The Construction of Clinical Competence in Psychiatric Mental Health Nursing Assessment

[[abstract]]本文目的爲建構精神衛生護理師在精神衛生護理評估實務能力之培訓內容，以提昇護理實務能力。以行動研究法由產學界專家所組成的「精神衛生護理臨床實務能力核心小組」，剛開始草擬對此核心項目之研究指標建構之研究現劃，再加上種子成員共同討論與分析「精神衛生護理評估」應具備之實務能力必備要項、舉辦種子團隊會議與研習會共同對「精神衛生護理評估」在實務能力之內容（必備能力要項、定義與行爲操作）做更臻完整之討論與統整，期望對精神衛生護理人員在精神衛生護理評估之能力的提昇，藉以推展甄審制度建立精神護理專業角色之定位，作爲日後甄審辦法訂定之依據。 The purpose of this study was to establish clinical competencies for the purposes of psychiatric mental health nursing assessments, and in order to improve the clinical skills of nurses. Using action research and starting from May, 2004, a group of experts was engaged to draw up a research plan in line with these terms of reference, and, along with up-and-coming talents in the profession, to discuss and analyze essential clinical competencies to be required in assessments for psychiatric mental health nursing. They held exploratory group meetings and workshops to engage in comprehensive, all-encompassing discussion of the content of clinical competencies for psychiatric health nursing (necessary competency standards, definitions, and actions to have been taken). These findings could serve as a basis on which the accreditation committee for psychiatric mental health nursing might evaluate the clinical competence of psychiatric mental health nurses in this core ability. The development of clinical competence for mental health nursing assessments may further enhance the skills of nurses in assessing psychiatric patients and in the professionalization of psychiatric mental health nursing

A Preliminary Study on the Evaluation of Resource-Based Relative Value Scale in Mental Health Nursing

[[abstract]]中華民國健保局參考美國Medicare發展醫療資源相對值表（Resource-Based Relative Value Scale，以下簡稱RBRVS）的方法，來訂定特定診療與技術的支付標準。這樣的支付標準產生對精神衛生護理之未來臨床實務與教育皆有很大之影響，因此本研究主要目的為：(1)探討國內精神專科RBRVS中精神衛生護理人員之診療項目；與(2)精神衛生護理於國內精神專科RBRVS之支付標準。研究方法與結果：(1)專家討論：本計畫邀請了十二位專家在座談中討論護理人員在心理治療、團體治療、生理回饋治療、行為治療和家族治療的角色外，以及設定精神衛生護理的診療項目，並分派專家討論各項精神衛生護理的診療項目之分類與項目之適當性，統整精神衛生護理的各項護理技術企望能分別規列在此三大護理層面中：精神科一般護理指導、精神科特殊護理處置與訓練、精神科深度護理治療；(2)實證座談：舉辦了11場「精神衛生護理的診療項目臨床實務護理師之實證座談」，是藉由臨床實務護理師之實證座談將精神衛生護理的診療項目作觀念溝通；(3)德懷法（Delphi）問卷調查：依據Hsiao等學者之等級估測法並用Delphi方式收集臨床精神衛生護理人員對此三層級中各項技術之時間、精神努力與判斷力、技術程度與體力、心理壓力等構面之投入。第一回共回收184份資料，第二回計有161份資料回收，結果(1)總工作量之平均值分別為「精神科一般護理指導」：120，「精神科特殊護理處置與訓練」：150，「精神科深度護理治療」：180；(2)工作強度（精神努力及判斷力＋技術程度及體力＋心理壓力）之平均值分別為「精神科一般護理指導」：382，「精神科特殊護理處置及訓練」：448，「精神科深度護理治療」：478。專家之間的一致性評估Equal-length Spearman-Brown為0.94，而Average Measure Intra-class Correlation為0.97。進一步以迴歸分析瞭解到真正影響工作量的主要原因為「精神努力及判斷力」和「技術程度及體力」。 This study was a preliminary exploration on the evaluation of Resource-Based Relative Value Scale (RBRVS) in mental health nursing as a reference for mental health payment. An expert consultation group was organized to select the services/procedures to be investigated by survey in mental health nursing. Eleven communication workshops were further established to improve the consensus in senior mental health nurses. A Delphi method was used to survey the procedure time, psychological efforts and relative value scale of the 21 major mental health nursing services/procedures among senior mental health nurses. The results of the study showed that three levels of mental health nursing services/procedures were categorized: (1) general mental health nursing guidance; (2) specialized mental health nursing intervention and training; and (3) advanced mental health nursing treatment. The range of the workload for the three-level of mental health interventions were 99.0~157.9, 132.3~195.4, and 160.7~164.2, respectively. The consistency among raters was ranged from 0.94-0.97 analyzed by equal-length Spearman-Brown and average measure Intra-class correlation. The result showed that major factors in predicting workload were mental efforts and clinical judgment and technical skill and physical effort

