背景
隨著老年人口快速增加，長期照護需求日益明顯，然目前台灣護理養成教育仍將長期照護課程列為選修，是以，強化長期照護之護理知能已為我國政府推動長期照顧政策之重要策略。

研究目的
探討參與衛福部長期照護Level II 課程護理人員之長期照護護理能力現況及其影響因素。

研究方法
本研究採橫斷性調查研究設計，研究對象為參與2013年衛生福利部長期照護繼續教育Level II 課程之護理人員。研究工具為自擬結構式問卷，內容包括「長期照護知識」、「服務意願」、「實務」、「護理能力」及「個人屬性資料」等五大部份，經專家內容效度與內在一致性測試與修正後，進而採網路問卷普查完成培訓且同意參與研究之護理人員，以電子郵件發出300份邀請，回收有效問卷122份，回收率51%。以SPSS 17.0軟體進行資料建檔，使用t-test、單因子變異數分析、皮爾森相關性分析與逐步回歸等分析。

結果
本研究對象皆為女性，平均年齡為37.86歲，已婚者佔66.4%，教育程度以大學學歷佔64%最多。工作職稱中以護理師佔48.8%最多，其次為護士佔14.4%，長期照護管理專員佔10.4%。研究對象工作領域大部分皆分佈於長期照護服務領域，以護理之家最多佔24%，其次為機構附設居家護理所佔13.6%、長期照顧管理中心佔10.4%。臨床護理工作年資平均為13.12年，長期照護工作年資平均為4.86年，有14.4%護理人員目前有在職進修中。通過102年長期照護Level II課程培訓考試者佔88.8%，受訓動機53.6%是因為工作需要，36.8%為個人興趣。長期照護現況結果分析，在長期照護知識部分，滿分10分，平均得分為6.6 ± 1.7分；在長期照護服務意願部分，總平均得分為2.96 ± 0.38趨近於同意，顯示護理人員對於長期照護工作從事意願高；在長期照護實務分析發現研究對象工作場域中以「經常」(3.05 ± 0.30)照護老年個案族群最多，在護理照護經驗中多有曾接觸過老年及失能或身心障礙個案之經驗。另有80%研究參與者曾經與「長者」同住。在護理學校養成教育中曾經接受「長期照護」課程者僅佔56.8%；曾經接受「老年護理」課程者佔66.4%。在長期照護護理能力分析發現，總平均得分為3.19 ± 0.37，介於「同意」與「非常同意」之間，其中得分以「長期照護責任、倫理、法律」平均為3.27 ± 0.40得分最高，其次為「長期照護角色專業發展」(3.19 ± 0.39)及「長期照護照護提供與管理」(3.17 ± 0.39)。在個人屬性與長期照護現況相關性分析發現，在職進修者在長期照護知識(t=-2.89, p<.05)、意願(t=-4.61, p<.001)及實務(t=-3.18, p<.05)皆優於未進修者；工作地點在長期照護知識(t=2.51, p<.05)及職稱在實務(t=3.18, p<.05)有顯著差異；護理年資(r=0.18, p<.05)及長期照護年資(r=.28, p<.05)與長期照護實務呈顯著正相關；參加培訓理由為個人興趣者在長期照護知識構面(F=3.50, p<.05)及服務意願構面(F=3.09, p<.05)表現優於單位主管要求來參與培訓者；通過長期照護課程培訓考試者(t=-2.41, p<.05)在長期照護實務構面顯著優於未通過者。在與長期照護能力相關性分析發現，長期照護知識(r=.23, p<.05)，服務意願 (r=.53, p<.001)，實務 (r=.26, p<.001)， 婚姻狀況 (t=-2.60, p<.05)及在職教育(t=3.62, p<.001)皆達顯著正相關性。將上述變相投入逐步回歸分析長期照護現況、個人屬性對長期照護護理能力的預測力，結果發現發現「服務意願」(B=0.42, β=0.43, p<.001)、「在職進修」(B=0.25, β=0.24, p<.05)及「婚姻狀況」(B=0.14, β=0.17, p<.05)皆達顯著影響，每增加「服務意願」一分會增加長期照護護理能力平均0.42分；有「在職進修」者會提升長期照護護理能力0.25分;「已婚狀況」者會提升長期照護護理能力0.14分。

討論
