探討團隊導向學習對加護病房護理人員安寧相關法令教育之學習成效

背景：現今加護病房需要照護許多末期的病人，而加護病房的護理人員對多次變革的「安寧緩和醫療條例」及108年即將實施的「病人自主權利法」卻有認知不足的情形。可能因為機構對安寧相關法令教育的不足或是教學方法的不具創新性所致，因此，需要導入創新的教學方法提升加護病房護理人員對安寧相關法令的知能學習。目的：本研究旨在(一)探討團隊導向學習對改善加護病房護理人員安寧相關法令之學習成效。(二)探討介入TBL後加護病房護理人員安寧相關法令之成績表現、自主學習能力、學習滿意度及團體參與評價之相關。方法：本研究為一類實驗設計之非隨機分派的「實驗組與控制組前-後測」設計；研究對象以方便取樣選取97位南部某教學醫院加護病病房護理師(含專科護理師)。實驗組為TBL教學共59人，控制組為傳統教學法共38人，全部研究對象接受「安寧相關法令認知評估量表」前測後，實驗組介入團隊導向學習法，控制組介入傳統教學法，並分別於課後隨即執行認知第一次後測以及課後2週進行認知第2次後測。資料以IBM SPSS Statistics 22 中文版套裝軟體進行描述性統計及Paired t-test、t test、Pearson’s correlation、ANOVA及Repeated Measure等推論性統計分析。結果：研究結果顯示：(一)介入TBL教學方法比起傳統教學法，對提升加護病房護理人員學習安寧相關法令認知得分具顯著成效。(二)介入TBL之實驗組之IRAT與TRAT的成對樣本t檢定具顯著性差異(t =-16.48, p< .000)，顯示TBL教學方法之團體互動可以讓學習成績具明顯提升效果。(三)實驗組之團體參與評價的高低，與個人認知前測與IRAT、團體成績TRAT與TBL、學習滿意度及自主學習能力具有正相關。(四)TBL成績表現與自主學習能力、學習滿意度及團體參與評價高低具正相關。結論：本研究個人認知前測結果顯示加護病房護理人員對安寧法令認知仍是不足，而創新/翻轉教育TBL能提升知能並引發自主學習動機；同時，課前的預習準備以及TBL課中的小組討論，都有助於提升課程內容的了解及學習滿意度。

關鍵字

團隊導向學習法；安寧緩和醫療條例；病人自主權利法；加護病房護理人員

並列摘要

Background: Many terminal patients received end of life care in intensive care units (ICU) in Taiwan. However, most of ICU nurses do not have adequate knowledge of “ Palliative Care Act” and “ Patient Self-Determination Act”. The main reasons may be caused by the lack of continue education of Palliative Care Act or using the traditional pedagogy as a teaching method. It is significant to intervene some creative learning methods to improve the knowledge of Palliative Care Act for ICU nurses. Purpose: This study tried to 1)evaluate the effects of applying team-based learning on Palliative Care Act for ICU nurses, 2)investigate the relationships within knowledge scores of Palliative Care Act, learning satisfaction, self-directed learning and peer evaluation after intervening the TBL. Methods: This was a quasi-experimental design study with the pre-test and post-test for experiment group and control group. Ninety-seven ICU nurses who work in a teaching hospital in southern Taiwan were recruited. The participants were divided non-randomly into 59 nurses in the TBL experiment group and 38 nurses in the traditional pedagogy control group. All of the research members received “ The knowledge of Palliative Care Act Assessment Scale” tests for four times those were before and just after teaching class, followed by 1 week and 2 weeks after class. Data were analyzed by IBM SPSS Statistics 22 with Paired t-test, t-test, Pearson’s correction coefficient, ANOVA and Repeated Measure. Results: The results indicated that 1) The ICU nurses in the TBL group may have significantly higher scores of knowledge on Palliative Care Act than those in the traditional pedagogy group, 2) In the TBL group, the TRAT scores may significantly higher than the IRAT scores (t=-16.48, p<.000). That meant the team work may improve the effects of learning. 3) The levels of peer evaluation in the TBL group were positively correlated with the scores of individual pre-test, IRAT, TRAT, TBL, students’ satisfaction and self-directed learning. 4) TBL grades were significantly associated with learning satisfaction, self-directed learning and peer evaluation scores. Conclusion: According to the pre-test scores, the lack of knowledge of Palliative Care Act still existed within ICU nurses. The creative/flipped education, such as TBL, may improve the motivation of self-directed learn- ing and the pre-class readiness may play an important role in understand the content of Palliative Care Act and learning satisfaction as well.