運用概念圖對護理人員敗血症照護學習成效之探討

論文名稱(中/英文)	研究生	指導教授
運用概念圖對護理人員敗血症照護學習成效之探討 The Effects of Concept Map on Nurses Sepsis Care Learning	賴妙娟	高毓秀博士
[ 摘要 ]
背景：敗血症死亡率極高，早期評估與提供適切照護對病人的存活與預後相當地重要。如何運用教學策略，讓臨床護理人員於百忙之中能有效學習敗血症照護知能是一重要議題。目的：探討運用概念圖對護理人員敗血症照護之學習成效。方法：本研究對象是台灣某區域教學醫院加護病房護理人員，採單位群集隨機分派，通過人體試驗倫理委員審查會之審查，研究對象係知情同意，研究期間於2015年10月21至2016年03月31日。自擬結構式問卷評量成效，採專家內容效度檢定(CVI.93)、預試(N=10)檢定問卷信度（敗血症照護認知測驗、態度評量表、行為自我效能評量表信度分別為.87、.72、.91）與試題難易度、鑑別度分析。敗血症照護課程內容依據敗血症拯救計畫活動第三版，實驗組接受概念圖教學，其中運用HELP ME( Harmful bacteria、Empirical Tx.、Lactate、Pressure、Moniter、Early weaning)口訣記憶、臨床案例示範等教學策略，對照組則參加傳統PPT簡報自學課程。結果採用SPSS19.0進行統計分析。結果：終計實驗組和對照組分別26、25人。概念圖教學介入後，敗血症照護認知、態度、行為自我效能量表得分，實驗組後測得分顯著高於前測（t = 5.67，p < .001；t = 2.15，p < .05；t = 2.87，p < .01），對照組則無顯著差異。兩組前測以共變數分析後，實驗組均顯著高於對照組（F ＝ 6.14，p <.05；F ＝ 14.18，p <.001；F ＝ 14.07，p <.01）。結論：運用概念圖教學教學介入對加護病房護理人員之敗血症照護認知、態度、行為自我效能均有顯著成效，可做為醫療機構相關教育訓練之參考以達最佳的臨床判斷模式，並建議應即時依據實證修改教學內容。
[ Abstract ]
Background: As the mortality rate of sepsis is extremely high, early assessment and the provision of proper care are extremely important for the survival prognoses of patients. How to make use of teaching strategies that enable clinical nurses to acquire effective learning amidst their busy work schedules has become a pressing issue. Purpose: To investigate the effects of using a concept map for nurses’ learning of sepsis care. Methods: The subjects of this study were nurses from the intensive care units of regional teaching hospital in Taiwan, selected by means of random assignment based on cluster sampling.This study was conducted from October 21, 2015 to March 31, 2016. A structured questionnaire was developed to evaluate the results, adopting expert-reviewed content validity (CVI 0.93) pretests (N=10) to test the reliability of the questionnaire (the reliability of the cognitive test on sepsis care, the attitudinal scale, and the behavioral self-efficacy scale was .87, .72, and .91, respectively), and an analysis of the difficulty level and discrimination of question items. Sepsis care course content was based on the Surviving Sepsis Campaign (SSC) Third Edition. The subjects were informed of and consented to the study. Concept map teaching was used for the experimental group, with such teaching strategies as the HELP ME ( Harmful bacteria、Empirical Tx.、Lactate、Pressure、Moniter、Early weaning) mnemonic and demonstration of clinical cases while the control group participated in the traditional self-learning courses through PPT. This study adopted the SPSS 19.0 statistical analysis. Results: Finally, the experimental group and control group were 26, 25 people.After the introduction of concept map teaching, scores of the experimental group, gauged in terms of sepsis care knowledge, attitude, and behavioral self-efficacy, were significantly higher than pretest scores (t = 5.67, p < .001; t = 2.15, p < .05; t = 2.87, p < .01) while there was no significant difference in the control group. Covariance analysis was performed on the pretest results of both groups, which showed that the experimental group had higher scores than the control group, overall (F = 6.14, p < 0.05; F = 14.18, P < 0.001; F = 14.07, P <0.01). Conclusions: The results indicate that the introduction of concept map teaching has a significant effect on nurses’ sepsis care knowledge, attitude and behavioral self-efficacy, which can be used as a reference for health organizations in their related education and training in order to achieve the best model of clinical judgment. It is also recommended that teaching contents be immediately revised according to the empirical evidence. Keywords: nurses, concept map, sepsis care, HELP ME, learning effect