26 Evidence-Based Nursing Practice in Hospitals ㈠ Johansson, Fogelberg-Dahm, & Wadensten, 2010; Melnyk et al., 2004; Uysal, Temel, Ardahan, & Ozkahram

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1 25 如何在醫院中推行實證護理實務陳玉枝 1* 湯麗君 2 周幸生 3 1 台北榮民總醫院護理部特約研究員國立臺北護理健康大學醫護教育研究所兼任副教授 2 慈濟技術學院護理系講師 3 台北榮民總醫院護理部副主任摘要 : 實證實務為臨床決策及健康照護的趨勢, 更是國內外臨床照護的核心能力及醫療教育的評鑑指標之一, 研究顯示實證實務能提升照護品質與滿意度, 及降低醫療照護成本, 也因而成為促使實證概念融滲於學校及繼續教育重要的方針為推廣實證實務概念, 醫療院所及專業學會都積極舉辦實證相關訓練及競賽活動, 但臨床實務的推動卻進行緩慢, 文獻指出, 缺乏推動實證實務的策略及模式是其因素之一本文中介紹影響實證實務推行的阻礙因素及促成因素, 以及如何推動的模式與策略, 再以實例分享醫院推動的經驗, 以提供國內推動實證護理實務的參考關鍵詞 : 實證照護實證護理實務輔導機制 Fineout-Overholt, Melnyk, & Schultz, 2005 evidence-based practice, EBP Fitzsimons & Cooper, 2012; Mason, Leavitt, & Chaffee, 2012 the Joint Commission on Accreditation of Healthcare Organizations, JCAHOThe American Nurses Credentialing Center, ANCC National League of Nursing, NLN Fineout-Overholt, Levin, & Melnyk, 2004; Mason et al., 2012; Schultz, nhri.org.tw/ Joanna Briggs Institute JBI 1996 Royal Adelaide Hospital Taiwan Joanna Briggs Institute Collaborating Center, TJBCC ym.edu.tw/front/bin/cglist.phtml?category= * ycchen@vghtpe.gov.tw doi: /jn

2 26 Evidence-Based Nursing Practice in Hospitals ㈠ Johansson, Fogelberg-Dahm, & Wadensten, 2010; Melnyk et al., 2004; Uysal, Temel, Ardahan, & Ozkahraman, 2010 Melnyk et al., 2004; Uysal et al., 2010 ㈡㈢ Fineout-Overholt et al., PICO patients/population/problems, intervention, comparison, outcome Fitzsimons Cooper 2012 ㈠ SMART S-specific M-measurable A- attainable R-relevant T-time bond Ogiehor-Enoma, Taqueban, & Anosike, 2010 ㈡ Ogiehor-Enoma et al., 2010; Tomey, 2009 ㈢ Fineout-Overholt et al., 2005 ㈣ Fitzsimons & Cooper, 2012 ㈤ Everett & Sitterding, 2011 ㈥㈦ Everett & Sitterding, 2011 ㈧㈨ The Advancing Research & Clinical Practice through Close Collaboration, ARCC ARCC Melnyk Melnyk 2002 ARCC mentorship Melnyk & Fineout- Overholt, 2013

3 27 Melnyk, Fineout-Overholt, Gallagher-Ford, & Stillwell, 2011; Wallen et al., 2010 Ogiehor-Enoma et al., 2010 Fineout-Overholt et al., 2004; Melnyk, Fineout-Overholt, Stetler, & Allan, Ogiehor- Enoma et al., 2010; Tomey, 2009 Melnyk et al., 2004; Uysal et al., 2010 Schultz, 2007 Ogiehor-Enoma et al., Joanna Briggs Institute, JBI comprehensive systematic review, CSR JBI JBI certificate of reviewers 21 CSR JBI A Melnyk & Fineout-Overholt, 2013; Melnyk et al., 2011; Wallen et al., N1 ㈠ 1

4 28 Evidence-Based Nursing Practice in Hospitals N2 ㈡ 1 N3 ㈠2 N4 ㈡2 N1 N2 PICO Fitzsimons & Cooper, 2012 Ogiehor- Enoma et al., Melnyk & Fineout-Overholt, JBI Fitzsimons Cooper ㈠ N1 N ㈡㈢ Ogiehor-Enoma et al., JBI 2012 JBI ㈣ bundle care

