數位學習方案對護理人員之物理性約束學習成效探討

論文名稱(中/英文)	研究生	指導教授
數位學習方案對護理人員之物理性約束學習成效探討 The Effectiveness of Physical Restraint Digital Learning Program for Nurses	張宏裕	林秋芬博士
[ 摘要 ]
自由是人的權利，物理性約束是一種限制身體活動自由、侵犯人權的處置，因此施行病人約束必須具備充分的理由與正當的目的，若缺乏正確的認知、態度可能造成操作行為的不當，進而導致病人生理、心理與社會之不良影響，甚至導致意外事件、醫療糾紛，造成醫病關係緊張。透過計畫性教學，可以提升護理人員的認知與態度。因此本研究目的為：一、設計符合護理人員需求之物理性約束數位教學方案；二、驗證物理性約束數位教學方案之學習成效；三、分析基本屬性與學習成效之相關；四、分析學習經驗與學習成效之相關。本研究採類實驗研究法，於北台灣某區域教學醫院之員工學習網上開設「物理性約束照護」課程，採單組前後測設計，教學實驗為期一個月。以護理人員為目標母群體，依據研究目的，界定母群體之納入與排除條件，採取方便取樣進行研究。研究透過醫院之員工網路學習平台，對於符合納入與排除條件之796位護理人員進行調訓，邀請人員參與研究。採自擬研究工具，工具一為物理性約束照護數位學習方案的設計包含三大重點：(一)設計基本內涵、(二)能力指標與教學目標、與(三)教學內涵與教學活動歷程，專家內容效度指標S-CVI值為1，並依照專家修正意見進行內容修正。工具二為物理性約束照護學習成效量表，包含認知測驗與態度量表，依據教學目標、參考相關文獻自行發展設計而得。其中物理性約束照護認知問卷內容根據本研究設計之學習方案的學習目標而產生，依照修訂版Bloom的教育目標分類法所發展之雙向細目表擬定試題，每次測驗由數位學習系統隨機選13道題目進行測驗。另外物理性約束照護態度量表初擬題目共計33題，經專家內容效度審查，再經由SPSS軟體進行項目分析，將反向題進行轉換後進行項目分析，Cronbach α值為.776，並刪除不適當題目後，再進行因素分析，得到KMO值為.916，累計解釋變異量變為70.37%，最後保留18道題目，信度檢定Cronbach α值為.881。物理性約束照護學習成效量表經專家內容效度指標檢定後S-CVI為0.96。以方便取樣方式選取40位護理人員進行預試，經相關結果檢定：信度Cronbach α = 0.947、難度指標為0.69，與鑑別度指標為0.3。本研究步驟以ADDIE教學模式依序進行(1)分析：針對研究主題之教學內容、學習對象以及教學環境進行分析；(2)設計：將進度進行規劃，評量方法與工具設計、教學策略的設計、教學大綱與腳本設計等；(3)發展：本階段發展教學策略、教材、教案及測驗題庫，完成教學方案設計；(4)實施：研究計畫經台北醫學大學暨附屬醫院聯合人體研究倫理委員會審查通過後，始於研究地點進行收案。收案時間為民國105年7月29日至8月26日，參與者登入系統進入課程後，於課程說明中告知參與人員之權利；(5)評值：教學活動結束後，將學習者所完成之資料進行整理，以統計軟體進行描述性統計與推論性統計，以了解學習者的學習成效，作為本教學方案未來改善之參考。研究結果：一、護理人員接受物理性約束照護數位學習方案後，物理性約束照護認知提升有顯著差異。二、護理人員接受物理性約束照護數位學習方案後，物理性約束照護態度改變無顯著差異。三、學習前、學習後物理性約束照護認知程度及前後程度差異與護理人員基本屬性無顯著差異。四、學習前、學習後物理性約束照護認知程度，認知程度差異與護理人員學習經驗無顯著相關。五、學習前物理性約束照護態度與護理人員基本屬性之工作單位呈顯著相關。六、學習後物理性約束照護態度與護理人員基本屬性之學歷呈顯著相關。七、學習後物理性約束照護態度差異與護理人員基本屬性無顯著相關。八、學習前、後物理性約束照護態度，及態度前後差異與護理人員學習經驗呈顯著相關。透過本研究設計物理性約束照護數位教學方案、驗證此教學方案的學習成效，發現護理人員接受物理性約束照護數位學習方案後，物理性約束照護認知提升有顯著差異，但是物理性約束照護態度改變無顯著差異。整體而言，數位學習並未能顯著改變護理人員對於物理性約束照護態度，其主要原因為改變學習者的態度實非簡易之事，若要透過數位方式提升護理人員之照護態度，則仍需進一步地研究如何在教材編制上讓數位學習者能成功學習，因此如何透過數位學習的方式提升人員的照護態度，可為未來研究之方向。
[ Abstract ]
Freedom is human rights, and physical restraint is a way of restricting the freedom of physical activity and violating human rights. Therefore, the implementation of patient restraint must have sufficient reason and proper purpose. If you lack correct cognition, the attitude may cause improper operation, which led to the patient's physical, psychological and social adverse effects, and even lead to accidents, medical disputes, resulting in illness and tension. Through the program of teaching, it can improve the awareness and attitude of nursing staff. The study will declare four purposes. First, the design of nurses in line with the needs of the physical restraints of digital teaching program; Second, verify the physical restraint of digital teaching program learning effectiveness; Third, the analysis of basic attributes and learning outcomes related; Fourth, the analysis of learning experience and learning outcomes related. The study is quasi-experimental, single-group pretest-post test was designed by convenience sampling, A "physical restraint care" course is offered online at the staff of a regional teaching hospital in North Taiwan for a month. According to the purpose of research, to define the inclusion and exclusion of the parent group, to facilitate the study of sampling. In the study, through the hospital's staff learning platform, 796 nurses who meet the inclusion and exclusion criteria are invited to participate in the study. Collected from the proposed research tools. Tool for the physical restraint to protect the design of digital learning programs, including three major points:(1) the basic meaning of the design,(2) competency indicators and teaching objectives, and (3) teaching content and teaching activities. Expert content validity index S-CVI value of 1, and in accordance with the expert amendments to the contents of the amendment. The other tool is a physical restraint care performance scale, which includes a cognitive test and attitude scale. According to the teaching objectives, refer to the relevant literature self-development design derived. The content of the physical restraint care questionnaire is based on the learning objectives of the learning program