臺灣博碩士論文加值系統

背景：
壓力性損傷好發於失能、制動及長期臥床的病人，根據衛福部報告指出慢性病人中，長期臥床病人約佔十分之一，而以壓力性損傷為最常見的併發症。在臺灣，住院病人的壓力性損傷發生率為36.8%，盛行率為7.53%；國際盛行率約為8~23%，估計每一個壓力性損傷個案的平均醫療花費從2,000至30,000美元不等；而在臺灣每位壓力性損傷病人的醫療費用約新臺幣7,000至80,000元左右。預防壓力性損傷是護理人員、醫療專業者和醫療機構的重要任務，而預防與管理壓力性損傷的關鍵因素在於護理人員照護時的決策因子。成功的壓力性損傷預防與管理必須著重對護理人員教育的策略，以及提升其對壓力性損傷預防的積極態度並能使照護時的行為改變，採取預防措施以減少壓力性損傷發生的機會。
目的：
一、透過跨國文化翻譯過程，發展臺灣版護理人員對壓力性損傷預防的自覺障礙量表並檢驗其信效度。
二、觀察護理人員自覺障礙的原因。
三、介入數位平台教育與微課程翻轉教育，比較護理人員對壓力性損傷之認知、態度、壓力性損傷管理的自我效能之學習成效以及滿意度。
研究方法：
本研究論文分為三階段進行。第一階段將護理人員對預防壓力性損傷的自覺障礙量表進行跨國文化翻譯，再進行描述性質性訪談，萃取出自覺障礙原因，最後將該量表的臺灣版本進行心理計量分析(psychometric analysis)檢定信效度；第二階段再以橫斷式研究法，採立意取樣(purposive sampling)，共計收案330人，調查自覺障礙之原因分佈；第三階段為類實驗性研究，實驗組有244人，控制組有160人，分別介入不同的教育策略，實驗組介入微課程翻轉教育併實體工作坊，控制組則介入數位平台教育；並以重複測量的研究設計，於教育訓練前進行前測(T0) (共404人)，訓練結束立即後測(T1)(共329人)，訓練結束後1個月再測(T2)(共310人)，以及訓練結束後3個月再測(T3) (共243人)，進而探討護理人員對壓力性損傷預防與管理的認知、態度與自我效能之成效，以及學習滿意度，並觀察不同的教育策略，其學習成效的持續效果。
結果：
第一階段：經由Brislin’s翻譯模式的過程確定了最終版的臺灣版預防壓損自覺障礙量表。再經描述性質性訪談，於護理人員對壓力性損傷風險評估中，萃取出有意義的主題共5項；於壓損預防，萃取出9項；於紀錄預防計畫的自覺障礙量表則萃取出4項；並驗證了該量表有良好的信度與效度，可應用於臨床測量。
第二階段：調查護理人員對進行壓力性損傷風險評估、進行壓損預防、進行護理紀錄之自覺障礙原因，發現缺乏專業培訓為妨礙進行壓損預防的重要因素，作為後續策略擬定的依據。
第三階段：在T1、T2、T3三個時機點後測成績與前測相比，介入微課程翻轉教育的知識得分與自我效能的進步幅度，比數位平台教育更顯著；而三次的態度後測成績，微課程翻轉教育組比數位平台教育組高；而滿意度也優於數位平台教育組。
結論：
介入微課程翻轉教育後的整體進步，確認了知識長期停留的有效性，且護理人員對預防壓損的整體態度表現總是積極的，也顯示個人有能力做到壓力性損傷預防與管理的信心。介入微課程翻轉教育的整體滿意度優於數位平台教育組。

Background:
Pressure injuries are more common in disabled, immobilized, and bedridden patients. According to the Ministry of Health and Welfare report, long-term bedridden patients account for about one-tenth, and pressure injury is the most common complication among chronic patients. In Taiwan, the incidence of pressure injury in hospitalized patients was 36.8%, the prevalence was 7.53%, and the international prevalence was about 8-23%. The average medical cost per pressure injury case ranges from US$2,000 to US$30,000. In Taiwan, the medical cost of each pressure injury patient is about NT$7,000 to NT$80,000. Preventing pressure injuries is essential for nurses, health professionals, and medical institutions. The key factor in preventing and managing pressure injuries lies in the decision-making factors of the nurses. Successful pressure injury prevention and management must focus on strategies to educate caregivers, promote positive attitudes toward pressure injury prevention, and enable changes in caregiving behavior and preventive measures to reduce the chance of pressure injury.
