護理臨床教師自評教學能力之研究

論文名稱(中/英文)	研究生	指導教授
護理臨床教師自評教學能力之研究 A study of teaching competences of self-assessment among clinical preceptors	邱綉雯	許麗齡博士
[ 摘要 ]
護理臨床教師指導護生實習的情況越來越普遍，經由研究者與多位護理臨床教師的訪談結果發現，多數的護理臨床教師都是在醫院的指派下擔任護理臨床教師的角色，大部分的護理臨床教師有豐富的臨床經驗和學識，普遍自覺缺乏教學技巧及信心，對於指導護生備感壓力與焦慮，同時也深感護理在職教育課程中缺乏敎與學相關概念，以及臨床指導員教育訓練的不普及，使得從護理人員在轉換成教師的角色有所困難。本研究旨在瞭解護理臨床教師自評教學能力情形與影響因素。本研究為描述性及相關性研究設計(descriptive and correlational study design)，採橫斷式調查方法(cross-sectional survey)，自擬「護理臨床教師教學能力自評表」，其內在一致性Cronbach’s α為0.99，進行專家內容效度檢定，題項內容效度(Item-Content validity index, CVI)為0.95與量表內容效度(Scale-CVI, S-CVI)為0.75；調查北部地區某家醫學中心及區域級醫院各科別之護理人員，總共發出154份問卷，回收147份問卷(有效回收率95.4％)。將回收的資料以SPSS 17.0進行資料分析，採用次數分配、百分比、平均數、標準差、單因子變異數分析(One-Way ANOVA)、無母數分析(Mann-Whitney test或Kruskal-Wallis test )、線性複迴歸(multiple linear regression)等方法進行推論性統計。研究結果發現: (一) 護理臨床教師自評教學能力平均單題得分範圍介於4.45分到3.67分（最高為5分），依平均數得分排序最高的前3個變項依序為「能要求學生回覆示教」、「提供安全實習環境」、「能和病人建立良好的關係」。(二) 護理臨床教師自評教學能力分數，會因個人背景因素之不同而有所差異；年齡越大、護理工作總年資越資深、進階層級為N3層級或N4層級、區域醫院的護理臨床教師、認為高薪資影響擔任護理臨床教師者、高度行政主管支持度者，其自評教學能力分數較高。(三) 經由複迴歸分析發現，在控制婚姻、教育程度、醫院等級及進階層級下，只有年齡及護理行政主管支持度是護理臨床教師教學能力之顯著獨立預測因子；換言之，年齡組別中41-58歲相較於21-30歲的護理臨床教師，其教學能力提高14.81分；護理行政主管支持度為高支持度者，其教學能力較普通支持度者高12.80分，此模式可解釋21.4%護理臨床教師教學能力之變異量。本研究結果期望能提升護理臨床教師教學能力及發展完整、客觀臨床教學能力之評值工具，可作為護理臨床教師自評教學能力之參考。
[ Abstract ]
An increasing number of veteran nurses are trusted with the task of training student nurses. Interviews between the author of this study and many clinical nurse trainers revealed the fact that the majority of clinical nurse trainers were given the role of nurse trainer by the hospital at which they work. The vast majority of clinical nurse trainers are well-versed and well-experienced in clinical practice, but many perceive themselves as lacking the skills and the confidence to pass their knowledge to student nurses, and feel anxious and stressed about their role as nurse trainer. Many of them believe that existing in-service nursing education does not provide enough guidelines for the transfer of knowledge between nurse trainer and nurse, and educational training opportunities for clinical nurse trainers have been scarce. Consequently, many nurse trainers have difficulty switching to the role of teacher. The purpose to this study was to investigate the teaching competencies of self-assessment and the related influencing factors among clinical preceptors. This is a descriptive andcorrelational study design using cross-sectional survey. There were 154 structural questionnaires sent out in a medical center and a regional educational hospital and 147 questionnaires were returned completed for data analysis. The return rate was 95.4%. The research instrument used in the study was the, questionnaire on teaching competencies of self-assessment among clinical preceptors with the Cronbach's α 0.994, Item-Content validity index (I-CVI) 0.95 and Scale-CVI(S-CVI) 0.75 valued by experts. Data was analyzed by using SPSS 17.0 with descriptive, one-way ANOVA, Mann-Whitney test and multiple linear regression analysis. The results disclosed: (1) The mean teaching competencies of self-assessment scores among the subjects was range from 4.45 to 3.67 (5-point Likert Scale); Order of the first three items of highest mean score was as the following: "Asking students to demonstrate preceptor teaching, "Providing a safe practice environment", and "Having good relationship with patients". (2) The teaching competencies of self-assessment among clinical preceptors appeared to be related to personal background. The following ones had higher scores: the older, the more years of nursing experience, the N3 and N4, working in regional hospital, the benefits or rewards-oriented, the higher supportive level of nursing administrators. (3) Multiple regression analysis showed that the influencing factors including age, marital status, education, class of working, clinical nursing ladder, and supportive level of nursing administrators explained 21.4% of total variance. (4) In controlling for the variances of age, marital status, education, class of working, clinical nursing ladder, and supportive level of nursing administrators, only the variances of age and supportive level of nursing administrators were as significant independent predictors. Compared with the groups of 21-30 years-old, when the groups of 41-58 years-old older each additional year-old, the mean score increased by 14.81 points. The mean score among the higher supportive level of nursing administrators was 12.80 points less than that of common ones. We hope this study to be able to benefit the teaching competencies of clinical preceptors, and to be an intact and objective instrument for clinical practices.