本研究利用次級分析法探討外科病房新進護理人員(簡稱新人)的照護情境掌握自信和護理執業能力精熟度及其影響因素；並分析外科病房新人的執業訓練需求。研究對象為行政院衛生署所屬醫院外科病房工作一年內的新人，採結構式問卷調查法收集資料，發出143份問卷(新人103份、病房負責人40份)，回收有效問卷127份(新人92份，病房負責人35份)，回收率為88.81%。本研究獲得資料的二個測量工具「照護情境掌握自信量表」(四個子量表，共50項)和「護理執業能力精熟度量表」(四個子量表，共86項)的內容效度經過五位外科護理專家檢測與確認；二個量表的四個子量表內容一致性檢測的Cronbach’s α值分別是：.946~.985和.947~.985，顯示量表的內容一致性高。   

本研究資料使用SPSS for Windows 15.0套裝軟體進行描述性統計、皮爾森相關係數（Pearson’s r）、獨立樣本t檢定（t test）、單因子變異數分析（one way ANOVA）和多元迴歸分析（multiple regression）分析推論問題，共獲得六個結果：(一)新人的四類照護情境掌握自信(0~10分)平均值分別為6.59(±1.38)、6.56 (±1.53)、6.65 (±1.48)、7.00(±1.75)；四類執業能力精熟度(1~4分)平均值分別為3.10 (±0.57)、3.24 (±0.56)、3.15(±0.60)、3.00(±0.54)。(二) 三組不同工作月數(三個月內、三至六個月內、六至十二個月)新人的照護情境掌握自信和護理執業能力精熟度，均是六至十二個月的新人顯著高於三個月內的新人。(三)新人的照護情境掌握自信與護理執業能力精熟度之間呈現顯著性正相關，前者可解釋後者18.9%的變異量。(四)個人因素(工作月數、執業能力精熟度)和組織因素(同儕支持度、病人及其家屬支持度)可解釋新人照護情境掌握自信的44.3%變異量，其中工作月數為照護情境掌握自信的重要影響因素。(五)新人培訓需求排序(1最高、5最低)是隨著工作月數增加而遞增。

四類照護情境掌握自信的排序在3以上者有21項，其中三個月內新人2項，三至六個月新人13項，六至十二個月新人六項。四類執業能力精熟度排序方面，三個月內新人自評的平均值均高於病房負責人的期待值(未呈現培訓需求)，三至六個月及六至十二個月新人組執業能力精熟度86項的培訓需求排序均在3以下。

本研究討論四類照護情境及執業能力項目的重要性、常見性及工作各期別被期待具備的能力，建議未來學校及臨床規劃與設計就業課程、職前與繼續教育課程可納入參考的內容大綱。

This study adopted a secondary analysis method to explore nursing practices situation handling confidence and nurse’s practicing competencies mastery and its related factors for new nurses who had worked in surgical wards for one year . The training needs of new nurses in surgical wards were also examined. The convenience sample included nurses who had worked for one year or less at hospitals Department of Health. Data were obtained from structural questionnaires. Out of 143 questionnaires issued (103 for nursing personnel and forty for ward supervisors)127 copies were collected (ninety-two from new nurses and thirty-five from ward supervisors, a validity rate of 88.81%. The two measurement tools in the study were the Nursing Practicing Situation Handling Confidence Scale (fifty items in four sub-scales) and the Nursing Practice Competencies Mastery Scale (eighty-six items in four sub-scales ). Content validity was examined by five surgical nursing experts. Two scales of four categories for Cronbach α between .946~.985 and .947~.985 revealed high internal consistency.

Descriptive statistical analysis was performed using SPSS 15.0 for Windows, Pearson r, t test, one-way ANOVA and multiple regression. The data analysis revealed the following six conclusions : (1) The averages of four categories of nursing practice situation handling confidence (0~10) were 6.59(±1.38), 6.56 (±1.53), 6.65 (±1.48) and 7.00 (±1.75). The averages for four categories of nursing practice competency mastery (1~4) were 3.10 (±0.57), 3.24 (±0.56), 3.15(±0.60) and 3.00(±0.54). (2) In nursing practice, situation handling confidence and nursing practice competency mastery of three groups of nurses who had worked less than one year (3 months, 3-6 months and 6-12 months), the group who had worked for 6-12 months had better performance than the other two groups. (3) Nursing practice situation handling confidence and nursing practice competencies mastery were positively related; the former explained 18.9% of deviation in the latter. (4) Individual factors (number of months of experience, nursing practice competencies mastery) and organizational factors (support from peers, patients and their families) explained 44.3% of the deviation in confidence of nurses in handling nursing practice situations. Working months was an important influential factor in nursing care self-confidence. (5) Training needs (1 highest to 5 lowest) of new nurses increased with the number of working months.

Twenty-one priority items were noted in three of the four categories, two for nurses who had worked for 3 months, thirteen for new nurses who had worked 3-6 months and six for new nurses who had worked for 6-12 months. In order of nursing practice competence mastery of the four categories, self-assessment values of new nurses who had worked for less than 3 months were higher than the expected values of nurses in charge of wards (no training needs available); eighty-six items in nursing practice competency mastery of new nurses who had worked for 3-6 months and 6-12 months is below 3. 
       This study explores the importance, prevalence and the expected abilities of four categories of care scenarios and practice ability items. Results of this study provide a valuable reference for incorporation in future nursing school curricula and clinical planning when designing courses for employment, orientation training and continuing education courses.