Aims:
Through the cross-cultural translation process, develop the Taiwanese version of the perceived barriers to pressure injury prevention on nurses; then observe the factors for the nurses' perceived barriers; and investigate micro-video flipped learning and digital learning on nurses' knowledge, attitude, and self-efficacy in preventing and managing pressure injury, and satisfaction.
Methods:
There were three stages in this study. In the first stage, Brislin's translation process was used to carry out cross-cultural translation, to establish the Perceive Barriers Towards Pressure Injury Prevention for Nurses- Taiwanese Version (PBPIP-T), and then conduct a descriptive interview to extract the factors of the perceived barrier in nurses. Finally, the PBPIP-T was tested by psychometric analysis for reliability and validity. In the second stage, a cross-sectional study was used, and a total of 330 participants were collected by purposive sampling to investigate the factors of the perceived barrier. The third stage was a quasi-experimental study. The experimental and control groups had 244 and 160 participants, respectively. The experimental group was involved in micro-video flipped learning and workshops, and the control group was involved in digital learning; In a repeated-measures study design, a pre-test (T0) (n=404) was conducted before learning, a post-test(T1) immediately after learning(n=329), and a post-test one month after learning (T2)(n=310), and post-test three months after learning (T3)(n=243), and then to explore the effectiveness of flipped learning with micro-video or digital learning on nurses' knowledge, attitude, and self-efficacy in preventing and managing pressure injury, and learning satisfaction.
Result:
The first stage: The Perceive Barriers Towards Pressure Injury Prevention for Nurses- Taiwanese Version, was determined through Brislin's translation process. Through the interview of phenomenological study, a total of 5 themes were extracted from the risk assessment of pressure injury; 9 themes were extracted from the pressure injury prevention; 4 themes were extracted from the perceived barrier of the record prevention program and verified that the scale has good reliability and validity and can be used in the clinical measurement.
The second stage: Investigate the reasons for the perceived barrier of risk assessment of pressure injury, pressure injury prevention, and record prevention program. It was found that lack of training courses was an important factor hindering pressure injury prevention, which is used as the basis for subsequent strategy formulation.
The third stage: Compared T1, T2, and T3 with the T0, the improvement of knowledge scores and self-efficacy in micro-video flipped learning was more significant than that in digital learning; as for the post-test scores of attitudes, the micro-video flipped learning group is higher than the digital learning group; and the satisfaction is also better than the digital learning group.
Conclusion:
The overall progress after the intervention of micro-video flipped learning confirms the effectiveness of long-term retention of knowledge, and the general attitude of nurses towards preventing pressure injury was always positive, which also shows the individual's confidence in the ability to prevent and manage pressure injury. The overall satisfaction of the micro-video flipped learning is better than that of the digital learning group.

