重症護理人員運用線上情境模擬互動教學之學習成效評估–以連續性腎臟替代療法警報處理教學為例

論文名稱(中/英文)	研究生	指導教授
重症護理人員運用線上情境模擬互動教學之學習成效評估–以連續性腎臟替代療法警報處理教學為例 Using Online Interactive Simulation Teaching Material to Assess the Learning Effectiveness for Critical Care Nurses – A Case Study on Alarm Troubleshooting of Continuous Renal Replacement Therapy	楊渝惠	劉純和博士
[ 摘要 ]
連續性腎臟替代療法(CRRT)是重症病人合併急性腎損傷常見的急性治療。若重症護理人員照護不當，會影響病人預後與安全。在實際臨床中，重症護理人員操作警報故障排除的機會有限，且缺乏練習機會。因此，為提升重症護理人員CRRT警報處理照護能力，藉由線上情境模擬互動教學，使護理人員能自主透過線上安全的教學環境下不斷練習直到精熟。本研究旨在探討CRRT警報處理之線上情境模擬互動教學介入後，重症護理人員於CRRT警報處理知識測驗、自評能力、學習滿意度與自信心、教材滿意度與學習回饋之學習成效探討。本研究採單組前測、後測及延宕測之類實驗研究設計(quasi-experimental design)，研究對象採方便取樣自台灣北部某醫學中心，研究對象須執行CRRT警報處理照護及完成技術考之加護病房護理人員，共收案82人。前測的內容包括知識測驗與自評能力，介入線上教材三週後，學習結束後學習者須完成學習記錄回饋單及後測，後測內容包括知識測驗、自評能力、線上情境模擬互動學習滿意度與自信心及教材滿意度；介入線上教材六至八週後進行延宕測，內容為知識測驗與自評能力。資料分析應用SPSS 21.0 版進行描述性統計分析及Generalized estimating equation進行分析。研究結果顯示：（一）CRRT警報處理知識測驗於教材介入平均得分後測及延宕測均顯著高於前測。（二）CRRT照護自評能力平均得分後測及延宕測均顯著高於前測。（三）線上情境模擬互動學習滿意度與自信心總平均為4.15(SD= 0.65)。（四）線上情境模擬互動教材滿意度總平均為4.21(SD=0.57)，整體滿意度為84.2%。（五）學習回饋之質性分析與整體感受，包含增進重症臨床知識、培養重症臨床技能、培育臨床重症照護信心、數位學習優點、數位學習建議與限制、推薦數位學習成為未來在職教育教材等。本研究結果建議：（一）推動線上情境模擬互動教學於臨床護理教育應用；（二）安排臨床教師資訊科技之師資培育與運用；（三）推薦醫護教育應用線上情境模擬互動結合臨床情境案例；（四）Scratch設計線上互動教學介入之具體建議等。藉此確定線上情境模擬互動教材之學習有效性，並能解決臨床問題，達到重症病人連續血液透析安全及高品質照護之目標。
[ Abstract ]
Continuous Renal Replacement Therapy (CRRT) is a common treatment for critically-ill patients with acute kidney injury. However, patient prognosis may not be compromised if the CRRT care is inappropriately performed. In the real world, Intensive Care Unit (ICU) nurses have limited opportunities to practice alarm troubleshooting, to reflect on feedbacks, and to be evaluated again. Therefore, in order to improve the nursing skills of critical care nurses on handling CRRT alarm troubleshooting, nursing staff can continue to practice using the online interactive simulation exercise in the safe online environment until they are well-trained. The study purpose was to investigate the learning outcomes of critical care nurses after the intervention of the online interactive simulation exercise on CRRT alarm troubleshooting training. The outcomes were evaluated by the CRRT alarm troubleshooting knowledge test, self-evaluation, learning satisfaction, material satisfaction, and feedback. This study adopted a quasi-experimental design which included pre-tests, post-tests, and delay-tests in a single group of 82 ICU nurses from a medical center of Taipei City, Taiwan. The nurses must have CRRT care experience and completed the technical examination. All nurses received the pre-, post- and delay-tests before and after the intervention. The content of the pre-test included a knowledge test and a self-evaluation. After three weeks of intervention using the online materials, the nurses must complete the learning records and provide feedback. The post-test includes a knowledge test, a self-evaluation, and satisfaction surveys of both the online tool and the materials. After six to eight weeks, the delay-test were conducted including a knowledge test and a self-evaluation. Data analysis was performed used SPSS 21.0 for descriptive statistics and Generalized estimating equation analysis. The results of the study showed that: (1) The average scores of the knowledge on CRRT alarm care were significantly higher in the post-test and delay-test comparing with the pre-test. (2) The average scores of CRRT care self-evaluation were also significantly higher in the post-test and delay-test than that in the pre-test. (3) The average satisfaction scores for the learning experience using the online simulation interactive exercise was 4.15 (SD = 0.65). (4) The average satisfaction scores for the online materials was 4.21 (SD = 0.57), and the overall satisfaction was 84.2%. (5) Qualitative analysis and the overall feedback toward the online interactive simulation exercise included promoting clinical knowledge, cultivating the clinical skills of critical care, cultivating the clinical confidence in critical care, advantages of digital learning, suggestions and restrictions of digital learning, recommending digital learning for future on-the-job training. Based on the results of this study, we have the following suggestions: (1)The application of the online interactive, situational simulation exercise could be promoted in clinical nursing education; (2)Teacher training program could be arranged to encourage clinical teachers to combine professional knowledge with information technology; (3)Clinical scenarios may be combined into the online interactive simulation exercises for medical education; (4)Teaching materials are provided for applying Scratch to design online interactive, situational simulation exercises; Hence, we could access the learning effectiveness of the online situational simulation interactive teaching materials and use it to solve clinical problems, thereby achieving the goal of providing safe and high-quality care for critically ill patients on continuous hemodialysis.