臨床研究護理師指導新進人員意願之探討

Abstract

【背景】我國的臨床試驗發展已邁向國際水準，現階段主管機關對於臨床研究護理師的教育訓練卻缺乏相關規定。各醫院的現況為臨床研究護理師人力不足、流動率大、招募困難等困境。目前聘用方式，多數由各臨床試驗主持人獨立招聘。因此，大部份的新人在單位內缺乏熟手的指導者。目前缺乏臨床研究護理師指導新人的相關研究之調查，以提供新人教育訓練與護理臨床教師培訓的相關資訊。 【目的】以Ajzen計畫行為理論為基礎，配合文獻資料編製成結構式問卷，探討臨床研究護理師指導CRN新進人員之行為意圖及其影響因素。 【方法】以橫斷式相關性研究設計及方便抽樣，收集目前在台大醫院工作及其臨床試驗或研究工作經驗滿一年(含)以上之臨床研究護理師。所收集之資料以SPSS 22.0進行描述性及推論性統計分析。 【結果】收案期間為2017年3月至4月，有效問卷147份。研究發現:台大臨床研究護理師指導CRN新人之行為意圖為3.51分(滿分5分)，介於普通和願意之間。計畫行為理論之知覺行為控制、態度、主觀規範變項，三者共可以解釋行為意圖62.3%的變異量。「對護理臨床教師角色及功能的認知、臨床護理年資、臨床研究護理師年資、CRN臨床教師年資、同事與主管支持度、參與2天(含)以上之臨床教師課程、曾經指導CRN新人的經驗、參與指導CRN新人的方式、護理臨床教師教育訓練課程的提供」亦可能影響行為意圖。 【結論】本研究發現CRN指導新人的行為意圖介於普通至願意之間，建議調整臨床教師工作量、增加主管支持、提供教育訓練以增加研究對象指導新人的意願，可考量設置CRN臨床教師教學模式課程，提供師資培訓與專業進階，方可有系統及可近性的傳承臨床研究護理師的專業角色與工作職責給予未來的臨床試驗新鮮人。

【Background】Clinical trials are well developed in Taiwan, included the ability to process early phase clinical trial. CRN’s working environment has become more complicated associated with the complexity of clinical trials. Moreover, high turnover rate, lack of on-the-job training, without professional certification and the gap between the clinical nurse and CRN may result in novice CRN failing to adapt to the environment of clinical trial practice. CRN’s profession performance is the essential element of ensuring patient safety and contributes to accurately operation of clinical trial. Although CRN have been involved in clinical trial for decades, so far lack of essay provides information about the CRN preceptor guide the new CRN. 【Purpose】This article explores the issues of CRN preceptors guide the new CRN, analyzes the root factors of these issues, and makes strategic suggestions for hospital to consider developing a preceptorship program in the future. 【Method】In this cross-sectional study, one hundred and forty-seven CRNs (at least 1 year experienced) completed a 43 item questionnaire based on the Theory of Planned Behavior, measuring behavior intention of guide the new CRN, as well as the attitudes, subjective norms, and perceived behavior control. 【Results】Exploratory factor analysis was used to determine the underlying dimensions. Principal components and principal axis factoring combine with Varimax rotations analyses on the TPB direct measurement variables and cognition of preceptor’s role yielded four component solutions, corresponding with the dimensions of the TPB. MTMI correlation matrix analyses result with good convergent and discriminant validity. Internal consistencies are all above to 0.7, only the behavior belief is less (Cronbach's alpha=0.488). Content validity Index reached 0.83. Linear regression analysis that attitude, subjective norm and perceived behavior control total can explain 62.3% variance of behavior intention. The top 4 factors affected CRN preceptors to teach new CRN were perceived behavior control, attitude, subjective norm, and the cognition of preceptors’ role and function. Other factors included preceptors’ seniority (clinical nursing practice, clinical research nursing practice, and preceptor experience), support of supervisors and colleagues to preceptors, days of attending related educational courses and provide of preceptor training program. Over 80% of CRNs in National Taiwan University Hospital well recognized the roles and responsibilities of preceptors. But only 60% will follow request to do it. Less than 40% will like to have a chance to be a preceptor. Perceived behavior control is the most weakness part to actually play this role. Deficiency of education and training, lack of support and without teaching resources is the most reasons of loss self-control. 【Conclusion】The study provides a valid and reliable questionnaire to measure intension, also demonstrates the validity of the TPB in predicting behavior related to guide new CRN. According to the beliefs within attitude, subjective norm, and perceived behavior control, reveal to building clinical trial teamwork relationship, create organization goal and commitment is crucial to motivate preceptors. Through preceptorship program will help preceptors to find out the career ladder and profession value, also resolve the high turnover rate and increase trial development.