致謝…………………………………………………………………….. i
中文摘要……………………………………………………………….. ii
英文摘要……………………………………………………………….. v
目次…………………………………………………………………….. viii
表目錄………………………………………………………………….. xiii
圖目錄………………………………………………………………….. xiv
第壹章 緒論
第一節 研究背景………………………………………….. 1
第二節 研究重要性……………………………………….. 3
第三節 研究目的………………………………………….. 5
第四節 研究問題………………………………………….. 6
第五節 名詞界定………………………………………….. 7
第貳章 文獻探討
第一節 壓力性損傷流行病學…………………………….. 12
第二節 護理人員照護壓力性損傷的自覺障礙………….. 14
第三節 護理人員對壓力性損傷預防與管理的知識、態度與自我效能… 17
第四節 預防壓力性損傷教育策略與成效……………….. 27
第五節 教學理論與翻轉學習在護理教育的應用……….. 33
第參章 研究方法
第一節 第一階段：自覺障礙量表翻譯過程與心理計量分析
1.1 研究目的………………………………………. 42
1.2 研究問題………………………………………. 42
1.3 研究設計………………………………………. 42
1.4 研究場所與對象………………………………. 45
1.5 研究工具………………………………………. 46
1.6 研究倫理與考量………………………………. 46
1.7 資料處理與分析………………………………. 46
第二節 第二階段：自覺障礙量之觀察性研究
2.1 研究目的………………………………………. 50
2.2 研究假設………………………………………. 50
2.3 研究設計………………………………………. 50
2.4 研究場所與對象………………………………. 50
2.5 研究工具………………………………………. 51
2.6 研究倫理與考量………………………………. 52
2.7 資料處理與分析………………………………. 53
第三節 第三階段：接受壓力性損傷教育策略之成效探討
3.1 研究目的………………………………………. 55
3.2 研究假設………………………………………. 55
3.3 研究設計………………………………………. 55
3.4 教育策略處置…………………………………. 58
3.5 研究場所與對象………………………………. 67
3.6 研究工具………………………………………. 68
3.7研究倫理與考量……………………………….. 75
3.8 資料處理與分析……………………………….. 75
第肆章 研究結果
第一節 第一階段：自覺障礙量表翻譯過程與心理計量分析
4.1 跨國文化翻譯……………………………….. 79
4.2 質性訪談…………………………………….. 78
4.3 心理計量分析……………………………….. 82
第二節 第二階段：自覺障礙量之觀察性研究
4.1 人口學特質………………………………….. 83
4.2 護理人員對進行壓力性損傷之自覺障礙….. 86
第三節 第三階段：接受壓力性損傷教育策略之成效探討
4.1 比較兩組人口學變項……………………….. 90
4.2 比較兩組認知測驗之差異………………….. 94
4.3 比較兩組態度測驗之差異……………….. .. 116
4.4 比較兩組自我效能測驗之差異………….… 127
4.5 比較兩組滿意度差異………………………. 143
第伍章 討論
第一節 第一階段：自覺障礙量表翻譯過程與心理計量分析
5.1 跨國文化翻譯………………………………... 145
5.2 質性訪談對象之特性………………………... 145
5.3 信效度檢測…………………………………... 146
第二節 第二階段：自覺障礙量之觀察性研究
5.1 護理人員對進行壓力性損傷之自覺障礙……147
5.2 自覺障礙因素對預防態度之影響……………148
第三節 第三階段：接受壓力性損傷教育策略之成效探討
5.1 比較兩組認知測驗之差異………………….. 151
5.2 比較兩組態度評估之差異………………….. 157
5.3 比較兩組自我效能評估之差異…………….. 163
5.4 比較兩組滿意度差異……………………….. 166
5.5 兩組完成前、後測驗與否之人口學差異…...168
第陸章 結論與建議
第一節 第一階段結論……………………………………. 173
第二節 第二階段結論……………………………………. 175
第三節 第三階段結論……………………………………. 176
第四節 建議
6.1 臨床教育……………………………………...178
6.2 未來研究……………………………………...178
第五節 研究限制…………………………………………. 180
參考資料
中文部分……………………………………………………... 182
英文部分……………………………………………………... 186
附錄
附錄一、預防壓力性損傷自覺障礙及態度量表翻譯授權… 200
附錄二、專家效度審查名單………………………………… 202
附錄三、第一階段研究之人體試驗委員會審查…………… 203
附錄四、預防與管理壓力性損傷自我效能量表翻譯授權… 204
附錄五、第三階段研究之人體試驗委員會審查…………… 205

中文部分