5 29 tebna.org.tw/ [Taiwan Evidence-Based Nursing Association. (n.d.). TEBNA introduction. Retrieved from Everett, L. Q., & Sitterding, M. C. (2011). Transformational leadership required to design and sustain evidence-based practice: A system exemplar. West Journal of Nursing Research, 33(3), doi: / Fineout-Overholt, E., Levin, R. F., & Melnyk, B. M. (2004). Strategies for advancing evidence-based practice in clinical settings. The Journal of the New York State Nurses Association, 35(2), Fineout-Overholt, E., Melnyk, B. M., & Schultz, A. (2005). Transforming health care from the inside out: Advancing evidence-based practice in the 21st century. Journal of Professional Nursing, 21(6), doi: / j.profnurs Fitzsimons, E., & Cooper, J. (2012). Embedding a culture of evidenced-based practice. Nursing Management, 19(7), Johansson, B., Fogelberg-Dahm, M., & Wadensten, B. (2010). Evidence-based practice: The importance of education and leadership. Journal of Nursing Management, 18(1), doi: /j x Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2012). Policy & politics in nursing and health care. St. Louis, MO: Elsevier Saunders. Melnyk, B. M., & Fineout-Overholt, E. (2013). Evidence-based practice in nursing & healthcare: A guide to best practice (pp ). Philadelphia, PA: Lippincott Williams & Wilkins. Melnyk, B. M., Fineout-Overholt, E., Feinstein, N. F., Li, H., Small, L., Wilcox, L., & Kraus, R. (2004). Nurses perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: Implications for accelerating the paradigm shift. Worldviews on Evidencebased Nursing, 1(3), doi: /j x x Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Stillwell, S. B. (2011). Evidence-based practice, step by step: Sustaining evidence-based practice through organizational policies and an innovative model. AJN: American Journal of Nursing, 111(9), doi: /01. NAJ e Melnyk, B. M., Fineout-Overholt, E., Stetler, C., & Allan, J. (2005). Outcomes and implementation strategies from the first U.S. evidence-based practice leadership summit. Worldviews on Evidence-Based Nursing, 2(3), doi: /j x Ogiehor-Enoma, G., Taqueban, L., & Anosike, A. (2010). 6 steps for transforming organizational EBP culture. Nursing Management, 41(5), doi: /01. NUMA c5 Schultz, A. A. (2007). Implementation: A team effort. Nursing Management, 38(6), doi: /01. NUMA Tomey, A. M. (2009). Nursing leadership and management effects work environments. Journal of Nursing Management, 17(1), doi: /j x Uysal, A., Temel, A. B., Ardahan, M., & Ozkahraman, S. (2010). Barriers to research utilization among nurses in Turkey. Journal of Clinical Nursing, 19(23-24), doi: /j x Wallen, G. R., Mitchell, S. A., Melnyk, B., Fineout-Overholt, E., Miller-Davis, C., Yates, J., & Hastings, C. (2010). Implementing evidence-based practice: Effectiveness of a structured multifaceted mentorship programme. Journal of Advanced Nursing, 66(12), doi: / j x

6 30 Evidence-Based Nursing Practice in Hospitals Strategy for Promoting Evidence-Based Nursing Practice in Hospital Yu-Chih Chen 1 * Lee-Chun Tang 2 Shin-Shang Chou 3 1 PhD, RN, Contract Research Fellow, Department of Nursing, Taipei Veterans General Hospital and Adjunct Associate Professor, College of Nursing, National Taipei University of Nursing and Health Sciences; 2 MSN, RN, Instructor, Department of Nursing, Tzu Chi College of Technology; 3 DNS, RN, Deputy Director, Department of Nursing, Taipei Veterans General Hospital. Abstract: Evidence-based practice has been demonstrated to improve quality of care, increase patients satisfaction, and reduce the costs of medical care. Therefore, evidence-based practice is now central to the clinical decision-making process and to achieving better quality of care. Today, it is one of the important indicators of core competences for healthcare providers and accreditation for healthcare and educational systems. Further, evidence-based practice encourages in-school and continuous education programs to integrate evidence-based elements and concepts into curricula. Healthcare facilities and professional organizations proactively host campaigns and encourage healthcare providers to participate in evidence-based related training courses. However, the clinical evidence-based practice progress is slow. The general lack of a model for organizational follow-up may be a key factor associated with the slow adoption phenomenon. The authors provide a brief introduction to the evidence-based practice model, then described how it may be successfully translated through a staged process into the evidence-based practices of organizational cultures. This article may be used as a reference by healthcare facilities to promote evidence-based nursing practice. Key Words: evidence-based healthcare, evidence-based nursing practice, mentorship. Accepted for publication: August 19, 2013 *Address correspondence to: Yu-Chih Chen, No. 17, Lane 4, Rong Hua 1st Rd., Peitou District 11217, Taiwan, ROC. Tel: +886 (2) ; ycchen@vghtpe.gov.tw

五卷六期變, 般於活動度較大的及腰發生率較高, 特別是 4~6 及 3~ 4 腰 ( 王,1997; 邱,1995; 陳郭, 1994) 常見致原因為 : 不穩定齡荷爾蒙外傷發炎反應遺傳肥胖等 ( 黃,1997);

五卷六期變, 般於活動度較大的及腰發生率較高, 特別是 4~6 及 3~ 4 腰 ( 王,1997; 邱,1995; 陳郭, 1994) 常見致原因為 : 不穩定齡荷爾蒙外傷發炎反應遺傳肥胖等 ( 黃,1997); 徐淑雲中文摘要本文探討因面臨手術治療, 連串生心社會衝擊而產生疼痛焦慮與知識缺失等健康問題筆在主期間 92 1 月 2 日 ~1 月 18 日運用會談觀察及傾聽等技巧收集資料 ; 藉由羅氏適應模式評估分析及歸納給予個案個別整體的活