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研究生:陳惠雯
研究生(外文):Chen, Hui-Wen
論文名稱:比較不同教學方法對醫護團隊訓練復甦團隊合作之學習成效
論文名稱(外文):Comparison of the effect of different resuscitation teamwork training methodologies on learning outcome in postgraduate-year residents and nurses.
指導教授:胡慧蘭胡慧蘭引用關係
指導教授(外文):Hu, Huey-Lan
口試委員:林寬佳莊宇慧楊令瑀鄭夙芬
口試委員(外文):Lin, Kuan-ChiaChuang, Yeu-HuiYang, Ling-YuCheng, Su-Fen
口試日期:2023-10-16
學位類別:博士
校院名稱:國立陽明交通大學
系所名稱:護理學系
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2023
畢業學年度:112
語文別:中文
論文頁數:241
中文關鍵詞:團隊合作桌遊教學模擬教學互動講座教學復甦學習成效
外文關鍵詞:teamworkgame-based learningsimulation-based learninginteractive lecture-based learningresuscitationlearning effectiveness
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背景:復甦患者的複雜度高、變化快,對臨床團隊充滿挑戰。研究顯示不佳的團隊合作會危害患者安全。目前的研究證實模擬教學為有效的團隊合作訓練方法,但相關的人力、師資、空間設備和資金需求度高,較難廣泛推行至各部門單位。
目的:比較復甦團隊合作之桌遊教學、模擬教學與互動講座教學,對兩年期醫師與護理師在復甦專業知識、團隊合作知識、復甦處置行為,以及團隊合作行為之學習成效。
方法:前瞻性、隨機分派、單盲、三組和重複測量之研究設計,採用方便取樣,共計 96 位兩年期醫師與護理師作為研究對象,實驗組 I 接受桌遊教學,實驗組II 接受模擬教學,控制組接受互動講座教學,各組共 32 位。學習成效評估時間於前測、後測及第三個月進行。研究工具,包含:基本人口學特性、復甦專業知識測驗卷、團隊合作知識測驗卷、學習認知負荷量表、學習經驗回饋,以及醫護團隊進行復甦情境模擬,由評分員觀看錄影方式,客觀地評核團隊的醫療處置行為和團隊合作行為。統計方法採用描述性統計、推論性統計、χ2 卡方檢定、Kruskal�Wallis H 檢定、Friedman 檢定和 Wilcoxon 檢定、廣義估計方程式,及文字探勘。
結果:三種教學介入後的學習成效,組間結果顯示,後測和第三個月皆沒有達到統計檢定上顯著差異。但互動講座教學在團隊合作知識顯著高於模擬教學(p = 0.04)。組內結果顯示,後測到前測進步量,三組在復甦專業知識與行為和團隊合作知識與行為的得分均有進步。三種教學方法皆能有效地提升學員的復甦專業知識(p < 0.001),桌遊教學在復甦專業知識能夠保留(Retention)至第三個月(p = 0.008)。互動講座教學能夠有效地提升團隊合作知識(p = 0.003)。模擬教學能夠有效地提升醫護團隊的復甦處置行為和團隊合作行為(p = 0.012),但桌遊教學和互動講座教學皆未能達到相同效果。在學習成效隨時間變化上,結果顯示互動講座教學,在後測的團隊合作知識得分顯著優於模擬教學(p = 0.04),另外模擬教學,在第三個月的復甦處置行為得分顯著優於互動講座教學(p = 0.02)。
結論與建議:桌遊教學能夠有效地提升學員的復甦專業知識,並且維持至第三個月。模擬教學主要能夠有效提升學員的復甦處置行為與團隊合作行為。另外,互動講座教學主要能夠有助於提升復甦專業知識與團隊合作知識。學員經教育訓練後,知識與行為能力大多會隨時間逐漸衰退,建議定期提供人員教學訓練,為了讓臨床人員能夠長期參與訓練,可以考慮使用分散學習課程或增加定期的加強訓練,以確保訓練後能力能夠持續地維持與進步。
Background: The complexity and rapid changes in patient recovery pose significant challenges for clinical teams. Research has shown that poor teamwork can jeopardize patient safety. While simulation-based training is effective in enhancing teamwork skills, its widespread implementation faces challenges due to resource requirements.
Objectives: The aim of this study was to compare the effectiveness of board game-based learning, simulation-based learning, and interactive lecture-based learning in enhancing resuscitation medical knowledge, teamwork knowledge, medical task performance, and teamwork performance among postgraduate-year residents and nurses undergoing resuscitation teamwork training.
Methods: This study employed a single-blind, prospective, randomized controlled trial design, using a convenience sampling method to recruit a total of 96 PGY doctors and nurses as participants. They were divided into three groups: Experimental Group I received board game-based learning, Experimental Group II received simulation-based learning, and the Control Group received interactive lecture-based learning, with each group comprising 32 participants. The effectiveness assessment was conducted at pre�test, post-test, and the third month. Research tools included assessments of resuscitation medical knowledge, teamwork knowledge, cognitive load during learning, and learning experience feedback. The team engaged in scenario simulations, with evaluators watching the recording objectively to assess the medical task performance and teamwork performance of healthcare teams. Statistical methods used included descriptive and inferential statistics, χ2 chi-square tests, Kruskal-Wallis H test, Friedman test, Wilcoxon tes, generalized estimating equations, and text mining.