王錦堂、沈靜茹、蕭惠樺、何文譽、李維哲、李智雄(2019)˙從鷹架理論探討畢業後一般醫學訓練學員臨床技能學習成效，台灣擬真醫學教育期刊，6(1)，14-25。[An Investigation of the Scaffolding Theory on the Learning Outcome of Clinical Skills Training for the Medical Post-Graduate Year trainees] doi:10.6582/jtssh.201906_6(1).0002
吳秀玲、莊秋萍、林麗華、鄒怡真、熊道芬、桑潁潁、周幸生(2017)˙探討壓損防治多元教學策略對護理人員認知及病人壓損發生率之影響，榮總護理，34(2)，118-129。[Effect of a Multistrategy Pressure Ulcer Prevention Education Program on Nurse Cognition and Pressure Ulcer Incidence Rates] doi:10.6142/vghn.34.2.118
吳淑芳(2006)˙國外量表之兩階段翻譯及信效度測試，護理雜誌，53(1)，65-71。
呂文娟、徐曼瑩、蔡衣帆、楊文理、高木榮、李俊秀(2017)˙護理新人的管路照護模組課程之混成式學習成效，北市醫學雜誌，14(3)，315-323。[The Effectiveness of Blended Learning on Tube Care among New Nurses] doi:10.6200/tcmj.2017.14.3.06
洪佳慧、林陳涌(2011)˙應用學習鷹架融入教學對於學生學習活動分析成效之探索，29(1)，82-106。[Integrating Scaffold Strategies into Activity Analysis to Enhance Students' Learning Achievement] doi:10.6594/jtota.2011.29(1).05
財團法人醫院評鑑暨醫療品質策進會(2021)˙台灣臨床成效指標(TCPI)綜合照護指標執行手冊修訂清單(2021.01起適用)˙取自https://tcpi.jct.org.tw/Files/2021.01%E7%B6%9C%E5%90%88%E7%85%A7%E8%AD%B7%E4%BF%AE%E8%A8%82%E6%B8%85%E5%96%AE0105_%E9%99%84%E4%BB%B6_132549837703110838.pdf
康以諾、林哲瑋、陳建宇、曾德銘、吳建志(2016)˙翻轉教學應用於擬真臨床技能學習之滿意度初探˙台灣擬真醫學教育期刊，3(1)，23-31。 [An Exploratory Study on Simulated Clinical Skill Learning Satisfaction in the Flipped Approach] doi:10.6582/jtssh.2016.3(1).03
張素惠、張彩秀、陳妮婉(2013)˙護理人員壓損預防行為之探討，弘光學報，(69)，136-153。 [Prevention of pressure ulcer by nurses] doi:10.6615/har.201303.69.11
許美玉、于博芮、蕭晴文、趙慧玲(2017)˙壓損名詞與分級系統變革，榮總護理，34(2)，110-117。[Changes to the Staging and Definitions of Pressure Ulcer] doi:10.6142/vghn.34.2.110
陳文香、羅惠敏(2019)˙溝通課程對提升護生人際溝通能力與學習滿意度之探討，健康科技期刊，6(1) ， 16-26。[An exploration of communication course enhancement of student nurse interpersonal communication skills and learning satisfaction] doi:10.6979/tjhs.201909_6(1).0004
陳妮婉、張彩秀、張素惠(2013)˙護理人員壓損預防行為之系統性文獻查證，澄清醫護管理雜誌，9(2)，40-47。[A Systematic Review of Nurses' Preventive Behavior with Regard to Pressure Ulcers]
陳婉兒、吳淑芳(2013)˙發展一個理論為基礎之衛教方案：以增進糖尿病患身體活動衛教為例，源遠護理，7(1)，29-35。[Develop a Theory-based Health Education Program on the Enhancement of Diabetic Mellitus Patients' Physical Activity] doi:10.6530/yyn.2013.7(1).05
湯麗君、蔡宗宏、蔡長書(2008)˙問題導向學習法中之學習內在動機促進因素研究－以兩所大專校院爲例，醫護科技雜誌，10(1)，65-76。 [Intrinsic Motivation in Problem-Based Learning: A Preliminary Study of Promoting Elements in Two Taiwan Universities] doi:10.6563/tjhs.2008.10(1).6
黃惠滿、鄭夙芬(2018)˙翻轉教室教學策略於護理教育課程之應用，護理雜誌，65(6)，5-12。 [Application of Flipped Classroom Teaching Strategy in Nursing Education].doi:10.6224/jn.201812_65(6).02