本研究藉由瞭解參與衛福部長期照護Level II 課程護理人員長期照護能力現況及應具備之長期照護能力相關要素，以期提供未來護理人員或護理教育於長期照護專業發展之建議。結果發現透過課程培訓能提升護理人員長期照護知能，增進長期照護之服務意願，能將培訓課程所學的應用於長期照護實務上，增進長期照護之護理專業。建議在護理養成教育中各級護理學校應將老人護理或長期照護列為必修課程，透過長期照護場域的護理實習，能增進護理學生對高齡者及失能者接觸頻率，提升護理學生對長期照護之意願。於臨床實務上應更加重視長期照護專業教育訓練，期能提供長期照護個案更完善的照護品質。

Longer average life expectancies and an ageing society have made long-term care an urgent and important issue in Taiwan. There is an increasing need for training to enhance nurses’ long term care nursing competence. This study utilized a cross-sectional research approach to analyze Taiwanese nurses’ nursing competence in long term care and its related factors. Subjects were with medium level of knowledge (6.6 ± 1.7), great intention (2.96 ± 0.38), frequent long-term care experience (3.05 ± 0.30), and high competent with long term care (3.19 ± 0.37). Significantly positive correlations were found between nursing competency and perception of knowledge, care intension, practice, continue education, and married status. Results of stepwise regression revealed pursuing continue education, married, and intention positively predicting long term care nursing competence. It is believed that improving Taiwanese nurses’ long term care intension and job training will enhance their nursing competence in long term care. Results of this study will provide further nursing education, practice, research and policy recommendations for the development of long term care in Taiwan.

中華民國護理師護士公會全國聯合會(2000，08月18日)．職場護理人員工作現況調查新聞稿．取自http://www.nurse.org.tw/ourStand/os_tab.aspx
內政部 (2004)．93年度施政績效報告．http://www.moi.gov.tw/chi/chi_public_info/node.aspx?sn=318.DOC
內政部 (2013，01月26日)．101年人口結構分析．取自http://www.moi.gov.tw/stat/news_content.aspx?sn=7121
台灣長期照護專業協會 (2013，10月05日)．長期照護歷史軌跡．取自http://www.ltcpa.org.tw/about/aboutus-304.php
白玉珠、徐南麗、汪蘋 (1999)．某醫學中心護理人員自評之護理能力及個人特質相關性研究．護理研究, 7(3), 209-220.
何靜玉 (2009)．護理人員對住院老人照護知識、態度、及照護意願之探討：以南部某區域教學醫院為例．台南:長榮大學護理學研究所。
吳姿蓉、鄧慶華、池美華、曾淑梅、袁素娟 (2007)．某醫學中心護理人員護理能力及其相關因素之探討．中山醫學雜誌, 18(2), 303-316.
