以行動研究探討教學鷹架對護理新人學習護醫溝通模組課程之成效
| 論文名稱(中/英文) | 研究生 | 指導教授 |
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以行動研究探討教學鷹架對護理新人學習護醫溝通模組課程之成效 Nurse-Physician Communication Modular Curriculum |
高櫻芬 | 徐曼瑩博士 |
| [ 摘要 ] | ||
| 護醫溝通任務是病房護理人員與醫師溝通住院病人病情的重要任務，卻是新進職場工作的護理新人受挫折而離職的因素之一。研究者在南部某區域教學醫院督導護理教學業務多年發現，護理臨床教師指導護理新人學習護醫溝通任務時發生以下的困境，包括護理新人不知哪種病人狀況需與醫師溝通、不了解護理新人學習護醫溝通任務的困難與問題、指導護理新人學習該任務缺乏指引與資源。透過文獻考察與研究團隊討論方式，確認上述教學業務問題，改善則必需建構內外科醫師和護理人員溝通時的共同心智模式，發展臨床教師在該任務的教學能力與提供教學資源等。 本研究目的在發展護理臨床教師實施護醫溝通模組課程教案、教學鷹架與教學資源，研究者採以行動研究法分為兩階段進行：第一階段的目的在準備醫師的溝通心智模式、設計教案、預估護理新人學習困難與發展教學鷹架。舉辦醫師與護理人員溝通研習訓練；舉辦焦點團體會議，邀請二位內外科病房專科醫師和五位資深護理長與護理師共同確認內外科病房常見的四類護醫溝通情境、課程學習目標的評值指標、評分規準與通過的標準。第二階段目的在驗證假設，發展教學方案與克服理新人學習護醫溝通任務課程的教學鷹架。研究者邀請一位醫師參與護醫溝通任務協同教學行動方案，透過三回合試教28位護理新人，以前後測驗、觀察、訪談、日誌與文件分析等方法蒐集教學過程與結果，分析結果據以調整與設計教案和教學鷹架。 研究結果包括：(一)確認本院護醫溝通教學的四類情境（新病人入院、病況改變、護理人員對治療有疑慮、病人或家屬對醫療處置有疑慮），(二)設計六個教學鷹架(常用醫學術語詞彙、醫囑系統問與答、溝通隨身記憶卡及溝通流程查檢表、身體評估查檢表、交接班查檢表、案例學習)，(三)設計教案與教學路徑，(四)編寫教學手冊。透過文獻查證與討論共獲得四個結論：(一) 因不同醫療機構而異，護醫溝通常見的情境需護理臨床教師與醫師共同確認。(二)護醫溝通任務涉及醫師與護理人員，教學前須先建構相關科別醫師與護理人員間的共同心智模式。(三)護醫溝通任務的教學活動，應採協同教學策略，由護理人員與醫師共同擔任臨床教師。(四)要成功實施護醫溝通模組課程，臨床教師需先精熟護醫溝通教案與教學路徑、教學策略、教學鷹架及評值評分表的使用。 建議：(一)醫院對護理新人的執業能力職前訓練，未來可採任務為基礎的模組化課程與教學。(二)未來臨床教師的教學能力應針對教學課程中的單元主題應有計畫的發展。(三)醫院師培中心或教學部在業務上應配合臨床教師的教學需求，同步發展教師手冊與教學資源。 |
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| [ Abstract ] | ||
| Nurse-physician communication is an important task for ward nurses and physicians to communicate the conditions about inpatients, but it is also one of the factors leading to frustration of the new nurses and their resignation. Researchers discovered in teaching educational hospital in some regions after many years of medical care teaching business supervision that nursing clinical instructors have the following dilemma when teaching newcomers to learn nurse-physician communication tasks: the newcomers don't know which kinds of patient situation are required to communicate with the physician, don't understand difficulties and problems for newcomers to learn medical care communication tasks, lacking of guidance and resources in guiding newcomers to learn the tasks. Through literature review and research team discussion, it is confirmed that the improvement of above teaching issues must construct a common mental model in communication between physician, surgeon and nurses, so as to develop the teaching ability of clinical instructors in the task and provide teaching resources etc. The purpose of this study is to develop teaching program, Scaffolding instruction and teaching resources of nursing-physician communication course for nursing clinical instructor implementation. Two researchers adopt action research method to implement in two stages: the purpose of the first stage is preparation of physician SBAR mental models, design of teaching plans, estimation of nursing learning difficulties and development of new Scaffolding instruction. Physicians and nurses SBAR studies and training are held; focus group meetings are held with two specialists of internal medicine and surgery wards and five senior nurse leaders as well as nurse specialists are invited to confirm the four common physician-nurse communication situations in internal medicine and surgery ward, appraisal pointers for learning objectives, evaluation standard specification as well as passing standards. The purpose of second phase aims to test the hypothesis, develop teaching programs and overcome newcomers' obstacles in physician and nurse communication tasks and Scaffolding instruction. The researchers invited a physician to participate in nurse-physician communication task coordinating teaching action plan, tried to teach 28 new nurses through three rounds, and applied before-after experiment, observation, interviews, log, file analysis and other methods to search data during teaching process and results, so as to analyze the result for adjusting and designing teaching program and Scaffolding instruction. The results include: (a) confirmation of four scenarios of nurse-physician communication teaching (new patient admission, illness conditions change, with doubts about the treatment of nurses, patient/family have doubts for medical treatment); (b) design of six Scaffolding instructions (common medical tests vocabulary, Q&A of doctor's advice system, SBARR portable memory card and communication process checklist, physical assessment checklist, shift checklists, case studies), and (c) design of teaching program and teaching path, (d) preparation of teaching manuals. Four conclusions can be obtained through documents: (a) Patient situation of different units differ in departments, so common scenarios of nurse-physician communication should be confirmed by nurse clinical teacher and ward physicians from various departments together. (b) Nurse-physician communication tasks involve both physicians and nurses, therefore a common mental model between physicians from relevant departments and nurses shall be constructed prior to teaching. (c) Teaching of physician-nurse communication tasks shall adopt collaborative teaching strategies and let nurses and physicians act as clinical instructors together. (d) To implement nurse-physician communication module course successfully, the clinical teacher shall first be proficient in nurse-physician communication teaching program and teaching path, teaching strategies, teaching aids and how to use the scaffolding instruction as well as appraisal score table. Suggestions: (1) pre-service training of hospital for the practicing ability of new nurses can be applied as task-based modular curriculum and teaching in the future. (2) Teaching ability of the future clinical teacher should have development with plans focusing on the units in teaching courses. (3) The hospital teacher training center or educational department should meet the needs of the clinical teacher and develop teachers' manual and teaching resources synchronously. |
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