臺灣傷口造口及失禁護理學會(2020)˙學術活動˙取自https://www.twocna.org.tw/
趙莉芬、劉雪娥 (1995)˙影響臨床護理人員對壓損認知與行為之探討，護理研究，3(3)，255-266。[Factors Related to the Knowledge and Preventive Behaviors of Pressure Sores by Clinical Nurses]doi:10.7081/nr.199509.0255
趙慧玲、黃薇瑄、李怡旻、徐千淯、劉錦蓉、簡宛晴、連恒煇(2016)˙運用系統教學設計模式建構壓損照護實作教學課，台灣擬真醫學教育期刊，3(1)，11-22。[Effectiveness of Using Systematic Design Method to Develop Pressure Ulcer Care Teaching Model] doi:10.6582/jtssh.2016.3(1).02
潘世尊(2004)˙Vygotsky對認知發展的觀點及其教學應用，弘光學報，(43), 131-146。[Vygotsky's Theory of Cognitive Development and Its Teaching Application] doi:10.6615/har.200405.43.14
衛生福利部中央健康保險署(2021)˙醫療服務給付項目及支付標準網路查詢服務˙取自 https://www.nhi.gov.tw/query/Query2.aspx
謝茉莉、洪利穎(2014a)˙醫病溝通教學的觀念與策略，人文社會與醫療學刊，(1)， 37-56。[Teaching Doctor-patient Communication Skills: Concepts and Strategies] doi:10.6279/jhssm.2014.1(1).02
謝茉莉、洪利穎(2014b)˙鷹架策略於醫病溝通教學之成效，北市醫學雜誌，11(3), 12-19。[The Efficacy of Scaffolding Strategy in a Doctor-Patient Communication Course] doi:10.6200/tcmj.2014.11.3.03

英文部分
ABA, A. B. A. (2000). Scope of nursing and midwifery practice framework/An Bord Altranais. -3663.
Adegoke, B., Odole, A., Akindele, L., & Akinpelu, A. (2013). Pressure ulcer prevalence among hospitalised adults in university hospitals in South-west Nigeria. 21(3), 128.
Agency for Healthcare Research and Quality (2017). Preventing Pressure Ulcers in Hospitals. Retrieved from https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/index.html
Ajzen, I., & Fishbein, M. (2005). The influence of attitudes on behavior.
Al-Ghamdi, A. M. (2017). Factors affecting nurses’ compliance in preventing pressure ulcer among hospitalized patients at King Abdulaziz University Hospital.
Anthony, D., Alosoumi, D., & Safari, R. (2019). Prevalence of pressure ulcers in long-term care: a global review. J Wound Care, 28(11), 702-709. doi:10.12968/jowc.2019.28.11.702
Avsar, P., Patton, D., O'Connor, T., & Moore, Z. (2019). Do we still need to assess nurses' attitudes towards pressure ulcer prevention? A systematic review. 28(12), 795-806.
Ayello, E. A., & Meaney, G. J. J. o. W. (2003). Replicating a survey of pressure ulcer content in nursing textbooks. 30(5), 266-271.
Bandura, A. (1989). Regulation of cognitive processes through perceived self-efficacy. 25(5), 729.
Bandura, A., Freeman, W., & Lightsey, R. (1999). Self-efficacy: The exercise of control: Springer.
