臺灣博碩士論文加值系統

護醫溝通任務是病房護理人員與醫師溝通住院病人病情的重要任務，卻是新進職場工作的護理新人受挫折而離職的因素之一。研究者在南部某區域教學醫院督導護理教學業務多年發現，護理臨床教師指導護理新人學習護醫溝通任務時發生以下的困境，包括護理新人不知哪種病人狀況需與醫師溝通、不了解護理新人學習護醫溝通任務的困難與問題、指導護理新人學習該任務缺乏指引與資源。透過文獻考察與研究團隊討論方式，確認上述教學業務問題，改善則必需建構內外科醫師和護理人員溝通時的共同心智模式，發展臨床教師在該任務的教學能力與提供教學資源等。
本研究目的在發展護理臨床教師實施護醫溝通模組課程教案、教學鷹架與教學資源，研究者採以行動研究法分為兩階段進行：第一階段的目的在準備醫師的溝通心智模式、設計教案、預估護理新人學習困難與發展教學鷹架。舉辦醫師與護理人員溝通研習訓練；舉辦焦點團體會議，邀請二位內外科病房專科醫師和五位資深護理長與護理師共同確認內外科病房常見的四類護醫溝通情境、課程學習目標的評值指標、評分規準與通過的標準。第二階段目的在驗證假設，發展教學方案與克服理新人學習護醫溝通任務課程的教學鷹架。研究者邀請一位醫師參與護醫溝通任務協同教學行動方案，透過三回合試教28位護理新人，以前後測驗、觀察、訪談、日誌與文件分析等方法蒐集教學過程與結果，分析結果據以調整與設計教案和教學鷹架。
研究結果包括：(一)確認本院護醫溝通教學的四類情境（新病人入院、病況改變、護理人員對治療有疑慮、病人或家屬對醫療處置有疑慮），(二)設計六個教學鷹架(常用醫學術語詞彙、醫囑系統問與答、溝通隨身記憶卡及溝通流程查檢表、身體評估查檢表、交接班查檢表、案例學習)，(三)設計教案與教學路徑，(四)編寫教學手冊。透過文獻查證與討論共獲得四個結論：(一) 因不同醫療機構而異，護醫溝通常見的情境需護理臨床教師與醫師共同確認。(二)護醫溝通任務涉及醫師與護理人員，教學前須先建構相關科別醫師與護理人員間的共同心智模式。(三)護醫溝通任務的教學活動，應採協同教學策略，由護理人員與醫師共同擔任臨床教師。(四)要成功實施護醫溝通模組課程，臨床教師需先精熟護醫溝通教案與教學路徑、教學策略、教學鷹架及評值評分表的使用。
建議：(一)醫院對護理新人的執業能力職前訓練，未來可採任務為基礎的模組化課程與教學。(二)未來臨床教師的教學能力應針對教學課程中的單元主題應有計畫的發展。(三)醫院師培中心或教學部在業務上應配合臨床教師的教學需求，同步發展教師手冊與教學資源。

