臺灣博碩士論文加值系統

　　本研究旨在探討翻轉教學模式介入透析安全照護課程，透析護理人員在透析病人安全認知測驗、病人安全照護技能自評、病人安全照護課程之學習滿意度學習成效。採準實驗性研究(Quasi-experimental design)及兩組前後測設計；研究對象以北部某醫學中心及其附屬醫院透析護理人員共74名；36名實驗組接受翻轉教學模式介入透析安全照護課程，38名控制組接受傳統課室教學，課程介入前後兩組接受透析病人安全照護認知測驗、病人安全照護技能自評測試。課程後兩組再接受課程學習滿意度測試。使用電腦系統軟體SPSS 21.0版，進行資料建檔、歸納、整理與統計分析。兩組同質性檢定以Pearson χ2-test、Fisher’s exact test及unpaired t test進行，由於兩組間於年齡、護理工作總月資、血液透析工作總月資、臨床教師工作年資、碰到病人安全事件有把握執行正確護理措施、碰到病人安全事件能感受病人需求而給予協助等，統計檢定呈統計上顯著差異，故組間差異與依變項前測(透析病人安全照護認知測驗分數與透析病人安全病人安全技能自評分數)以ANCOVA執行共變項單因子變異數分析。組內差異以成對樣本 t 檢定分析。研究結果顯示：翻轉教學模式介入透析安全照護課程(一) 實驗組病人安全照護認知測驗得分組間顯著高於控制組；組內亦呈統計上顯著差異，但控制組進步29.72 %多於實驗組25.76 %；(二) 兩組間病人安全技能自評後測分數無統計上顯著差異；組內呈統計上顯著差異，控制組進步18.86 %多於實驗組14.09 %。(三) 兩組間學習滿意度得分皆無統計上顯著差異。依據研究結果提出以下建議：1.未來研究應擴大研究對象分析透析護理人員運用翻轉教學模式於臨床實務之學習成效。2.課程設計應以學習者需求為首要，此次研究中控制組對課程主題有學習動機，組內學習成效呈顯著差異，說明課室教學若可配合授課時間亦有其效益。3.錄製情境知能影片，有效結合臨床知能，若能推廣可有效排除地域性教學資源分配不均的問題。4.未來繼續規劃專業模組課程於其他專科教育訓練課程。

This study aimed to investigate the effect of flipped teaching on recognition and care skills of patient safety as well as satisfaction of patient safety course in dialysis nurses. Quasi-experimental design was employed. A total 74 dialysis nurses from single medical center in Taipei and two of its branches were recruited and randomized to either flipped or traditional learning. All participants received survey about patient safety recognition and self-evaluation about care skills of patient safety before and after the learning course. All statistical analyses were performed using SPSS version 21.0. Pearson test, Chi Square test, Fisher’s exact test and unpaired t test were introduced for test of homogeneity. For significant difference between groups in age, seniority (nurses, dialysis nurses or clinical teachers), confidence in conducting correct nursing for patient safety and helping patients with empathy, analysis of covariance was made by ANCONA. Difference within group was analyzed via paired t test. Our result showed participants underwent flipped learning had significantly higher score on the test of patient safety recognition but those underwent traditional learning had more marked progress. Although there was no significant difference in self-evaluation about care skills after completion of learning course between the two groups, participants with traditional learning had more progress. No difference between the two groups in satisfaction was noted. Accordingly, further study may be suggested to investigate the effect of flipped teaching in dialysis nurses. Otherwise, participants underwent traditional learning had higher academic motivation about the topics which resulted in significantly different learning effect within group. Therefore,learning course design should be based on the demand of learners. Besides, widely-used video containing medical knowledge and technology may narrow the urban-rural gap in teaching and education recourses. Finally, application of flipped teaching to the learning course of other specialties may be suggested.

中文摘要 …………………………………………………………………. i

英文摘要 …………………………………………………………………. ii

目次 ………………………………………………………………………. iii

表次 ………………………………………………………………………. v

圖次 ………………………………………………………………………. vi

第一章 緒論……………………………………………………………… 1
第一節 研究背景與動機 ……………………………………………… 1
第二節 研究目的 ……………………………………………………… 6
第三節 研究問題 ……………………………………………………… 6
第四節 研究假設 ……………………………………………………… 7
第五節 名詞解釋 ……………………………………………………… 7
第二章 文獻查證………………………………………………………….. 9
第一節 血液透析相關概念……………………………………………... 9
第二節 透析病人之安全照護…………………………………………... 11
第三節 透析護理人員在職教育訓練…………………………………... 15
第四節 翻轉教學介入護理人員教育訓練……………………………... 17
第五節 相關研究………………………………………………………... 19
第三章 研究方法…………………………………………………………… 22
第一節 研究設計………………………………………………………... 22
第二節 研究架構………………………………………………………... 23
第三節 研究對象及場所………………………………………………... 24
第四節 研究介入………………………………………………………... 26
第五節 研究工具………………………………………………………... 33
第六節 資料收集………………………………………………………... 38
第七節 資料處理與分析………………………………………………... 38
第八節 研究倫理………………………………………………………... 41
第四章 研究結果…………………………………………………………. 42
第一節 研究對象屬性分析……………………………………………... 42
第二節 不同教學模式介入對組間差異效應………………………….... 47
第三節 不同教學模式介入對組內差異效應………………………….... 51
第五章 討論……………………………………………………………….. 53
第一節 運用翻轉教學模式於透析安全照護之課程介入……………… 53
第二節 兩組透析病人安全照護認知測驗得分之分析………………… 55
第三節 兩組透析病人安全照護技能自評得分之分析………………… 57
第四節 兩組課程學習滿意度得分之分析……………………………… 59
第六章 結論與建議……………………………………………………….. 62
第一節 結論 …………………………………………………………….. 62
第二節 研究限制………………………………………………………… 64
第三節 研究應用………………………………………………………… 65
參考文獻…………………………………………………………………….. 69
中文部分 ………………………………………………………………… 69
外文部分 ………………………………………………………………… 71
附錄………………………………………………………………………….. 79
附錄一 人體試驗審查委員會計畫執行許可書…………………………. 79
附錄二 課程學習滿意度問卷授權書……………………………………. 80
附錄三 專家效度委員一覽表……………………………………………. 81
附錄四 專家效度結果一覽表……………………………………………. 81
附錄五 專家意見修改一覽表……………………………………………. 82
附錄六 透析病人安全照護各式量表……………………………………. 95
附錄七 透析病人安全照護認知測驗表難易度與鑑別度統計…………. 104
附錄八 實驗組護理人員網路自學次數與時間分析……………………. 105
附錄九 實驗組護理人員網路自學次數統計與時間百分比分析………. 107

中文部分

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劉怡甫(2013)‧翻轉課堂：落實學生為中心與提升就業例的教改良方‧評鑑雙月刊，(41)，31-34。
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