designed in this study. Prepare questions in accordance with the revised two-way schedule developed by the revised Bloom's Educational Objectives Classification. Each test by the digital learning system randomly selected 13 questions to test. In addition, the physical restraint of the care attitude scale total of 33 questions, the contents of the review by the expert content, and then through the SPSS software for project analysis, the reverse title of the project after the conversion, Cronbach α value of .776, and delete After the problem is not appropriate, the KMO value is .916, the cumulative explanatory variance becomes 70.37%, and finally the 18 questions are retained. The Cronbach α value is .881. The physical fitness care scale was 0.96 after S-CVI was verified by expert content validity index. To facilitate the sampling method selected 40 nursing staff for pre-test. The correlation test results: reliability Cronbach α = 0.947, difficulty index of 0.69, and the discriminant index of 0.3. The study steps are based on the ADDIE teaching model.(1) analysis: for the study of the theme of the teaching content, learning object and teaching environment for analysis; (2) design: the progress of planning, assessment methods and tool design, teaching strategy design, teaching syllabus and script design; (3) development: the development of teaching strategies, teaching materials, lesson plans and test questions, the completion of teaching program design; (4) Implementation: The study plan by the Taipei Medical University and affiliated hospital joint human body research ethics committee after review, began at the research site to receive the case. The date of receipt is July 29, 2006 to August 26, 2005, the participants log into the system after entering the course, in the course description to inform the participants of the rights; (5) Evaluation: After the end of the teaching activities, the learners will complete the information to sort out the statistical software to carry out descriptive statistics and deductive statistics to understand the learners learning effectiveness, as the future improvement of the teaching program reference. Research results: First, the nursing staff to accept the physical restraint of digital learning program, the physical restraint of care to enhance the awareness of significant differences. Second, the nursing staff to accept the physical restraint of digital learning program, the physical restraint of care attitude change no significant difference. Third, before and after learning, there is no significant difference between the degree of physical care and the degree of physical education and the basic attributes of nursing staff. Before and after learning, there is no significant correlation between the degree of cognition and the learning experience of nursing staff. Fifth, the physical restraint before the physical care attitude and nursing staff of the basic attributes of the work unit was significantly related. Six, after learning the physical restraint of care attitude and the basic attributes of nurses education was significantly related. There was no significant correlation between physical attitudes and physical care. Eight, before and after the study of physical restraint attitude, and attitude differences before and after the nursing staff learning experience was significantly related. Through this study, we designed the physical restraint of digital teaching program to verify the effectiveness of this teaching program. There were significant differences in the cognitive improvement of physical restraints, but there was no significant difference in the attitude of physical care. Overall, digital learning did not significantly alter the attitudes of nurses to physical care, and the main reason was that it was not easy to change learners' attitudes. In order to enhance the caregiver's attitude through digital means, it is still necessary to further study how to make digital learners successful in teaching materials. So how to enhance the attitude of people through the way of digital learning, for the future direction of the study.