Nurse-physician communication is an important task for ward nurses and physicians to communicate the conditions about inpatients, but it is also one of the factors leading to frustration of the new nurses and their resignation. Researchers discovered in teaching educational hospital in some regions after many years of medical care teaching business supervision that nursing clinical instructors have the following dilemma when teaching newcomers to learn nurse-physician communication tasks: the newcomers don't know which kinds of patient situation are required to communicate with the physician, don't understand difficulties and problems for newcomers to learn medical care communication tasks, lacking of guidance and resources in guiding newcomers to learn the tasks. Through literature review and research team discussion, it is confirmed that the improvement of above teaching issues must construct a common mental model in communication between physician, surgeon and nurses, so as to develop the teaching ability of clinical instructors in the task and provide teaching resources etc.
The purpose of this study is to develop teaching program, Scaffolding instruction and teaching resources of nursing-physician communication course for nursing clinical instructor implementation. Two researchers adopt action research method to implement in two stages: the purpose of the first stage is preparation of physician SBAR mental models, design of teaching plans, estimation of nursing learning difficulties and development of new Scaffolding instruction. Physicians and nurses SBAR studies and training are held; focus group meetings are held with two specialists of internal medicine and surgery wards and five senior nurse leaders as well as nurse specialists are invited to confirm the four common physician-nurse communication situations in internal medicine and surgery ward, appraisal pointers for learning objectives, evaluation standard specification as well as passing standards. The purpose of second phase aims to test the hypothesis, develop teaching programs and overcome newcomers' obstacles in physician and nurse communication tasks and Scaffolding instruction. The researchers invited a physician to participate in nurse-physician communication task coordinating teaching action plan, tried to teach 28 new nurses through three rounds, and applied before-after experiment, observation, interviews, log, file analysis and other methods to search data during teaching process and results, so as to analyze the result for adjusting and designing teaching program and Scaffolding instruction.
The results include: (a) confirmation of four scenarios of nurse-physician communication teaching (new patient admission, illness conditions change, with doubts about the treatment of nurses, patient/family have doubts for medical treatment); (b) design of six Scaffolding instructions (common medical tests vocabulary, Q&A of doctor's advice system, SBARR portable memory card and communication process checklist, physical assessment checklist, shift checklists, case studies), and (c) design of teaching program and teaching path, (d) preparation of teaching manuals. Four conclusions can be obtained through documents: (a) Patient situation of different units differ in departments, so common scenarios of nurse-physician communication should be confirmed by nurse clinical teacher and ward physicians from various departments together. (b) Nurse-physician communication tasks involve both physicians and nurses, therefore a common mental model between physicians from relevant departments and nurses shall be constructed prior to teaching. (c) Teaching of physician-nurse communication tasks shall adopt collaborative teaching strategies and let nurses and physicians act as clinical instructors together. (d) To implement nurse-physician communication module course successfully, the clinical teacher shall first be proficient in nurse-physician communication teaching program and teaching path, teaching strategies, teaching aids and how to use the scaffolding instruction as well as appraisal score table.
Suggestions: (1) pre-service training of hospital for the practicing ability of new nurses can be applied as task-based modular curriculum and teaching in the future. (2) Teaching ability of the future clinical teacher should have development with plans focusing on the units in teaching courses. (3) The hospital teacher training center or educational department should meet the needs of the clinical teacher and develop teachers' manual and teaching resources synchronously.

第壹章 緒論 11
第一節 研究問題與背景 11
第二節 研究目的與研究待答問題 14
第三節 名詞解釋 15
第貳章 文獻查證 16
第一節 護醫溝通任務 16
第二節 教學鷹架理論 18
第三節、焦點團體法 26
第四節、 行動研究法 29
第五節、模組化課程的學習路徑與課程發展 34
第叁章 研究方法 38
第一節 研究情境與研究對象 38
第二節 研究時間與研究流程 39
第三節、研究工具及其效信度的考驗 56
第四節、倫理的考量 59
第四章 行動研究結果 60
第一節 護理新人學習「護醫溝通模組課程」的學習困難與問題 60
第二節 設計「護醫溝通模組課程」教學鷹架 66
第三節 教學鷹架對護理新人達成溝通學習目標的成效 86
第五章 討論與建議 90
第一節 行動研究歷程對「課程發展」階段上的意義 90
第二節 研究設計對於達成學習護醫溝通任務上的意義 93
第三節 教學鷹架與達成學習護醫溝通任務進步上的意義 95
第六章 結論與建議 99
參考資料 101
中文參考資料 101
英文參考資料 109
附錄ㄧ學習手冊 114
附錄二 焦點團體訪談法規畫、訪談指引 137
附錄三 研究者日誌 148
附錄四 教學手冊 182

