運用高擬真教學提升氣管內管異常事件評估與處置之學習成效探討

Utilizing Simulation Teaching to Enhance the Assessment and Management of Endotracheal Tube Accidents

舒伊敏(Yi-Min Shu) ； 章正俐(Cheng-Li Chang) ； 陳乃菁(Nai-Ching Chen) ； 杜雅惠(Ya-Hui Tu) ； 柯雅婷(Ya-Ting Ke)

《台灣擬真醫學教育期刊》 6卷1期 (2019/06) Pp. 26-36

https://doi.org/10.6582/JTSSH.201906_6(1).0003

摘要

背景與目的：氣管內管是急重症照護單位常見且高風險的醫療裝置，如何正確、安全執行氣管內管照護，是急重症護理師、呼吸治療師與醫師基本且重要的專業能力。本研究運用Simmin3G高擬真模擬人與擬真情境教學法指導加護病房第一年（3-12個月）護理人員（Nurse Post Graduate Year；以下簡稱NPGY學員或學員），評量學員面臨氣管內管異常事件之評估、處置及團隊溝通，探討擬真教學之成效。研究方法：本研究採單組前後測類實驗設計，收案期間為2019年5至7月加護病房第一年NPGY學員為教案介入對象（n=17），導入「氣管內管異常事件評估與處置」高擬真教學，比較氣管內管異常事件評估與處置之知能、技能之差異及能力自信度。研究結果：導入高擬真教案之學習成效，知能前後測平均得分分別為87.6（±9.7）分與98.8（±3.3）分，呈現顯著差異（p ＜ 0.00），技能前後測平均得分分別為10.4（±1.6）分與17.2（±1.2）分，呈現顯著差異（p ＜ 0.00），學員自評與教師評值學員的自信程度均為「很有自信」。結論：透過高擬真情境及客觀結構式臨床技能測驗（Objective Structured Clinical Examination；以下簡稱OSCE）測驗可多面向評量專業技能、態度及團隊溝通能力，增加第一年NPGY學員對於氣管內管異常事件評估的處置能力。

關鍵字

氣管內管異常 ； 客觀結構式臨床技能測驗 ； 擬真情境教學 ； 二年期護理師

並列摘要

Objective: An endotracheal tube is a common but high-risk medical device used in acute and critical care units. Performing endotracheal tube care correctly and safely is a basic and an important professional skill for acute and critical care nurses, respiratory therapists, and physicians. This study aims to provide a guide for third to twelfth Nurses Post Graduate Year (NPGY) in the intensive care unit to assess and manage team communications during an endotracheal tube accident, through Simmin3G simulators and simulation teaching and by discussing its effectiveness. Methods: This study is quasi-experimental, with a single-group pre- and post-test design. Seventeen NPGY nurses were included in the study, who were employed from May to July of 2019. Simulation teaching was utilized, comparing the knowledge, skills, and confidence in the evaluation and management of an endotracheal tube accident. Results: After a 2-week intervention, there was a significant difference between pre-test and post-test mean scores, with 87.6 (± 9.7) vs 98.8 (± 3.3) for knowledge (p ＜0.00) and 10.4 (± 1.6) vs 17.2 (± 1.2) for skill (p ＜0.00). Self-evaluation from the NPGY nurses and the teacher's evaluation were both scored as ＂very confident.＂ Conclusion: The results confirm that an NPGY nurse training program, based on the objective structured clinical examination with simulation teaching, was effective. The program improved the professional skills, attitudes, and team communication of NPGY nurses during endotracheal accident assessments and management, as well as strengthened their confidence in clinical practice.

並列關鍵字

Endotracheal Tube Accident ； Objective Structured Clinical Examination ； Simulation Teaching ； Post Graduate Year Nurse