[] 191 運用 KAS 思考模版導入醫院跨領域團隊合作 照護與教育 楊惠芳 1,2 鍾欣怡 3 高東煒 2 林永崇 1,4 陳金順 1,4 查岱龍 1,5 林石化 1,4 劉峰誠 1,4 現今醫療照護的最終目標是希望達到提昇全人醫療照護品質, 利用探討跨領域團隊合作照護 (interprofessional practice, IPP) 與跨領域團隊合作照護教育 (interprofessional education, IPE), 來學習不同專業間如何以尊重的態度互動, 並掌握團隊合作的知識與技巧, 需要協助時如何正確地接觸對象並適時求援, 強化醫療體系提供適切的醫療服務, 以病人為中心, 達成改善疾病預後 本文提供一紅斑性狼瘡個案情境以 KAS (knowledge attitude skill) 思考模版方式導入之團隊合作照護與教學方式, 經由跨領域的案例討論方式, 使新進受訓人員能瞭解其他領域的專業內容, 進而知道各職類在照護病人過程中所扮演的不同角色, 培育尊重彼此各專業之特色 共享專業知識及以病人為中心之分享決策過程, 一起解決病人的健康問題, 進而持續推展施行於醫院各臨床科部與各職類醫事人員, 讓此模式可以常規地運用在每日臨床照護病人身上, 並使所有的醫療團隊成員可以在工作中持續地成長與增進照護病人的能力 2017; 27: 191-200 DOI: 10.3966/168232812017122704001 跨領域團隊合作照護 領域團隊合作照護教育 全人照護 思考模版 [1] [2] (interprofessional education, IPE) (interprofessional practice, IPP) [3] [4] [4] 1 國防醫學院三軍總醫院一般醫學部 2 家庭暨社區醫學部 3 臨床病理科 4 內科部 5 外科部受理日期 :106 年 6 月 29 日修改日期 :106 年 8 月 30 日同意刊登 :106 年 9 月 21 日通訊作者 : 劉峰誠通訊地址 :114 台北市內湖區成功路二段 325 號三軍總醫院一般醫學部
Taiwan J Fam Med 192 KAS 思考模版導入跨領域團隊合作照護與教育 2017 Vol.27 No.4 [5] 2016 KAS KnowledgeAttitudeSkill IPPIPE Interprofessional EducationIPE (Center for Advancement of Interprofessional Education, CAIPE) [6] [7-9] IPE IPE (interprofessional practice, IPP) [7] Kirkpatrick [10] IPEIPP 1 [7] IPE (core)(contextualized) - [] - [] - [] IPE IPP - [] 1 KirkpatrickInterprofessional Practice/Education(IPP/IPE)
台灣家醫誌 民國 106 年 27 卷 4 期 楊惠芳鍾欣怡高東煒等 193 (knowledge, attitude, skill, KAS)double C-KAS KAS 2 2 Interprofessional Education (IPE) 72011; 5: 67-73 IPP 47 2013 20158 20158 9 242 mg/ dl4.2 mg/dl 4.5 (4.7 g/dl) (90K)24 mg/dl 4.2 mg/dl 1.8 g/dl 258 mg/dl4.8 mg/dl 20167 3 SIP Tea Sense(sense the need in the clinical care)initiate(initiate and activate the team)patient-centered (patient-centered goal setting) Team work
Taiwan J Fam Med 194 KAS 思考模版導入跨領域團隊合作照護與教育 2017 Vol.27 No.4 3 IPE 1 IPP IPE (Team Resource Management, TRM) TRM
台灣家醫誌 民國 106 年 27 卷 4 期 楊惠芳鍾欣怡高東煒等 195 1 Interprofessional practice (IPP) SIP TeaSense InitiatePatient-centeredTeam work TIPsWhat I can help to team? What help I need from team? Sense 1. Team Patient-centered 1. 2. 3. IPP Team work 1. 2. 3. 1. 2. 3. 4. Core-KAS IPECC-KAS 1. 2. 3. 4. 5. 1. 2. Contextualized-KAS 1. 2. 3. 4. 5. 1. 2. 3. 1. 2. 3. 1. 2. 3. 4.
