基本救命術課程中不同教學設計之立即成效探討
The Immediate Effect between Innovative and Conventional Teaching Designs in

Basic Life Support Courses

本研究之主要目的在探討高中一年級學生在成人基本救命術課程中，對創新教學設計介入方案之立即認知和技能成效。採用準實驗研究法的「不等組前後測設計」，實驗組、對照組前後測方式進行。實驗處理乃以實驗組接受創新教學設計介入方案，而對照組則接受現行教學設計介入方案。以立意取樣方式選擇北部某兩所公立高中一年級中的各四個班級為實驗組和對照組，結果前後測收案資料共有307人，其中實驗組有155人，對照組有152人。研究工具使用自設之客觀認知測驗、錄影記錄和紀錄安妮客觀資料（VIDRAP）、國際急救教育委員會修正之五分主觀整體評分表和心肺復甦術檢核表。資料處理以SAS for Window 8.2版之統計軟體進行統計分析，統計方法含描述性統計分析、獨立樣本t檢定，χ2檢定、配對t檢定、麥內瑪檢定和共變數分析。研究對象平均年齡15.35歲，年齡層均介於15歲至16歲之間，平均學業成績為75.34分，介於38.1分至91.8分之間，男女比率和有無參加心肺復甦術訓練的經驗比率相近，而參加其他急救相關訓練的經驗比率和實際執行其他急救相關技術的經驗比率居少數，和均無實際執行心肺復甦術的經驗。主要研究結果如下：

一、 本研究對象之成人基本救命術起點行為認知測驗為8.11分（得分指數為 
32.46分），五分主觀整體評分表表現，以「不具有能力的」最多，佔92.83％（285人），心肺復甦術檢核表表現為3.33分（得分指數為14.49分），人工呼吸正確率之總平均值為1.43％，胸部按壓正確率之總平均值為11.10％，胸部按壓速率正確率之總平均值為13.03％，顯現高一學生之成人基本救命術起點行為仍十分貧乏。

二、 影響成人基本救命術前測成效的基本背景變項，以有參加心肺復甦術訓練的經驗和其他急救相關訓練的經驗為主；性別則只影響胸部按壓正確率，且男性優於女性。

三、 教學介入前後，實驗組和對照組在認知總體表現和危急徵象之辨認、啟動緊急醫療網、心肺復甦術、呼吸道異物哽塞等四個面向均顯高於計畫前。

四、 教學介入前後，實驗組和對照組在五分主觀整體評分表表現、心肺復甦術檢核表總體表現和啟動系統、重建呼吸、重建循環和急救順流程上等四個面向的表現、人工呼吸正確率、胸部按壓正確率、胸部按壓速率正確率均顯著高於計畫前。

五、 經兩組前測為共變項之共變數分析之後，實驗組後測之「認知能力總體表現」和「危急徵象之辨認」、「心肺復甦術認知」、「解除吸道異物哽塞認知」等三個面向的分數皆顯著高於對照組後測之分數。而「啟動緊急醫療網時機認知」則無顯著差異。

六、 經兩組前測為共變項之共變數分析之後，實驗組後測之「五分主觀整體評分表表現」、「心肺復甦術檢核表總體表現」和「重建循環現」、「急救順序流程上的表現」等兩個面向、「人工呼吸正確率」、「胸部按壓速率正確率」的分數皆顯著高於對照組後測之分數。心肺復甦術檢核表中的「啟動系統上的表現」、「重建呼吸的表現」兩個面向和「胸部按壓正確率」則無顯著差異。

綜合上述結論，以創新教學設計介入於高中課程，可有效的提升高一學成人基本救命術認知和技能中多個層面的急救能力。

The purpose of this study was to investigate the immediately cognitive and skill effects between innovative and conventional teaching designs in basic life support courses. A Quasi-experimental design was utilized and purposive sampling was conducted at two public senior high schools of northern Taiwan. Three hundred and seven subjects were assigned into experimental and control group. The experimental group, which consisted of 155 subjects, participated in a program of innovative teaching design. The intervention program applied the video-assisted, peer-assisted, and sound-assisted and simplification teaching strategies to aid subjects in developing effective learning. The control group, which consisted of 152 subjects, participated in a program of conventional teaching design. The subjects completed an objective structured cognitive test and a skill test, including five-point subjective overall rating, CPR checklist, and video recording combined with the recording Resusci-Anne printout. Statistical analyses included descriptive statistics, independent sample t test, chi-square test, paired t-test, McNemar test, analysis of covariance. After teaching intervention, the results in the experimental group of follow- up test showed that (1)the initial behaviors of first grade senior high school in adult BLS is poor, (2)the predictors of adult BLS pre-test were experience and gender, (3) the cognitive performance had higher estimated score than those of pre-test,(4) the skill performance had higher estimated score than those of pre-test,

(5) the all cognitive performance, including identifying critical signs, CPR and FBAO had significantly higher than those in the control group of follow-up test while initiating EMS was no difference, and (6) the five-point subjective overall rating, the all skill performance, including reconstruct circulation and sequence procedure, the percentage of correct ventilation, and percentage of correct compression rate had significantly higher than those in the control group of follow-up test while initiating EMS, reconstruct ventilation and correct percentage of chest compression were no difference.