本研究之目的以分析台灣安寧療護居家及共同照護護理師之臨床現況及困境為起點，充分理解與評估後，量身訂作一套安寧療護居家及共同照護護理師之培育方案。資料來源採用台灣安寧緩和護理學會所舉辦「2010年安寧居家及安寧共同照護護理師品質提升計畫」全台灣97位北、中、南分區共融營參加學員，資料有人口學、臨床現況、困境、課前填寫問卷及症狀控制考試成績，做次級資料分析，藉由描述性統計、推論性統計及質性資料內容分析法，瞭解安寧居家及共同照護護理師臨床現況、困境；理想中應有與實際具備的知識、技能及態度之裂缺。
經統整歸納後發現安寧居家及共同照護護理師所面臨之困境包含：一、照護專業性與能力不足；二、身兼數職，工作量大，內外上下夾攻，心力交瘁；三、缺乏醫療團隊的支持；四、新進人員熱忱不足，缺乏使命感；五、新進人員缺乏角色模範。以臨床情境的試題瞭解護理師的知識、技能及態度的現況與理想期望之裂缺，經分析結果得知，針對安寧居家與共同照護護理師的知識、技能與態度於「護理工作年資」之差異分析發現，護理工作年資愈資深者，其臨床推理能力與資淺的護理人員不具有統計的差異。因此推論護理人員並未隨著歲月增加而精進。在針對護理師的知識、技能與態度於「安寧護理工作年資」之差異分析結果得知，問題解決與邏輯思考能力與安寧工作年資的深淺雖無統計上之差異，但資料顯示安寧年資愈資深其答錯的題目較多，分析原因可能是因為資深護理人員過去的護理教育受北美NANDA護理診斷系統的僵化思考，限制了護理人員在問題解決及邏輯思考的能力。為了彌補理想中應有與實際具備的知識、技能及態度的裂缺，由上述資料之分析結果發展出一套安寧居家及安寧共同照護護理師之培育方案，透過多元化、活潑的教學技巧及策略，促進護理人員在學習中精進其知識、技能與態度。
透過此研究的資料分析與培育方案設計，期望能供作政策、教育與臨床服務之參考，協助台灣安寧緩和護理學會制訂安寧居家及安寧共同照護護理師的養成訓練課程，以培養符合臨床需求之進階護理師，並提供病人高品質之照護。

The goal of this study is to analyze the problems and setbacks of hospice home care and hospice shared care in Taiwan. The data sources originate from 97 participants in three district (northern, central, and southern) training camps organized by the Society of Taiwan Hospice Palliative Care in Taiwan, including demography, clinical practices, setbacks, pretest questionnaires, and results from the symptom control exam. I incorporated in the study secondary data analysis, along with descriptive statistics, inferential statistics, and qualitative content analysis in order to provide an understanding of the current status, difficulties, the knowledge and skills and attitudes of the home care and shared care nurses in the study.
An analysis of the data from the focus group shows that the current problems existing within our hospice nursing staff can be summed up in the following ways: 1) lack of professional ability, 2) increased workload due to the multiple roles our hospice nurses play, 3) insufficient support from the medical team, 4) lack of passion and enthusiasm in the new nursing staff, and 5) rare role models.
In my research, I made use of scenario questions, not only to get at the knowledge, skills and attitudes of nurses nowadays, but also to define the gap between the present state and the ideal situation. What came out of the analysis was that there was no correlation between the number of years of nursing work and the knowledge, skills and attitudes of those nurses providing hospice home care and hospice shared care. In other words, their knowledge, skills, and attitudes did not correlate with their seniority. The statistical outcome showed that the more senior nurses did not exhibit better clinical reasoning than the more junior nurse. Further analysis showed that the ability to solve problems and think logically was not proportional with seniority. Contrary to what one would expect those with much greater seniority in hospice scored lower on the exam than nurses with less seniority. Senior nurses were influenced by North America Nursing Diagnosis Association (NANDA) training. It has been shown that this educational background often results in rigid thinking which restricts a nurse’s ability to think logically and deliberately solve problems.
Thus, my goal is to develop a well-rounded system that may be incorporated into the training of hospice nurses, not only to facilitate the development of new skills and acquisition of new knowledge, but also to encourage proper attitudes towards hospice care. Using this system, nurses can advance their nursing skills in an interactive environment, using versatile forms of learning.
In sum, my greatest wish is that this proposed program can be used clinically to cultivate nurses with greater compassion in their hospice work. Furthermore, nurses who perform hospice shared care and hospice home care can be equipped with proper and adequate skills and know-how that will improve the quality of care given to the terminally ill.

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