吳淑瓊、莊坤祥（2001）．在地老化：臺灣二十一世紀長期照護政策的方向．臺灣衛誌，20，192-201。
吳淑瓊、陳正芬（2000）．長期照護資源的過去、現在與未來．社區發展季刊．92，19～31。
李彩緣、徐慧娟、周怡伶、陳鈺如 (2012)，中部某醫學中心護理人員對老人態度及照顧意願之探討，護理暨健康照護研究, 8(4), 297-305。doi: 10.6225/jnhr.08.4.297
李麗娜 (1998)．高雄市市立醫院護理人員對老人照護知識、態度及意願之探討．未發表的碩士論文，台中：中山醫學院護理研究所。
汪華斌、舒進 (2010)．對臨床護士護理核心能力的見解．醫療品質雜誌，46(5)，54-56。
林宜蓉、杜玉卿、謝旭玲 (2009)・護理專科學生護理能力之探討－護理人員與臨床護理教師之評價・護理暨健康照護研究，5(3)，220-230。doi: 10.6225/jnhr.5.3.22
林秋芬、盧美秀、康偉玲 (2004)・護理能力標準：國際版與台灣版之比較・新臺北護理期刊，6(2)，11-22。
林貴滿 (2000)．老年護理課程對護生其老化態度及老人行為意向差異之探討．未發表的碩士論文，台中：中山醫學院護理研究所。
施美倫 (2008)．五專護理科學生對長期照護之知識'態度與照護意願之探討．未發表的碩士論文，台中：亞洲大學。
教育部（2013，10月04日）．教育部補助大學校院辦理跨領域學位學程及學分學程要點．取自 http://idp-moe.iiiedu.org.tw/index.php
陳秀玫、李怡娟、謝政賢 (2013，08月)．護理人員於長期照護之角色與功能．護理人員於長期照護之角色與功能論壇南區場．台北: 台灣護理學會。
陳惠姿 (2008)．老人及長期照護人力培育．護理雜誌，55(4)，11-16。
陳惠姿、李光廷 (2012)．長期照護專業人員核心能力與培育．護理雜誌，59(6)，12-18。
陳靜敏 (2012)．101年度護理人員長期照護繼續教育計畫成果報告(行政院衛生福利部101年度長期照護醫事人員繼續教育計畫)．台北:行政院衛生福利部。
陳靜敏 (2013)．102年度護理人員長期照護繼續教育計畫成果報告(行政院衛生福利部102年度長期照護醫事人員繼續教育計畫)．台北:行政院衛生福利部。
陸　洛、高旭繁（2010）．臺灣大學生對老人態度與其從業意向之關連性．教育與心理研究，33（1），33－ 54。
葉淑惠、林麗味、王興耀、賀天蕙 (2001)．護理之家護理人員對老人照護知識及老人照護在職教育之需求．護理研究，9(3)，300-310。
劉立凡、葉莉莉 (2004)．探討臺灣長期照護資源整合與管理機制建立之實務面．社區發展季刊，106，106-114。
劉錫炳、林炳錚、滕以魯、陳永昭、張先信 (1988）．牛津高級英漢英英雙解辭典．台北市：東華。[Liu, X. M.,Lin, P. Z., Teng, T. L., Chen, Y. Z., & Zhang, X. X. (1988).Oxford advance
蔡淑鳳、王秀紅 (2008)．台灣長期照護政策發展．護理雜誌，55(4)，24-29。
蔣佳祝 (2010)．護理之家護理人員對長期照護知識態度與照護意願之探討．未發表的碩士論文，台中：亞洲大學。
衛生福利部 (2013)．行政院衛生署中程施政計畫（102至105年度）．http://www.mohw.gov.tw/cht/Ministry/DM2.aspx?f_list_no=6&fod_list_no=564
鄭雪英、于漱、許瑛真、林佳欣 (1996)．公共衛生護理人員照護老年個案之知識、態度與能力之研究．護理研究，4(4)， 321-332。
盧美秀、陳靜敏、張淑卿、李莉、金美雲、楊雅嵐 (2013)．長期照護:護理綜論．台北:華杏。
鍾春櫻 (1997)．護專生對老人態度、行為意向和影響因素之研究．大仁學報，15，76-91。
魏玲玲 (1995)．護生老化知識及對老人態度之調查．護理研究， 3(2)， 171-180。
藺寶珍 (2006)．護理之家護理人員留任意願及其相關因素之探討－以台南地區為例．長期照護雜誌，10(4)，363-378。
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., ... & Scott, P. A. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.mortality, 13, 17.
