探討運用擬真情境教學提升心導管檢查術後肢體評估與處置之學習成效

背景與目的：心導管檢查與使用抗凝血藥物是心肌梗塞病人最常見的治療，如何正確執行心導管檢查術後的肢體評估，藥物或相關因素導致的出血合併症發生時，如何快速正確的評估及處置，需結合醫師、護理師及藥師的專業能力與跨領域合作。本研究運用擬真情境教學法指導醫師、護理師之PGY（Post Graduate Year；以下簡稱PGY）學員，並以客觀結構式臨床技能（Objective Structured Clinical Examination；以下簡稱OSCE）之評分方式，以探討教學成效。研究方法：本研究為單組前、後測類實驗性設計，收案期間為2021年7至9月，進行醫師PGY（N=14）與護理師PGY（N=20）之學員以「心導管術後肢體評估及相關處置」之教學教案導入，此教學法運用擬真情境教學模式並以OSCE驗收成效。以SPSS 19.0版以獨立t檢定分析，分析PGY學員在教學法介入前、後的知識、與自信度之差異及學員自評與臨床教師評量自信度之差異。研究結果：導入擬真情境教學之學習成效，20位護理PGY學員的知識前測、教案介入後立即測及二週後測平均得分分別為78.0（±13.2）分、91.0（±7.9）分及89.0（±9.7）分，呈現顯著差異（p ＜ 0.00），14位醫師PGY學員的知識前測、教案介入後立即測及二週後測平均得分分別為79.3（±14.9）分、90.0（±8.8）分及86.4（±7.4）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」，均達顯著差異（p ＜ 0.00）。顯示擬真情境教學法於心導管術後肢體評估及相關處置，不僅可提升學員的知識，在態度的自信度上也同步提升。結論：透過擬真情境教學法及客觀結構式臨床技能可評量學員專業知識、技能及跨領域溝通能力，增加PGY學員對心導管術後肢體評估與處置能力。

關鍵字

擬真情境教學；客觀結構式臨床技能測驗；心導管術後肢體評估與處置

並列摘要

Objective: Cardiac catheterization and anticoagulants have been the most commonly used treatment for myocardial infarction. An accurate assessment of extremity function after cardiac catheterization and comprehensive management of drug-induced bleeding complications or related factors, require cross-disciplinary collaboration of physicians, nurses and pharmacists. This study investigates the effectiveness of simulation-based education for postgraduate year (PGY) physicians and nurses using score of the objective structured clinical examination (OSCE). Methods: The study employed a single group pre-and post-test design that included a total of 34 PGY physicians (N=14) and nurses (N=20) to evaluate the effectiveness of the simulation-based educational program Post Cardiac Catheterization Assessment of Extremity Function and Management using OSCE from July to September 2021. An independent sample t-test (SPSS version 19.0) was conducted to evaluate the difference in students' knowledge and confidence scores before and after training and the confidence levels in students' self-assessment and teacher assessment. Results: The average knowledge scores of 20 PGY nurses on pre-test, immediate post-test and two-week post-test of the program were 78.0 (±13.2), 91.0 (±7.9) and 89.0 (±9.7), respectively, showing a significant difference (p ＜ 0.00); the pre-test, immediate post-test and two-week post-test scores for the 14 PGY physicians were 79.3 (±14.9), 90.0 (±8.8), and 86.4 (±7.4), respectively, also demonstrating a significant difference (p ＜ 0.00). The confidence levels in both students' self-assessment and teacher assessment were high, with a significant difference (p ＜ 0.00). The simulation-based educational program improved students' knowledge and confidence in the post cardiac catheterization assessment of extremity function and management. Conclusion: Simulation-based education and the OSCE can be used to assess PGY physicians' and nurses' professional knowledge, skills and interdisciplinary communication skills and improve their ability to assess extremity function in patients undergoing cardiac catheterization and provide responsive management.

並列關鍵字

Simulation-Based Education ； Objective Structured Clinical Examination ； Post Cardiac Catheterization Assessment of Extremity Function and Management

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