Results: The effectiveness of three intervention groups was assessed, and the between-group results showed no statistically significant differences in post-test and three-month later test outcomes (p > 0.05). However, the interactive lecture-based learning group demonstrated significantly higher teamwork knowledge compared to the simulation�based learning group (p = 0.04). In within-group results, all three groups showed improvements in scores for resuscitation medical knowledge, teamwork knowledge, medical task performance, and teamwork performance from the post-test to the pre�test. All three teaching methods were effective in enhancing participants' resuscitation medical knowledge (p < 0.001), with board game-based learning showing retention up to the third month (p = 0.008). Interactive lecture teaching was effective in improving team teamwork knowledge (p = 0.003). Simulation teaching improved medical task performance and teamwork performance in healthcare teams (p = 0.012), but board game-based teaching and interactive lecture-based learning did not achieve the same
effect (p > 0.016). The trend in learning effectiveness over time indicated that the change in teamwork knowledge scores through simulation-based learning was significantly lower compared to the interactive lecture-based learning group (p = 0.04). However, the change in medical task performance in the three-months later test was significantly higher in the simulation-based learning group compared to the interactive lecture-based learning group (p = 0.02).
Conclusion: Board game-based teaching effectively enhances learners' resuscitation medical knowledge and can retain it for up to three months. simulation-based learning group is effective in improving learners' medical task performance and teamwork performance. On the other hand, lecture-based learning group primarily enhances learners' resuscitation medical knowledge and teamwork knowledge. After educational training, most learners experience a gradual decline in both knowledge and behavioral abilities over time. It is recommended to provide regular personnel training to enable clinical staff to participate in training over the long term. Consider implementing spaced learning courses or booster training to ensure that the acquired skills and knowledge are maintained and continually improved after training.
目錄
中文摘要i
英文摘要ii
目錄iv
圖目錄vii
表目錄viii
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7
第四節 名詞解釋8
第二章 文獻查證12
第一節 團隊合作的發展與構面12
第二節 臨床復甦團隊合作的重要性與障礙16
第三節 復甦團隊合作訓練之研究現況21
第四節 醫療團隊人口學特徵與團隊合作之相關因素26
第五節 應用模擬教學於醫護教育訓練31
第六節 應用桌遊教學於醫護教育訓練35
第七節 教學訓練之相關模型與理論38
第三章 研究方法52
第一節 研究設計52
第二節 研究架構54
第三節 研究場所與收案對象55
第四節 研究步驟57
第五節 師資教學訓練與共識77
第六節 評分員評核訓練78
第七節 情境後反饋79
第八節 研究工具81
第九節 研究變項資料處理90
第十節 統計分析94
第十一節 研究倫理考量101
第四章 研究結果102
第一節 研究對象收案流程結果102
第二節 研究對象基本屬性分析105
第三節 三種教學方法在復甦專業知識於前測、後測及第三個月追蹤之學習成效108
第四節 三種教學方法在團隊合作知識於前測、後測及第三個月追蹤之學習成效112
第五節 三種教學方法在復甦處置行為於前測、後測及第三個月追蹤之學習成效116
第六節 三種教學方法在團隊合作行為於前測、後測及第三個月追蹤之學習成效120
第七節 三種教學方法之學習認知負荷程度124
第八節 研究對象在三種教學方法之學習經驗128
第五章 討論132
第一節 探討三種教學方法在組間的學習成效及影響原因132
第二節 探討三種教學方法在組內的學習成效及影響原因138
第三節 探討三種教學方法在長期的學習成效及影響原因147
第四節 教學者未來選擇教學之應用151
第六章 結論與建議153
第一節 結論153
第二節 研究建議154
第三節 研究限制156
參考文獻157
中文部分157
英文部分159
附錄196
附錄一 復甦團隊合作訓練與學習成效之研究概況196
附錄二 復甦情境之團隊合作評核工具203
附錄三 研究工具207
3-1 攝錄影/錄音同意書207
3-2 基本人口學調查208
3-3 復甦專業知識測驗卷210
3-4 團隊合作知識測驗卷217
3-5 復甦醫療處置能力評核表223
3-6 團隊合作觀察量表224
3-7 學習認知負荷量表225
3-8 學習經驗回饋226
附錄四 研究工具使用授權函227
4-1 學習認知負荷量表227
4-2 團隊合作觀察量表227
附錄五 專家效度委員228
5-1 復甦專業知識測驗卷與團隊合作知識測驗卷之專家效度委員228
5-2 復甦專業知識測驗卷之回覆翻譯228
5-3 復甦醫療處置行為評核表之專家效度委員228
附錄六 專家內容效度審查結果229
6-1 復甦專業知識測驗卷之專家效度評分229
6-2 團隊合作知識測驗卷之專家效度評分(第一次)230
6-3 團隊合作知識測驗卷之專家效度評分(第二次)231
6-4 復甦醫療處置行為評核表之專家效度評分232
附錄七 研究倫理委員通過證明函233
7-1 臺北醫學大學暨附屬醫院聯合人體研究倫理委員會(通過證明函)233
7-2 臺北醫學大學暨附屬醫院聯合人體研究倫理委員會 (修正案)235
7-3 國立陽明交通大學人體研究倫理審查委員會(同意人體研究證明書)236
附錄八 知情同意書237
附錄九 著作彙編之學位論文資訊及彙編學術著作之共同作者貢獻聲明書240
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