Aud, M. A., Bostick, J. E., Marek, K. D., & Roxanne, W. M. (2006). Introducing Baccalaureate Student Nurses to Gerontological Nursing. Journal of Professional Nursing, 22(2), 73-78. doi: http://dx.doi.org/10.1016/j.profnurs.2006.01.005
Benner, P.(1984). From Novice to Expert Excellence and Power in Clinical Nursing Practice. The American Journal of Nursing, 84(12), 1479.
Benner, P., 1984. From novice to expert: excellence and power in clinical nursing practice. Addison-Wesley, California.
Black, J., Allen, D., Redfern, L., Muzio, L., Rushowick, B., Balaski, B., . . . Round, B. (2008). Competencies in the context of entry-level registered nurse practice: a collaborative project in Canada. International Nursing Review, 55(2), 171-178.
Calman, Lynn. (2006). Patients’ views of nurses’ competence. Nurse Education Today, 26(8), 719-725. doi: http://dx.doi.org/10.1016/j.nedt.2006.07.016
Claflin, N. (2005). Continuing education needs assessment of acute care and long-term-care nurses in a Veterans Affairs Medical Center. Journal Of Continuing Education In Nursing, 36(6), 263-270.
Cowan, D. T., Norman, I., & Coopamah, V. P. (2005). Competence in nursing practice: a controversial concept--a focused review of literature. Nurse Educ Today, 25(5), 355-362. doi: 10.1016/j.nedt.2005.03.002
Cowan, D. T., Wilson-Barnett, J., & Norman, I. J. (2007). A European survey of general nurses' self assessment of competence. Nurse Education Today, 27(5), 452-458.
Cowan, D. T., Wilson-Barnett, J., Norman, I. J., & Murrells, T. (2008). Measuring nursing competence: development of a self-assessment tool for general nurses across Europe. International Journal of Nursing Studies, 45(6), 902-913.
DeVellis, R. F. (2011). Scale development: Theory and applications (3rd ed.). Newbury Park, CA: Sage publications.
Dracup, K., & Bryan-Brown, C. W. (2004). From novice to expert to mentor: shaping the future. American Journal of Critical Care, 13(6), 448-450.
Girot, E. A. (1993) Assessment of competence in clinical practice: a phenomenological approach. Journal of advanced nursing, 18(1), 114-119.
Girot, Elizabeth A. (2000). Assessment of graduates and diplomates in practice in the UK – are we measuring the same level of competence? Journal of Clinical Nursing, 9(3), 330-337. doi: 10.1046/j.1365-2702.2000.00393.x
Gropelli, T. (2009). Integrating gerontology content in the clinical setting. Nurse Educator, 34(4), 146-147. doi: 10.1097/NNE.0b013e3181aabe0b
Harvath, T. A., Swafford, K., Smith, K., Miller, L. L., Volpin, M., Sexson, K., . . . Young, H. A. (2008). Enhancing nursing leadership in long-term care: a review of the literature. Research in Gerontological Nursing, 1(3), 187-196.
Hobday, John V., Savik, Kay, Smith, Stan, & Gaugler, Joseph E. (2010). Feasibility of Internet training for care staff of residents with dementia: the CARES program. Journal Of Gerontological Nursing, 36(4), 13-21. doi: 10.3928/00989134-20100302-01
Harrison, L. L., & Novak, D. A.(1988). Evaluation of a gerontological nursing continuing education program: effect on nurses' knowledge and attitudes and on patients' perceptions and satisfaction. Journal of Advanced Nursing, 13(6), 684-692. doi: 10.1111/j.1365-2648.1988.tb00558.x
Kishimoto, M., Nagoshi, M., Williams, S., Masaki, K. H., & Blanchette, P. L.
(2005). Knowledge and attitudes about geriatrics of medical students,
internal medicine residents, and geriatric medicine fellows. Journal of
the American Geriatrics Society, 53(1), 99-102.
Kogan, N. (1961). Attitudes towards old people: The development of a scale
and an examination of correlates. Journal of Abnormal and Social Psychology, 62, 44-54.
