設置管路是維護病人安全最重要與最基本的侵入性處置；若照護不慎易引起病人生命安全的立即性威脅。有鑑於護理新人接受管路照護傳統課室教學的學習成效不彰且缺乏實證性資料，因此，本研究以翻轉學習模式爲參考架構，設計「管路照護任務模組課程」教案（簡稱“翻轉教案”）並規劃實驗計劃，目的在評值護理新人學習成效及探討其影響因素。研究分成兩個階段進行，階段一在發展翻轉教案、規劃實驗計劃、設計學習成效評值工具，採用質性研究法中的文獻查證、焦點團體訪談法收集文字、影音、圖與表等資料；階段二在驗證護理新人學習成效的假設與探討影響因素。採用二組前測與後測控制組準實驗研究設計，以臺北市某院工作三個月內之內外科護理新人為研究對象，以設置內外科病房的五家院區為研究情境，隨機抽取三家為實驗院區、二家為對照院區，再於五個院區提供的內外科病房護理新人名單編號中隨機取樣各33位為研究樣本。實驗組接受實驗計劃；控制組無接受實驗計劃。研究結果包括：(一)實驗組護理新人管路照護的後測平均總分高於前測，具有統計的顯著意義。認知平均總分：後測（233.45±30.42）顯著高於前測（187.39±45.06），t=5.772 , P < .001；技能精熟度平均總分：後測（64.39±9.36）顯著高於(55.58±9.21)，t=4.474, P< .001。（二）實驗組護理新人管路照護後測的認知平均總分（233.45±30.42）顯著高於控制組後測（208.97±14.10），t=4.195, p< .001。（三）實驗組護理新人的認知學習增益平均為35.7 %（最低 -161.4%、最高82.0%），技能精熟度增益平均為80.2%（最低12.5%、最高100%）。（四）實驗組護理新人學習成效的影響因素方面：已有管路照護經驗者比無管路照護經驗者的技能精熟度的學習成效高。(五) 接受管路照護課程、先備知能、管路照護經驗對護理新人技能精熟度學習成效具有影響力（F=3.099, r=.49）解釋力為24% (p<.05)；其中「接受管路照護課程」的預測能力最高（β=0.432，t=2.646, p<.05）
關鍵字：管路照護任務模組課程、翻轉教案、學習成效、學習增益 |
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Invasive tube introduction is the most important and fundamental invasive treatment to maintain patients' life. The lives of patents can be easily threatened with any minor careless invasive tube care. The traditional training method on invasive tubes care for new incoming nurses was ineffective and had insufficient technical data. This research designed and implemented a holistic invasive tube care training with reference to flipped classroom learning.
The research aims to evaluate new incoming nurses learning outcomes and understands the factors that affect their learning. The research was separated into two stages. The first stage includes the development of flipped learning method, organization of experiment planning and design tools for learning outcome evaluations. This is done through qualitative research of data gathering, such as focus group interview, videos and images. Stage two verifies the learning outcomes of the nurses and evaluates the effects.
A scientific control experiment was conducted for the new incoming nurses with less than 3 months experience in a Taipei City hospital. The nurses were distributed to 5 different hospitals with both internal and surgical wards; 3 hospitals were experimental groups and 2 were control groups. A random selection of 33 nurses were selected for evaluation. The experimental group receive the educational training while the control group did not.
The research results reflect (1) the average grade of invasive tube care for experimental group was higher than that of control group. The knowledge grade for experimental group was 233.45±30.42, which is higher than the control group of 187.39±45.06, t=5.772 , P< .001. The average grade for technical ability for experimental group was 64.39±9.36 which was higher than the control group of 55.58±9.21, t=4.474, P< .001. (2) The experimental new coming nurses had a higher grade for invasive tube care（233.45±30.42）compared to the control group (208.97±14.10), t=4.195, p<.001. (3) The average learning gain for the knowledge of experimental group was 35.7% (with the lowest of -161.4% and highest of 82.0%) and the technical ability improvement of 80.2% (with the lowest of 12.5% and highest of 100%). (4) The learning outcomes and technical ability of invasive tube care for experienced nurses was higher than those without prior experience on invasive tube care. (5) Factors that influence the technical ability of new incoming nurses are: the receiving of invasive tube care training, prior knowledge and experience in invasive tube care (F=3.099, r=.49). Above all, those nurses who received invasive tube care has the highest ability of predictability (β=0.432，t=2.646, p<.05).
Keywords: Invasive tube care training model, Flipped learning, Learning outcomes,Learning gain
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