Taiwan J Fam Med 196 KAS 思考模版導入跨領域團隊合作照護與教育 2017 Vol.27 No.4 TRM [7] 5R(Reporting, Responding, Relating, Reasoning, Reconstructing) [11] IPE IPE 2 double C-KAS IPE 20164 IPP/IPE 63811 94% IPPIPE IPPIPE IPP IPE 82-85% 20168 (Association for Medical Education in Europe, AMEE) Professor Kathy ChappellLawrence Sherman 201710 (Institute of Medicine) IPP/IPE Precourse During-course Post-course
台灣家醫誌 民國 106 年 27 卷 4 期 楊惠芳鍾欣怡高東煒等 197 2 Interprofessional Education(IPE) Core-KAS CC-KAS Contextualized-KAS PGY 1. 2. 3. 1. 2. 3. 4. 5. 1. 2. 3. 4. 5. 1. 2. 1. 2. 3. 1. 2. 3. 1. 2. 3. 4. 1. 2. 3. 1. 2. 1. 2. 3.
Taiwan J Fam Med 198 KAS 思考模版導入跨領域團隊合作照護與教育 2017 Vol.27 No.4 2017211 72 47% 12%16% 25%68 94% (Healthcare Matrix) IPP/IPE 4IPP/ IPEKAS KAS 41062 ACGME: ACGME ICS: (Interpersonal and Communication Skills ) PC: (Patient Care) MK: (Medical Knowledge ) PBLI: (Practice-Based Learning and Improving) SBP: (System-Based Practice) PRO: (Professionalism) HCM: (Healthcare Matrix)
台灣家醫誌 民國 106 年 27 卷 4 期 楊惠芳鍾欣怡高東煒等 199 1. World Health Organization: Framework for Action on Interprofessional Education and Collaborative Practice. Health Professions Networks Nursing and Midwifery Human Resources for Health, 2010. 2. Smetzer JL: Medication error reporting system. In: Cohen MR ed. Medication Errors. 2nd ed. Washington DC: American Pharmacists Association, 2007: 535. 3. Velji K, Baker GR, Fancott C, et al: Effectiveness of an adapted SBAR communication tool for a rehabilitation setting. Health Q 2008; 11(3 Spec No.): 72-9. 4. Proudfoot J, Jayasinghe UW, Holton C, et al: Team climate for innovation: what difference does it make in general practice? Int J Qual Health Care 2007; 19: 164-9. 5. Strasser DC, Falconer JA, Stevens AB, et al: Team training and stroke rehabilitation outcomes: a cluster randomized trial. Arch Phys Med Rehabil 2008; 89: 10-5. 6. Barr H: Center for the Advancement of Interprofessional Education (CAIPE), 2002. http://www.caipe.org.uk/ Accessed August 8, 2016. 7. 2011567-73 8. 2012675-85 9. 105 201635 2016 10. Reeves S, Boet S, Zierler B, Kitto S: Interprofessional education and practice guide no. 3: Evaluating interprofessional education. J Interprof Care 2015; 29: 305-12. 11. 201525165-73
200 [Monograph] Application of KAS Thinking Template in Hospital Interprofessional Practice and Education Hui-Fang Yang 1,2, Hsing-Yi Chung 3, Tung-Wei Kao 2, Jun-Chung Lin 1,4, Jin-Shuen Chen 1,4, Tai-Long Cha 1,5, Shih-Hua Lin 1,4 and Feng-Cheng Liu 1,4 The ultimate goal of today s medical care is to improve the quality of holistic health care. By exploring interprofessional practice and education, we can learn how professionals in diverse fields interact and collaborate with each other in a mutually respectful and task-oriented manner to learn the knowledge and skills necessary for effective teamwork. In addition, we can understand how to approach patients in ways that meet their needs and when to call for timely assistance. The health care system can also be strengthened in order to provide patient-centered medical services that improve prognoses. This article examines a case of lupus erythematosus, where the KAS (Knowledge, Attitude, Skill) thinking template is incorporated into the cooperative health care and teaching methods. Through cross-disciplinary case discussion, new trainees are able to learn about professional expertise in other disciplines, thereby gaining valuable knowledge about the different roles the members of an interdisciplinary team play in the health care process. This cultivates respect for the specialties of various professions, enables the sharing of expertise and experience, and initiates a shared decision-making process that places patients at the center, whereby their health problems are solved in a cooperative manner. The model can be routinely applied to clinical healthcare to help promote continuous learning of team members at work and enhance their ability to care for patients. (Taiwan J Fam Med 2017; 27: 1 9 1-2 0 0) DOI: 10.3966/168232812017122704001 Key words: holistic health care, interprofessional education, interprofessional practice, thinking template 1 Departments of General Medicine, 2 Family and Community Medicine, 3 Division of Clinical Pathology, 4 Internal Medicine and 5 Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Received: June 29, 2017; Revised: August 30, 2017; Accepted: September 21, 2017.