中醫護理人員自評臨床照護能力及其相關因素之研究
The study of self-evaluated clinical care competencies and its related factors among the traditional

Chinese medicine nurses

背景 自 1995 年中醫正式被納入健保，中醫醫療工作隨之蓬勃發展，醫學中心 陸續設有中醫部，護理人員亦已積極參與中醫照護業務。為提升中醫的照護水 準，訂立中醫護理人員具照護能力之標準已是刻不容緩。因此評量中醫護理人員之臨床照護能力，是目前很重要的議題。

目的本研究目的主要在探討中醫護理人員中醫臨床照護能力自評之情形、中醫臨床照護能力之差異性、及分析影響中醫護理人員中醫臨床照護能力之相關因 素，包括個人基本資料、臨床實務經驗及中醫護理學習。

方法 本研究採橫斷式問卷調查，方便取樣自某醫療財團法人北中南各院區中醫 臨床護理人員，研究工具為自擬結構式自評中醫護理臨床照護能力問卷。本研究 共發放 322 份問卷，有效問卷數為 301 份，回收率 93.5%。資料分析使用描述性統計和變異數分析與線性迴歸的推論性統計。

結果 中醫護理人員自評中醫臨床照護能力整體帄均得分為 2.51 分(SD=0.54 )， 帄均得分最高題項為依遠紅外線燈操作程序協助執行中醫針灸護理 3.61 分(SD=0.64)和最低題項為依藥浴程序協助執行中醫傷科護理 1.20 分(SD=1.39)。中醫護理人員自評中醫臨床照護能力之教育程度、進修狀態、中醫護理工作總年資、護 理進階職級、工作場所、工作單位、在中醫護理單位之工作意願、中醫護理學習 經驗有顯著差異性。多元線性迴歸顯示工作場所、參與專案或研究、受過中醫護 理基礎訓練為中醫護理人員自評中醫臨床照護能力顯著預測因子，可解釋中醫護理人員自評中醫臨床照護能力 26.3%變異量。

結論 中醫護理人員中醫臨床照護能力之自評帄均數偏低(2.51)( 5 分法)，教育程 度、進修狀態、中醫護理工作總年資、護理進階職級、工作場所、工作單位、在 中醫護理單位之工作意願、中醫護理學習經驗具顯著差異性，及工作場所、參與 專案或研究、受過中醫護理基礎訓練為顯著預測因子。研究結果可做為中醫護理 人員在職教育課程規劃之參考、培訓中醫護理人員能力之指標依據、提升行政資 源對於中醫人才培育之支持、加強跨團隊合作及落實全人照護之理念。

關鍵字  中醫護理人員、中醫臨床照護能力、醫療輔助行為

Background: Chinese medicine had been officially covered by National Health Insurance since 1995, along with the vigorous development of Chinese medicine healthcare work. Medical centers had established the Department of Traditional Chinese Medicine (TCM) and the nursing staff had also actively involved in Chinese medician healthcare practice. Building the standardized care competence in Chinese medicine nurses is imperative for promoting nursing care level of Chinese medicine. Therefore, assessment of clinical care competence of Chinese medicine nurses is a very important issue.

Aims: The purposes of this study were to (1) explore the status of self-rated Chinese medicine clincal care competence among Chinese medicine nurses; (2) compare mean differences in Chinese medicine clinical care competence in Chinese medicine nurses by various basically personal information, clinical experience, and learning experience of Chinese medicine nursing; and (3) analyze factors associated with Chinese medicine clinical care competence among Chinese medicine nurses. Methods: The study was a cross- sectional survey. Chinese medicine nurses were recruited from northern, middle, and southern locations of the Medical Foundation used a convenience sample. The instrument was a self-designed structured questionnaire of the Self-Rated Chinese Medicine Clincal Care Competence. The study distributed 322 questionnaires and 301 questionnaires were returned with 93.5% of returned rate. The data was analyzed using descriptive statistics and inferential statistics, including one-way ANOVA and linear regression.

Results: The grand mean score of self-rated Chinese medicine clinical care competences among Chinese medicine nurses was 2.51 (SD = 0.54). The highest mean score was assistance in performing Chinese acupuncture nursing care according to far-infrared light operational procedure (mean = 3.61, SD = 0.64), whereas thelowest mean score was assistance on executing Chinese trauma nursing care according to medicated bath (mean = 1.20, SD = 1.39). There were mean differences in education, status of the advanced study, working experience of Chinese medicine nursing, clinical ladder of nursing, workplace, working units, working willingness of Chinese medicine nursing unit, and learning experience of Chinese medicine nursing. Multivariate linear regression showed workplace, ever attended projects or researchs, and ever underwent basic training in traditional Chinese medicine nursing were significant predictors of self-evaluated Chinese medicine clinical care competence. This multivariate linear regression accounted for 26.3% variance of self-evaluated clinical care competence.

Conclusion: The self-rated Chinese medicine clinical care competence was below 3 using the 5-points Likerst Scale. In addition , the self-rated Chinese medicine clinical care competence was diverse by education, status of the advanced study, working experience of Chinese medicine nursing, nursing clinical ladder, workplace, working units, willingness of working in Chinese medicine nursing unit, and learning experience of Chinese medicine nursing. Workplace, ever attended projects or researchs, and ever underwent basic training in traditional Chinese medicine nursing could predict Chinese medicine clinical care competence. This finding could be a reference of planning inservice educaitno program in Chinese Medicine nurses, the index of cultivating Chinese medicine nurses’ competence, support of promoting administrative resources for Chinese medicine personnel cultivation, and enhancement of multidisciplinary collaboration and implemention of the concept of holistic care.

Keyword: Chinese medicine nurses, Chinese medicine clinical care competence, medical assistance behavior