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陳仕佑（2001）維高斯基鷹架學習在提升特殊學生潛能上的應用台東特教簡訊，13，47-49。
Shiyou Chen (2001) Vygotsky, the application of scaffolding learning in improving special students’ learning potentials, Taidong Special Education Newsletter.
陳惠邦（1998）教育行動研究，台北市：師大書苑。
Huibang Chen (1998) Educational Action Research, Taipei: National Taiwan Normal University Bookstore.
陳銹陵、陳明博、韓宜娣（2011）鷹架類型與先備知是對高職電腦軟體應用課程之成效探討數位學習科技期刊，3（1），101-120。
Xiuling Chen, Mingbo Chen, Yiti Han(2011) The effectiveness analysis of computer software applications vocational courses, Digital learning journal. 3（1），101-120.
陳志恆(2009)‧自我調整學習理論對學生課業學習外部干擾的處理與啟示‧台灣心理諮商季刊，1(4)，1-13。
Zhiheng Chen(2009) The handling and enlightenment of self-regulated learning theory to students external study interference Taiwan Psychological Counseling Quarterly Journal. 1(4)，1-13.
施勳鉁（1997）生活科技課程模組化教學之探討中華工藝教育30（7），16-20。
Xunzhen Shi (1997) The exploration of life science and technology curriculum modularized teaching, Chinese arts and crafts education. 30（7），16-20.
楊振嘉（2000）鷹架理論在國小酸鹼化學網站的應用研究‧未發表碩士論文，台中：靜宜大學應用化學研究所。
Zhenjia Yang (2000) The study of tbe application of scaffolding theory in acid-base chemistry research sites, unpublished master's thesis, Taizhong: Providence University Applied Chemistry Research Institute.
趙柏原（1999）國中學生自我效能、求助態度與課業求助行為之相關研究未發表碩士論文，彰化：國立彰化師範大學教育研究所。
Boyuan Zhao(1999) Relevant studies of junior high school students self-efficacy, attitudes and seeking help behaviors on their study, unpublished master's thesis, Changhua: National Changhua University Educational Research Institute.
趙建豐、林志隆（2005）評分規準(Rubric)的類型、發展方式與使用原則國教天地161，99-107。
Jianfeng Zhao, Zhilong Lin(2005) Types, developing methods, and applying principals of scoring standards, National Education Land. 161，99-107.
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Jinli Su ( 2011) University students learning assessment, Educational Research Monthly. 207，18-30
潘明宏、陳志瑋（譯）（2001）焦點團體訪談：教育心理學適用（原作者：Vaughn, S., Schumm, J. S,.＆ Sinagub, J.）台北市：五南。（原出版年：1996）
Minghong Pan, Zhiwei Chen(translated) (2001 ) focus group interviews : the application of educational psychology ( author :. Vaughn, S., Schumm, J. S, & Sinagub, J.) Taipei City:Wunan ( Originally published in :1996).
邱修平（譯）（1998）教學心理學：學習的認知基礎（原作者：Gagne, E. D., Yekovich, C. W., ＆ Yekovich, F. R.）台北市：遠流。（原出版年：1993）
uping Qiu(translated) ( 1998) Teaching Psychology: Cognitive -based learning ( author : Gagne, ED, Yekovich, CW, & Yekovich, FR) Taipei : Yuanliu ( Originally published in :1993)
鄒慧英（2006）規準分析模式的寫作教學與評量示例現代教育論壇15，665-667。
Huiying Zou(2006 ) Writing Instruction and Evaluation Samples of criteria based analysis models, modern education forum. 15，665-667.
蔡清田（2000）教育行動研究，台北市：五南。
Qingtian Cai (2000) Educational Action Research ,Taipei City: Wunan.
葉明珍（2007） 應屆畢業護生進入職場前預期工作壓力與企盼資源 弘光學報，51，39-50。
Mingzhen Ye (2007 ) Pre-graduating nursing students’s work pressure and expected resources before joining the work force, Hongguang Journal. 51，39-50.
謝伯榮（2005）國中生時間管理與學業成就關係之研究未發表碩士論文，台北：國立台北大學統計學系研究所。
Borong Xie (2005) Study of the relationship of junior high school students’s study time and academic achievements, unpublished master's thesis , Taipei:National Taipei University Statistics Department Research Institute .
盧珍瑩（2007）運用鷹架理論於國小二年級科學概念學習之研究-以「聲音」教學為例未發表碩士論文，屏東：國立屏東教育大學數理教育研究所。
Zhenying Lu (2007) Study of using scaffolding theory in second grade science concepts learning—take the example of voice teaching, Pingdong, National Pingtung University of Education Math and Science Educational Research Institute.

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