臺灣博碩士論文加值系統

背景：
在臺灣，事故傷害長年位居國人十大死因，胸部創傷屬高比率重度傷害，遺漏、延遲通報病情恐危及生命。護理師應具備快速評估與處置及臨床推理能力，提升創傷照護能力。然而，全面性創傷課程受限空間及成本，難以提供大量護理人員持續性訓練。透過『Care I Decide！』線上情境模擬輔助教學能夠提供臨床護理人員持續性胸部創傷課程訓練，有效提升護理人員胸部創傷照護知識及臨床推理能力。
目的：
本研究目的旨在驗證『Care I Decide！』線上情境模擬輔助教學對提升護理人員胸部創傷照護知識及臨床推理能力成效探討。
方法：
本研究是採隨機分派試驗(Randomized clinical trial, RCT)。以簡單隨機取樣進行雙組重複測量之研究。共有95位臺灣北區某區域教學醫院之急診及外科護理師參與研究。實驗組(n=49)接受「課室教學及『Care I Decide！』線上情境模擬輔助教學」胸部創傷課程，對照組(n=46)接受「課室教學及案例分享」胸部創傷課程。於課程開始前進行前測，於課程結束後一週及課程結束後12週進行後測及延宕測。研究工具包含：護理人員基本屬性、胸部創傷知識量表、臨床推理能力量表及學習投入度量表。
結果：
兩組護理人員於課程介入前，胸部創傷知識、臨床推理能力並無顯著差異。在課程介入後，整體胸部創傷知識第一次後測及延宕測，實驗組護理師得分皆高於對照組，達顯著性差異(p < .01)。臨床推理能力在實驗組延宕測得分高於前測，達顯著性差異(p < .05)。雙組護理師對於胸部創傷課程的學習投入度皆高度肯定，但未達統計顯著差異(p > .05)。
結論與建議：
本研究結果證實兩種胸部創傷課程皆可提升臨床護理師胸部創傷知識及臨床推理能力。『Care I Decide！』線上情境模擬輔助教學課程以互動式線上模擬案例提供護理師不受時間及空間限制，彈性進入線上教學平台重複學習案例。透過線上案例練習，引導護理師臨床推理及決策處置判斷，經由即時回饋，以釐清學理觀念。護理師在線上情境模擬互動式影片中運用臨床推理能力判斷病情變化過程，有助於創傷知識複習、臨床信息判斷及決策訓練。未來於護理教育中使用於臨床在職訓練進行相關教學，能提升臨床護理師胸部創傷知識及臨床推理能力，增加不同系統創傷之案例，並持續運用於臨床繼續教育中。
關鍵字：胸部創傷、線上情境模擬教育、臨床推理能力、學習投入、護理繼續教育