Stress Perception of Newly Diagnosed Breast Cancer Women

[[abstract]]台灣地區乳癌發生率逐漸升高，好發年齡亦逐漸年輕化，此現象已嚴重衝擊到中年婦女的健康與生活。本研究目的為探討初診斷乳癌婦女之壓力感受，收集某醫學中心乳房外科病房之初診斷乳癌婦女為樣本，以質性訪談法進行深度訪談，共訪談20位。結果萃取出無法操控、沉重負荷、面對挑戰與無法預期等四個主題。初罹患乳癌婦女感受到無法操控時，需要引導及提供正確資訊以增加其控制力；負荷沉重方面，親友與病友的支持非常重要；面對挑戰時，心理與認知上是需要給予時間重建，以提供病人做決策；此外在無法預期的感受方面，對罹癌婦女而言，從接納自己、接受疾病、面對新生活，及面對未來疾病的變化雖不可預期，但可建構一個新的更具有意義的生活世界。本研究建議初診斷乳癌婦女面臨壓力，需要整合醫療團隊如醫師、護理師、心理師、社工師或宗教者等，提供病人合適的照護計畫與措施。另研究者亦可將研究所萃取的主題發展成乳癌患者之壓力量表，提供醫護人員藉由此工具快速評估病人的壓力狀態，以提升乳癌照護品質。 In Taiwan, the incidence rate of breast cancer steadily increases, and the statistics also show that the onset age gets younger and younger. Both trends of incidence and onset age result in a serious impact on the health and life of middle-aged women. The purpose of this study was to explore the women's perception of stress, who were newly diagnosed as breast cancer. The subjects of this study were from a surgical ward of a medical center. Through in-depth interviews, 20 women were recriuted and interviewed. The results sugest that four themes including uncontrollable, overloaded, facing the challenges and unpredictable were extracted from the data collected. The research findings showed that the newly diagnosed breast cancer women perceive uncontrollable, these women may improve their abilities in making decisions when professional guidance and assistance were provided. When they perceive overloaded, supports from friends and families are important factors in helping these women go through the overloaded stress. When the women perceive facing the challenges, it indeed takes time to reconstruct the women's mental health and recognition to allow them to make a decision. Besides, when the women perceive unpredictable, they can further face their new life flexibly when they accept of themselves and the disease. The cancer itself grants different meaning to the life of these women. They may still be able to construct a meaningful life even they might be staging into the unpredictable future. This study suggested that the newly diagnosed breast cancer women should seek help from a medical care team to deal with the stress through appropriate care plans and interventions provided by doctors, nurses, psychologists, social workers and religionists. In the future, the researchers may develop a stress scale for breast cancer women, to help the clinicians quickly assess the patients' stress to improve the care efficiency and quality of breast cancer patients

JUNO Sensitivity on Proton Decay p→νˉK+p\to \bar\nu K^+ Searches

The Jiangmen Underground Neutrino Observatory (JUNO) is a large liquid scintillator detector designed to explore many topics in fundamental physics. In this paper, the potential on searching for proton decay in $p\to \bar\nu K^+$ mode with JUNO is investigated.The kaon and its decay particles feature a clear three-fold coincidence signature that results in a high efficiency for identification. Moreover, the excellent energy resolution of JUNO permits to suppress the sizable background caused by other delayed signals. Based on these advantages, the detection efficiency for the proton decay via $p\to \bar\nu K^+$ is 36.9% with a background level of 0.2 events after 10 years of data taking. The estimated sensitivity based on 200 kton-years exposure is $9.6 \times 10^{33}$ years, competitive with the current best limits on the proton lifetime in this channel

JUNO sensitivity on proton decay p → ν K + searches*

The Jiangmen Underground Neutrino Observatory (JUNO) is a large liquid scintillator detector designed to explore many topics in fundamental physics. In this study, the potential of searching for proton decay in the $p\to \bar{\nu} K^+$ mode with JUNO is investigated. The kaon and its decay particles feature a clear three-fold coincidence signature that results in a high efficiency for identification. Moreover, the excellent energy resolution of JUNO permits suppression of the sizable background caused by other delayed signals. Based on these advantages, the detection efficiency for the proton decay via $p\to \bar{\nu} K^+$ is 36.9% ± 4.9% with a background level of $0.2\pm 0.05({\rm syst})\pm$$0.2({\rm stat})$ events after 10 years of data collection. The estimated sensitivity based on 200 kton-years of exposure is $9.6 \times 10^{33}$ years, which is competitive with the current best limits on the proton lifetime in this channel and complements the use of different detection technologies