[委托:护理教育中的创新与实践]

[Entrustment: Innovation and Practice in Nursing Education].

作者信息

Chang Chia-Chuan

机构信息

Post-Baccalaureate Program in Nursing, Fu Jen Catholic University, Taiwan, ROC.

Department of Nursing, Fu Jen Catholic University, Taiwan, ROC.

出版信息

Hu Li Za Zhi. 2025 Aug;72(4):4-6. doi: 10.6224/JN.202508_72(4).01.

Abstract

The World Health Organization has projected a global shortage of 5.7 million nurses by 2030 (World Health Organization, 2024). However, the International Council of Nurses warns that, in light of the COVID-19 pandemic and ongoing workforce shortages, this gap could escalate to as many as 13 million over the same timeframe (International Council of Nurses, 2021). With nursing personnel shortages, rising disease complexity, and aging populations, healthcare systems around the world, including Taiwan, are faced with considerable challenges. To address the challenges faced specifically by the nursing workforce in Taiwan over the next decade, the Ministry of Health and Welfare and the National Health Research Institutes convened a national forum in 2021, bringing together dozens of nursing experts to propose forward-looking strategies and policy recommendations. The forum emphasized the urgent need to reform nursing education and workforce development in order to expand capacity through innovation. Key proposals stressed the importance of enhancing both the quality and quantity of the nursing workforce, aligning educational curricula with real-world demands, and bridging the persistent theory-practice gap that currently impedes new graduates from transitioning smoothly into clinical roles. The aim was to cultivate competent and practice-ready professionals capable of delivering safe, high-quality patient care and contributing to public health (National Health Research Institutes, 2022). This issue turns the spotlight on Entrustable Professional Activities (EPAs) as a new and potentially effective framework for nursing education and workforce preparation. EPAs refer to key professional tasks that a trained professional can be entrusted to perform independently (ten Cate, 2020). Successful implementation of these activities requires trainees' contextual competence in integrating canonical knowledge (including foundational medical science, clinical reasoning, physical assessment, and professional and ethical standards) into actual clinical settings (ten Cate et al., 2024). EPAs emphasize real-world tasks at their core. By directly observing trainees' performance in completing tasks within real situations, educators can evaluate their readiness for independent responsibility, make informed, competence-based entrustment decisions, and appropriately delegate patient care duties (ten Cate et al., 2024; ten Cate & Taylor, 2021). EPAs bridge competencies and tasks, embodying an outcomes-oriented, practical approach to teaching and evaluation (ten Cate & Favier, 2022). This model is rapidly gaining traction globally as a viable approach to cultivating independent and practice-ready nursing professionals (Pietsch et al., 2025). Given the complex and multifaceted nature of nursing tasks, proficiency in isolated skills or knowledge areas alone is insufficient to ensure task readiness. Effective clinical practice demands the integration of knowledge, technical skills, and attitudes. Due to the current and long-term nursing shortage, nursing students, novice nurses, and advanced nursing practitioners must all be equipped with the competencies necessary to perform core clinical responsibilities. Also, facilitating their transformation from trainees into accountable professionals is key to maintaining the safety and quality of patient care. This issue features four articles written by nursing scholars that explore the multifaceted role of EPAs, including their development in nursing education and clinical training, application in student learning and assessment, use in shaping advanced curriculum design and clinical competence, and implementation in clinical training. It is hoped these expert perspectives and experiences will spark thoughtful reflection on the use of EPAs within a model of entrusted professional development. By grounding nursing education in EPAs, nursing can collectively drive innovation in both academic and clinical settings, fostering seamless transition from classroom learning and hands-on practice. Ultimately, this approach aims to cultivate future nurses who are competent in carrying out clinical responsibilities independently to deliver safe and quality care and, through doing so, elevating the impact and visibility of the nursing profession.

摘要

世界卫生组织预计,到2030年全球将短缺570万名护士(世界卫生组织,2024年)。然而,国际护士理事会警告称,鉴于新冠疫情和持续的劳动力短缺,在同一时期内,这一缺口可能会扩大到多达1300万(国际护士理事会,2021年)。由于护理人员短缺、疾病复杂性增加以及人口老龄化,包括台湾地区在内的世界各地医疗系统都面临着巨大挑战。为应对台湾地区护理人员在未来十年面临的具体挑战,台湾地区卫生福利部和台湾地区“国家卫生研究院”于2021年召开了一次全国性论坛,汇聚了数十名护理专家,以提出前瞻性战略和政策建议。该论坛强调迫切需要改革护理教育和劳动力发展,以便通过创新扩大能力。关键建议强调了提高护理人员质量和数量的重要性,使教育课程与实际需求相匹配,并弥合目前阻碍新毕业生顺利过渡到临床岗位的长期存在的理论与实践差距。其目标是培养有能力且为实践做好准备的专业人员,能够提供安全、高质量的患者护理并为公共卫生做出贡献(台湾地区“国家卫生研究院”,2022年)。本期聚焦可托付专业活动(EPAs),将其作为护理教育和劳动力培养的一种新的且可能有效的框架。可托付专业活动是指经过培训的专业人员可以被托付独立执行的关键专业任务(滕·凯特,2020年)。成功实施这些活动要求受训人员具备情境胜任能力,即将规范知识(包括基础医学科学、临床推理、体格检查以及专业和道德标准)融入实际临床环境中(滕·凯特等人,2024年)。可托付专业活动以现实世界中的任务为核心。通过直接观察受训人员在实际情境中完成任务的表现,教育工作者可以评估他们承担独立责任的准备情况,做出基于胜任能力的明智托付决策,并适当地分配患者护理职责(滕·凯特等人,2024年;滕·凯特和泰勒,2021年)。可托付专业活动架起了能力与任务之间的桥梁,体现了一种以结果为导向的实用教学和评估方法(滕·凯特和法维尔,2022年)。作为培养独立且为实践做好准备的护理专业人员的一种可行方法,这种模式正在全球迅速获得认可(皮茨等人,2025年)。鉴于护理任务的复杂性和多面性,仅精通孤立的技能或知识领域不足以确保做好执行任务的准备。有效的临床实践需要知识、技术技能和态度的整合。由于当前及长期的护理人员短缺,护理专业学生、新手护士和高级护理从业者都必须具备履行核心临床职责所需的能力。此外,促进他们从受训人员转变为有责任感的专业人员是维持患者护理安全和质量的关键。本期有四篇由护理学者撰写的文章,探讨了可托付专业活动的多方面作用,包括其在护理教育和临床培训中的发展、在学生学习和评估中的应用、在塑造高级课程设计和临床能力方面的用途以及在临床培训中的实施。希望这些专家观点和经验能引发对在可托付专业发展模式中使用可托付专业活动的深入思考。通过将护理教育建立在可托付专业活动的基础上,护理行业能够共同推动学术和临床环境中的创新,促进从课堂学习到实践操作的无缝过渡。最终,这种方法旨在培养未来能够独立履行临床职责以提供安全和高质量护理的护士,并借此提升护理行业的影响力和知名度。

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