Background:
In Taiwan, accidental injuries have long been among the top ten causes of death, with thoracic trauma being a high proportion of severe injuries. Nurses must possess the skills of quick assessment and management and clinical reasoning to enhance their competency of trauma care. Despite the importance of comprehensive trauma courses, the implementation is often hindered by spatial and financial constraints, posing challenges to the provision of ongoing education for a large number of nurses. Through the “Care I Decide!” online simulation assisted teaching, practicing nurses may receive continuous thoracic trauma course training, effectively enhancing nurses’ knowledge and clinical reasoning skills in thoracic trauma care.
Purpose:
The purpose of this study was to evaluate the effectiveness of the “Care I Decide!” online simulation assisted teaching in promoting nurses’ knowledge and clinical reasoning skills in thoracic trauma care.
Method:
This two-group, repeated-measures, randomized controlled trial utilized a simple random sample of 95 ER and surgical nurses from a regional teaching hospital in Northern Taiwan. The experimental group (n=49) received a thoracic trauma course delivered through a combination of classroom teaching and the “Care I Decide!” online scenario-based simulation. The control group (n=46) was taught through classroom teaching and case sharing. Participants completed a pre-test before the intervention, a first post-test one week after the intervention, and a second post-test 12 weeks after the intervention. The instruments used included a demographic sheet, the Thoracic Trauma Knowledge Scale (TTKS), the Clinical Reasoning Skills Scale (CRSS), and the Learning Engagement Scale (LES).
Results:
There were no statistically significant differences between groups in the thoracic trauma knowledge and clinical reasoning skills prior to the intervention. After the intervention, the experimental group was significantly higher in the overall thoracic trauma knowledge in the first and second post-tests (p < .01). The experimental group’s clinical reasoning skills for the second post-test was significantly higher than the pre-test (p < .05). High learning engagement was found in both groups but did not reach statistical significance (p > .05).
Conclusion and Recommendations:
The findings of this study indicated that both thoracic trauma courses significantly improved nurses’ knowledge of thoracic trauma and their clinical reasoning skills. The “Care I Decide!” course allowed for flexible practice without the limitations of time and space. These online scenario-based exercises guided nurses through the clinical reasoning and decision-making processes and clarified any unclear concepts through real-time feedback. Furthermore, the course’s interactive videos enabled nurses to apply their clinical reasoning skills in making clinical judgments about the disease process, thereby enhancing the retention of thoracic trauma knowledge and the clinical decision-making process. This approach is recommended for use in continuing education to promote nurses’ knowledge of thoracic trauma and their clinical reasoning skills. Future applications of this approach could consider expanding to a variety of trauma scenarios for ongoing clinical education.
Keywords: thoracic trauma, online scenario-based simulation, clinical reasoning skills, learning engagement, nursing education  

摘要..............................................i
ABSTRACT.....................................iii
目次..............................................v
表次..............................................vii
圖次..............................................viii
第一章 緒論.................................1
第一節 研究背景及動機.................1
第二節 研究目的及提問.................6
第三節 名詞界定..........................7
第二章 文獻查證..........................9
第一節 胸部創傷概念....................9
第二節 臨床推理能力....................17
第三節 學習投入..........................26
第四節 多媒體互動學習................33
第三章 研究方法..........................40
第一節 研究設計..........................40
第二節 研究架構..........................42
第三節 收案場所與研究對象..........43
第四節 研究工具..........................45
第五節 研究步驟..........................52
第六節 研究倫理考量....................73
第七節 資料處理與分析.................74
第四章 研究結果...........................75
第一節 護理師人口學特性之分布及差異..........75
第二節 兩組不同胸部創傷課程教學方案介入前後，護理師在胸部創傷知識得分差異 .....................................................82
第三節 兩組不同胸部創傷課程教學方案介入前後，護理師臨床推理能力得分差異..........87
第四節 兩組胸部創傷課程介入後學習投入度之差異..................98
第五節 『Care I Decide！』線上情境模擬輔助教學課程學習反饋..............................103
第六節 總結.........................................................................................................105
第五章 討論.........................................................................................................107
第一節 『Care I Decide！』線上情境模擬輔助教學課程對護理師學習成效分析...........107
第二節 『Care I Decide！』線上情境模擬輔助教學課程設計與反饋學習投入度與反思心得.113
第六章 結論與建議................................................................................................116
第一節 結論.........................................................................................................116
第二節 建議.........................................................................................................117
第三節 研究限制...................................................................................................119
參考資料................................................................................................................120
中文文獻................................................................................................................120
英文文獻................................................................................................................121
附錄......................................................................................................................128
附錄一 護理師基本資料表........................................................................................128
附錄二 胸部創傷知識量表........................................................................................129
附錄三 臨床推理量表...............................................................................................133
附錄四 學習投入量表...............................................................................................134
附錄五 德菲法研究法專家評分表...............................................................................135
附錄六 量表內容專家評定結果..................................................................................140
附錄七 人體試驗委員會審核通過證明........................................................................154
附錄八 量表使用同意書...........................................................................................156
附錄九 學位論文原創性比對檢核表...........................................................................158

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