介入護理訓練對於護理人員在臨床技能測驗成效之探討

背景與目的：2007年衛生福利部委託醫策會推動臨床醫人員培訓計畫，其中護理師的培訓計畫是指取得專業證照四年內之護理師，在臨床教師指導下，使臨床實務操作能有階段性的學習，培養專業核心能力，稱為NPGY。核心能力中，輸血技能是常見的醫療處置，也被認為是較學習難度較高的項目，護理師在執行該技能佔有重要的角色，應從培訓計畫中紮實學習。因此本研究以輸血技能為例，探討護理師人口特性與臨床技能測驗之成效與相關影響因素，並進一步探討NPGY介入培訓計畫後，與一般護理師測驗成效之差異。方法：採回溯性分析2017年至2019年某區域教學醫院臨床技能成績，比較分為實驗組88人（接受NPGY護理訓練）及與對照組76人（接受一般護理訓練），其基本特性：年齡、學歷、職業稱謂、工作單位、編制、年資、NPGY與否、NPGY培訓階段等自變項與測驗成效之差異。研究工具為醫院制定之輸血監測量表，分為三大構面：準備面、執行面與記錄面。統計分析包含描述性統計、獨立樣本t檢定與單因子變異數分析及多元複迴歸。結果：測驗成績平均為93.62分，準備、執行、記錄面平均分數分別為89.91、94.37、94.07分；2019年總分平均為93.68分，較過去兩年平均分數高出0.11分。各個面向平均分數介於93~95分，除了2019年期間，準備面分數偏低為85.23分。實驗組在準備面顯著高於對照組；25歲以下在準備面顯著高於36歲以上；10~24個月在準備面顯著高於25個月以上；急重症單位與一般急性病房在總分顯著高於特殊單位，急重症單位在執行面顯著高於特殊單位；公職人員在執行面顯著高於約用人員。結論：在介入二年期護理訓練後，在準備面NPGY分數優於非NPGY，顯示NPGY訓練是具有成效的，雖然僅是臨床技能測試，但能養成新進人員在忙碌及容易被干擾的的臨床工作中，培養熟記輸血準備期的作業流程。常執行輸血技術的單位，在測驗分數優於不常輸血的工作單位，因此，需加強教育非頻繁執行輸血技術的工作單位。

關鍵字

二年期護理訓練(PGY) ；臨床技能測驗；教育成效；輸血

並列摘要

Background and objectives: In 2007, the Ministry of Health and Welfare entrusted the Joint Commission of Taiwan to promote a clinical healthcare staff training program. This is known as the training plan for nurses to obtain a professional license within four years. Under the guidance of a mentor, they learn clinical practice in stages and cultivate professional core competence, called the Nurse Post Graduate Year (NPGY). Blood transfusion is one of the core competencies in medical treatment and is considered difficult to learn. It is an essential nursing skill and should be included in the training plan. Therefore, this study focuses on analyzing the performance, basic characteristics, and clinical skills necessary to successfully learn the blood transfusion process. The study also explores the differences between the PGYN intervention training program and the General Nursing Training Program. Methods: A retrospective analysis was conducted on trainees’ clinical skills scores at a regional teaching hospital from 2017 to 2019. The study participants were divided into the experimental group (88 nurses; receiving NPGY nursing training) and the control group (76 nurses; receiving general nursing training). The independent variables that were tested to identify the basic characteristics were as follows: age, education, professional title, work unit, public officials or not, level of seniority, pre- or post-graduate, and the phase of NPGY training. The evaluation tool was a “blood transfusion monitoring scale” developed by the hospital and divided into three major dimensions: preparation, execution, and recording. The statistical analysis included descriptive statistics, t-test, one-way ANOVA, and multiple regression. Results: The average overall score was 93.62 points, and the average scores for preparation, execution, and recording were 89.91, 94.37, and 94.07 points, respectively. The overall score for 2019 was 93.68 points, which is 0.11 points higher than the average score for the past two years. The average score of each aspect ranged from 93 to 95 points, except for 2019 when the preparation score was low at 85.23 points. The overall score indicated that the experimental group was significantly better prepared than the control group; nurses aged 25 scored significantly higher than the 36-year-olds; nurses with 10-24 months’ experience scored significantly higher than those who were in training for 25 months and longer.The overall scores of the emergency and intensive care units and the general acute wards were significantly higher compared to other special units; the emergency and intensive care units were significantly higher than the other special units in the execution dimension; the official public nurses scored significantly higher in the execution dimension than the non-official nurses. Conclusion: After a two-year nursing training program, the NPGY score was better than the non-PGYN in the preparation dimension, showing that the NPGY training was effective. Although it is only a clinical skills exam, it can improve new nurses’ skills in busy clinical work where they are often disturbed, to memorize the blood transfusion preparation. Units that frequently perform blood transfusion techniques had better test scores than work units that do not perform frequent transfusions. Therefore, it is essential to improve training at work units that regularly perform blood transfusion techniques.