Kuske, B., Luck, T., Hanns, S., Matschinger, H., Angermeyer, Matthias C., …& Riedel-Heller, S.G. (2009). Training in dementia care: a cluster-randomized controlled trial of a training program for nursing home staff in Germany. International Psychogeriatrics, 21(2), 295-308.
Lenburg, C. B. (1999). The framework, concepts and methods of the Competency Outcomes and Performance Assessment (COPA) Model. Online Journal of Issues in Nursing, 17p.
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382-385.
Liu, M., Kunaiktikul, W., Senaratana, W., Tonmukayakul, O., & Eriksen, L. (2007). Development of competency inventory for registered nurses in the People's Republic of China: scale development. International Journal of Nursing Studies, 44(5), 805-813.
Meretoja, R., Isoaho, H., & Leino-Kilpi, H. (2004). Nurse competence scale: development and psychometric testing. Journal of Advanced Nursing, 47(2), 124-133. doi: 10.1111/j.1365-2648.2004.03071.x
Mezey, M., Quinlan, E., Fairchild, S., & Vezina, M. (2006). Geriatric Competencies for RNs in Hospitals. Journal for Nurses in Staff Development, 22(1), 2-10.
Miller, J. M., Coke, L., Moss, A., & McCann, J. J. (2009). Reluctant gerontologists: integrating gerontological nursing content into a prelicensure program. Nurse Educator, 34(5), 198-203. doi: 10.1097/NNE.0b013e3181aaba3f
Palmore, E. (1977). Facts on aging: a short quiz. Gerontologist, 17(4), 315-320.
Potter, G., Clarke, T., Hackett, S., & Little, M. (2013). Nursing students and geriatric care: The influence of specific knowledge on evolving values, attitudes, and actions. Nurse Education in Practice, 13(5), 449-453. doi: http://dx.doi.org/10.1016/j.nepr.2013.02.007
Scott-Tilley, D., Marshall-Gray, P., Valadez, A., & Green, A. (2005). Integrating long-term care concepts into baccalaureate nursing education: the road to quality geriatric health care. Journal of Nursing Education, 44(6), 286-290.
Stone, R., & Harahan, M. F. (2010). Improving The Long-Term Care Workforce Serving Older Adults. Health Affairs, 29(1), 109-115. doi: 10.1377/hlthaff.2009.0554
Tzeng, H. M., & Ketefian, S. (2003). Demand for nursing competencies: an exploratory study in Taiwan's hospital system. Journal of Clinical Nursing, 12(4), 509-518.
Verderber, D. N., & Kick, E. (1990). Gerontological curriculum in schools of nursing. Journal of Nursing Education, 29(8), 355-361.
Wang, C. C., Liao, W. C., Kao, M. C., Chen, Y. J., Lee, M. C., Lee, M. F., & Yen, C. H. (2009). Taiwanese medical and nursing student interest levels in and attitudes towards geriatrics. Annals of the Academy of Medicine Singapore, 38(3), 230－236.
Watson, R., Stimpson, A., Topping, A., & Porock, D. (2002). Clinical competence assessment in nursing: a systematic review of the literature. Journal of Advanced Nursing, 39(5), 421-431. doi: 10.1046/j.1365-2648.2002.02307.x
Wyble, S. J., Hanafin, L. F., Brugge-Wiger, P. A., & Kushkowski, M. A. (1990). A plan for development in gerontological nursing. Journal of Nursing Staff Development, 6(6), 291-295.
Yen, C. H., Liao, W. C., Chen, Y. R., Kao, M. C., Lee, M. C., & Wang, C. C. (2009). A Chinese version of Kogan’s attitude toward older people scale: Reliability and validity assessment. International Journal of Nursing Studies, 46(1), 38－44. doi:10.1016/j.ijnurstu.2008.05.004
Zhang, Z.X., Luk, W., Arthur, D., & Wong, T. (2001). Nursing competencies: personal characteristics contributing to effective nursing performance. Journal of Advanced Nursing, 33(4), 467-474. doi: 10.1046/j.1365-2648.2001.01688.x