHC competencies, develop tiered training standards, and set the assessment methods to be used at each ladder level. Nursing schools should incorporate standardized EBHC core curricula into their programs. In addition, collaboration among professional organizations may facilitate the development of systematic, digital continuing education modules to improve accessibility and support the clinical application of EBHC.