高擬真模擬教學對護理學生於健康評估課程學習成效探討-以心血管系統評估為例

研究背景：健康評估技巧是護理實務必備的核心能力之一，它仰賴生物、醫學課程和護理專業教育為基石，也是建構往後內外科護理學、臨床實習及臨床照護的重要基礎。熟練的健康評估技巧對於臨床推理、提供高質量的護理相當重要，進而影響日後病人安全及照護品質。國外文獻研究發現高擬真模擬教案運用於護理教育將可有助於提高學生於知識、情意及技能層面的分數，但目前尚不清楚此法運用於台灣護理系學生於健康評估課程之成效，故藉此研究了解台灣學生在此科目學習狀態及高擬真模擬教案介入後之學習成效分析。研究目的：健康評估課程是綜合護理學生在完成基本護理學、解剖生理學、病理學等先備知識後集大成所必修的重要科目，也是往後內外科護理學、臨床實習以及踏入臨床工作的重要基礎。本研究係探討護理學系學生在學習「健康評估」課程與實習時的現況，依該課程教學目標及學生需求設計高擬真模擬教案，探討高擬真模擬教案教學法介入後對學生於知識、情意及技能之間的相關性。研究方法：本研究採二階段進行，第一階段以行動研究法確認教案內容；其後以類實驗研究法，採雙組前後測，招募北部國立某大學之護理學系學生為研究對象，共收案59位受訪者，有效回收率為74.7%。研究工具包含自擬式問卷及人口學特性、先備知識的信心程度、健康評估課程與實習的學習現況、高擬真模擬教具及心衰竭教案，由研究者（專科護理師）負責研擬和各組教學。研究資料以IBM SPSS Statistics 22.0版統計軟體進行資料建檔與分析，進行描述性統計及推論性統計。研究結果：心血管系統是受訪學生於健康評估課程中最喜歡但自覺學習最困難的單元，本研究因此設計心衰竭個案高擬真模擬教案，教案經專家效度檢定CVI值為0.93～0.95。經過逐步多元迴歸分析建立學習成效迴歸模型，研究結果顯示：年齡、入學方式、對內外科護理學的信心程度及自學時數…等皆為影響學習成效之單變項顯著因子，以逐步複迴歸法分析結果：知識及學習態度等變項是健康評估技術考成績之正向預測因子，此迴歸模型預測力R2值為 0.513；高擬真模擬教案組的技術考成績高於對照組1.45分；且在控制了組別因素下，學習態度和紙筆測驗亦為技能成效之正向預測因子（p < .001），期末考成績愈高、其後的技能測驗也能顯著增加0.59分（p < .001），總解釋變異量為51.3%。結論：行動研究法能了解學生在健康評估課程的學習需求，設計合適的高擬真情境模擬教案。以高擬真教具教學之護理學生於健康評估技術考和學習態度均有正向學習效果，此結果能提供未來教育研究、教學設計、臨床照護訓練參考。

關鍵字

健康評估；高擬真模擬教案；情境教學；護理教育；行動研究法；學習成效

並列摘要

Background: Health assessment and skills are one of the core abilities of nursing practice. The subject relies on biology, medical education and professional nursing education as the cornerstones; it is also a vital foundation for Medical-Surgical Nursing, clinal practice and clinical care in the future. Proficient health assessment skills are essential for clinical reasoning, providing high-quality care and improving patient safety. In previous studies, the high-fidelity simulation on nursing education could improve the scores of knowledge, affection and skill ability, but the effect on health assessment courses in Taiwan was unclear. Therefore, the purpose of this study is to investigate the learning status of health assessment courses and the related and effect on knowledge, attitude and skill ability of a nursing student with high-fidelity simulation scenarios. Purpose: The health assessment course is an important required course for the nursing students after completing fundamentals of nursing, anatomic physiology, pathology and other prerequisite knowledge. It is also a vital subject and foundation for medical and surgical nursing, clinical practice and clinical work in the future. This study aims to investigate the learning status and learning dilemma of the nursing student in health assessment course; the high-fidelity simulation scenarios designed according to the curriculum goals of health assessment course and student needs, the purpose of the study was to explore the related and effect of knowledge, attitude and skill ability of a nursing student with high-fidelity simulation scenarios in health assessment course. Method: This study was conducted in two phases. The first phase used the action research method to confirm the content of the lesson plan; afterwards, the second step we adopted the Quasi-experimentation and non-randomized control-group pretest-posttest design, we recruited nursing students from a northern state university in Taiwan as the research subject. 59 respondents were accepted, and the effective recovery rate was 74.7%. Research tools in the study include self-developed questionnaires and demographic characteristics, confidence of prior knowledge, learning status of health assessment courses, high-fidelity simulation teaching aids, and lesson plans of heart failure. The researcher (Nurse Practitioner) is responsible for all the research formulated and implement. The research data are filed and analyzed with IBM SPSS Statistics 22.0 version statistical software, and descriptive statistics and inferential statistics are performed. Result: The cardiovascular system is the most favorite, but learning difficulties subject of the health assessment course for the nursing students, and thus the high-fidelity simulation scenarios with heart failure patient assessment was designed according to the curriculum goals of health assessment course and student needs, the Item-level CVI of the scenarios is .95, the Scale-level CVI is .93. After stepwise multiple regression analysis, a regression model of learning effectiveness was established. The results of the study demonstrate that age, school enrollment, confidence in medical and surgical nursing, and self-study hours... are all significant univariate factors that affect learning effectiveness, and stepwise multiple regression analysis: knowledge and learning attitude are positive predictors of health assessment technical test scores, the predictive power of this regression model R2 value is 0.513; the OSCE scores of the high-fidelity simulation scenarios group are higher than the control group by 1.45 points; And under control for group factors, learning attitude and written test are also positive predictors of skill effectiveness (p <.001). The higher the final exam score, the subsequent skill tests can significantly increase 0.59 points (p < .001), the total explained variance is 51.3%. Conclusion: The action research method could realize the learning needs, and consequently to design the befitting high-fidelity teaching plan for the nursing students in the health assessment course. Nursing students who taught with high-fidelity simulation teaching scenarios, and lesson plans of heart failure patient have positive learning effects in health assessment skills and learning attitudes. This result can provide references for future education research, teaching design, and clinical nursing training.

並列關鍵字

health assessment course ； high-fidelity simulation scenarios ； situational teaching ； nursing education ； action research ； learning effectiveness

參考文獻

王秀禾、孫嘉玲、陳美慧、洪兆嘉、周培萱、賴玉敏、林育興、陳櫂豐（2015）・客觀性結構式臨床測驗（OSCE）應用於護理系課程之成效・技術及職業教育學報,6(2), 1~15。

Google Scholar

王秀雲、蔡景仁、黃涵薇(2014年11月19日)・認知、態度與身體性別關係:醫學教育中的醫學生同儕身體檢查之探討・科技部補助專題研究計畫成果報告(NSC 101-2629-S-006-001-)。http://taiwan-gist.net/files/past_plan/101/101-37.pdf