病人手術期大量出血問題是手術室發生重大合併症與死亡的主要原因。手術期間病人的主要照護者麻醉護理師應該具備那些能力以因應處置臨床罕見、複雜與高度重要的情境。因此，本研究目的在：（一）建構與標準化病人手術期大量出血照護與管理任務流程；（二）設計「病人手術期大量出血照護與管理任務」模組化課程及教學。研究分為三個階段十一個步驟進行。第一階段為標準化任務流程；第二階段為模組化課程與教材；第三階段為檢核課程品質與修正。因考量該任務之突發危急與不可及性，研究設計採質性研究，透過文獻查證、個別訪談與焦點團體訪談過程完成資料收集與分析，據以設計「病人手術期大量出血照護與管理任務」模組化課程與教學，並經由數位學習的發展，提供相關單位作為教育訓練發展之參考 。

       研究結果包括：(一)標準化流程；(二)模組化課程；(三)模組化教學。對未來的教育研究提出六項具體建議：(一) 建立情境案例資料庫；(二) 建立團隊合作學習之規範與教育；(三) 發展網路數位之課程與教材；(四) 發展實境模擬學習與檢核；(五) 建立先備知能模組之數位學習平台；(六) 繼續檢核修正本模組課程。並歸納六項結論：(一) 建構標準化流程(圖)可提供作為臨床作業指引與建立查檢清單之依據；(二)以實證知識管理建構模組化課程，提升任務的執行能力；(三)設計學習手冊，提供學習者自主學習的指引工具；(四) 設計案例問題導向學習法的教學，經由「決策-行動步驟路徑」的學習遷移，提升照護者情境覺察、決策與問題處理的能力；(五)設計非技術技能合作學習的教學，提升麻醉護理人員對整體任務內容的認知，以提高團隊效能；(六)發展數位網路課程，提供學習者彈性、自主的學習。

關鍵詞：手術期大量出血；任務分析；任務為基礎模組課程；非技術技能力

Massive surgical Hemorrhage is one of the major causes of comorbidity and death in the operating room. The nurse anesthetists who are the chief care takers of the surgical patients should have adequate training and knowledge to manage such situations.  The goals of this study are to: (1) build a standard task flowchart for management of surgical blood loss, and (2) design a task-based modular curriculum.  This study consists of 11 steps to be carried out in 3 phases.  The first phase is for completion of the standard task flowchart, the second is the task-based modular curriculum, and the last phase is for evaluation and modification of the curriculum quality.  Taken into consideration the high volatility and vast extent involved in the surgical setting, this study is of a qualitative nature.  The design of the “Management of massive surgical blood loss” modular curriculum is done through review of key literature with analysis of data collected from interviews of individuals and focus groups.  The finding will be shared in digital forum with related units for educational training purposes. 

Our discussion covers three major areas: (1) the impact of the standard flowchart on the task development and safety of the clinical anesthesia care, (2) special features of the modular curriculum design, and (3) the special features of the teaching design in the modular curriculum.  We made six practical suggestions on the future educational research: (1) set up a databank for cases of different surgical bleeding scenarios, (2) establish a guideline for team collaborations, (3) develop digital curriculum and materials, (4)develop virtual learning with follow-up evaluation, (5) build a digital learning forum of prerequisite module, and (6) continuous evaluation and modification efforts on this curriculum.

There are six key points in our conclusion: (1) the standard flowchart can be used as a clinical guideline and basis for protocol check list, (2) the evidence-based modular curriculum adds to the task feasibility, (3)a learning manual is an effective tool for independent learning, (4) the case oriented teaching enhances the surrounding awareness, decision making, and problem solving skills of the nursing staff through the learning fluidity in the step illustration of “from decision to action”, (5) the teaching of collaboration with the non-technical skills enhances the nurse anesthetists’ recognition of the task entirety , which in turn increases the OR team effectiveness, and (6) digital curriculum can provide the flexibility of independent learning. 

Keyword：perioperative massive hemorrhage、tasks analysis、Task-based modular

curriculum、non-technical skills