內外科護理模擬教案與客觀結構式臨床評量表之發展

護理是高度的實務作業，應用模擬教學可迅速達到學習成效。客觀結構式臨床測驗（Objective Structured Clinical Examination, OSCE）利用高度真實健康問題的模擬情境，作為護生臨床能力評估。本研究於某專科學校護理科學生之內外科護理學課程，從教學系統設計開始，參考臨床教案模板，以ADDIE（Analyze, Design, Develop, Implement, Evaluate）方法學，建置急性心肌梗塞護理、基本救命術與自動體外電擊操作及硬腦膜下出血護理等三項臨床模擬教案，發展OSCE評分表，內容效度考驗分別為.98、.99及.98。教師間評分信度肯德爾和諧係數呈現高度一致性。收案專四及專五學生共126名，三項主題OSCE評分以Cronbach's Alpha驗證均達中、高信度，並顯示OSCE分數足以作為學科總結性評量之預測指標。專五學生OSCE成績顯著高於專四學生，推論實習經驗及其他學習經歷因素使成績表現較好。本研究為行動研究，以情境模板結合ADDIE設計，透過產學合作及專家共識，能貼近臨床實務，達到優異之信效度。建議針對學習對象能力及學科教學重點，考量難度並設計題目，優化臨床技能評估工具，使教學及評量更精準，未來可類推適用於臨床護理照護之能力驗證與持續教育。

關鍵字

客觀結構式臨床測驗；模擬情境；內外科護理

並列摘要

Because nursing is an operational practice, simulation training can rapidly provide learning outcomes. The Objective Structured Clinical Examination (OSCE) involves simulated scenarios to evaluate nursing students' clinical competence. This study examined the medicine and surgery nursing course for fourth-year students in a junior college of nursing. We designed a teaching system, referenced templates, and applied the ADDIE (analyze, design, develop, implement, and evaluate) approach. Clinical simulation lesson plans and the OSCE checklists were developed. The content validity of the OSCE checklist was 0.98, 0.99, and 0.98 for Acute Myocardial Infarction, Basic Life Support and Automatic External Defibrillator, and Subdural Hemorrhage Nursing courses, respectively. The inter-rater reliability measured using the Kendall W coefficient revealed that the findings had high consistency. A total of 126 fourth-year and fifth-year students participated in this study. The reliability of the OSCE score, which was corroborated using Cronbach's α, was moderate and high. The OSCE scores in the three subjects were significantly correlated with the summative assessment scores of the fourth-year and fifth-year students, indicating that OSCE performance was an effective predictor of the subject's summative assessment. The OSCE scores of the fifth-year students were significantly higher than those of the fourth-year students, indicating that internship experience and other learning experience factors contributed to better performance. Through industry-university cooperation and expert consensus, this study used an action research approach and combined a scenario template with an ADDIE design that could be applicable to clinical practice and achieve excellent reliability and validity. We suggest that this model can be applied in the design of nursing simulation scenarios and the development of OSCE checklists. With consideration for the abilities of students, key aspects of a teaching subject, and the difficulty of test items are crucial factors for designing an effective clinical skill assessment tool that leads to strong learning outcomes. This method can be used for the assessment of nursing skill in clinical practice.

並列關鍵字

objective structured clinical examination ； simulation scenario ； medical-surgical nursing

參考文獻

張念中、謝銘勳、陳榮邦、朱娟秀、蔡純娟、曾啟瑞(2010)．客觀結構式臨床測試之規劃及執行．北市醫學雜誌，7 (1)，1-12。

蔡麗紅(2018a)．實施「客觀結構式臨床技能測驗- 整合型長站設計」於護理系臨床實作組之實驗．長庚科技學刊，28 ，29-45。https://doi.org/10.6192/CGUST.201806_ (28).5

蔡麗紅(2018b)．臨床情境案例教學於四技護理系「統合護理技能實作」課程之評量．長庚科技學刊，29 ，37-52。

Atul, B. (2018). Applying addie model to evaluate faculty development program. Issues and Ideas in Education, 6(1), 11-28. https://doi.org/10.15415/iie.2018.61001

Bambini, D. (2016). Writing a simulation scenario: A step-by-step guide. AACN Advanced Critical Care, 27(1), 62-70. https://doi.org/10.4037/aacnacc2016986

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