Barakat-Johnson, M., Barnett, C., Wand, T., & White, K. (2018). Knowledge and attitudes of nurses toward pressure injury prevention: a cross-sectional multisite study. Journal of Wound Ostomy & Continence Nursing, 45(3), 233-237.
Baranoski, S., & Ayello, E. A. (2008). Wound care essentials: Practice principles: Lippincott Williams & Wilkins.
Barbour, C., & Schuessler, J. B. (2019). A preliminary framework to guide implementation of The Flipped Classroom Method in nursing education. Nurse Educ Pract, 34, 36-42. doi:10.1016/j.nepr.2018.11.001
Beeckman, D., Defloor, T., Schoonhoven, L., & Vanderwee, K. (2011). Knowledge and attitudes of nurses on pressure ulcer prevention: a cross-sectional multicenter study in Belgian hospitals. Worldviews Evid Based Nurs, 8(3), 166-176. doi:10.1111/j.1741-6787.2011.00217.x
Beeckman, D., Vanderwee, K., Demarré, L., Paquay, L., Van Hecke, A., & Defloor, T. (2010). Pressure ulcer prevention: development and psychometric validation of a knowledge assessment instrument. Int J Nurs Stud, 47(4), 399-410. doi:10.1016/j.ijnurstu.2009.08.010
Bergmann, J., & Sams, A. (2012). Flip your classroom: Reach every student in every class every day: International society for technology in education.
Bostrom, J., & Kenneth, H. (1992). Staff nurse knowledge and perceptions about prevention of pressure sores. Dermatology Nursing, 4(5), 365-368, 378.
Brabec, K., Fisher, K., & Pitler, H. (2004). Building Better Instruction: How Technology Supports Nine Research-Proven Instructional Strategies. Learning & Leading with Technology, 31(5), 6-11.
Brame, C. (2013). Flipping the classroom. Vanderbilt University Center for Teaching.
Bredesen, I. M., Bjøro, K., Gunningberg, L., & Hofoss, D. (2016). Effect of e-learning program on risk assessment and pressure ulcer classification—A randomized study. Nurse education today, 40, 191-197.
Brislin, R. (1986). The wording and translation of research instruments.
Caliri, M. L., Miyazaki, M. Y., & Pieper, B. (2003). Knowledge of pressure ulcers by undergraduate nursing students in Brazil. Ostomy Wound Management, 49(3), 54-63.
Caruso, R., Fida, R., Sili, A., & Arrigoni, C. (2016). Towards an integrated model of nursing competence: an overview of the literature reviews and concept analysis. Professioni infermieristiche, 69(1).
Caruso, R., Pittella, F., Zaghini, F., Fida, R., & Sili, A. (2016). Development and validation of the Nursing Profession Self-Efficacy Scale. Int Nurs Rev, 63(3), 455-464. doi:10.1111/inr.12291
Charalambous, C., Koulouri, A., Roupa, Z., Vasilopoulos, A., Kyriakou, M., & Vasiliou, M. (2019). Knowledge and attitudes of nurses in a major public hospital in Cyprus towards pressure ulcer prevention. Journal of tissue viability, 28(1), 40-45.
Chu, T.-L., Wang, J., Monrouxe, L., Sung, Y.-C., Kuo, C.-l., Ho, L.-H., & Lin, Y.-E. (2019). The effects of the flipped classroom in teaching evidence based nursing: A quasi-experimental study. PLoS One, 14(1), e0210606.
Clark, M., Semple, M. J., Ivins, N., Mahoney, K., & Harding, K. (2017). National audit of pressure ulcers and incontinence-associated dermatitis in hospitals across Wales: a cross-sectional study. BMJ open, 7(8), e015616.
Cohen, J. (1992). Statistical power analysis. Current directions in psychological science, 1(3), 98-101.
Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it.
Cox, J., Roche, S., & Van Wynen, E. (2011). The effects of various instructional methods on retention of knowledge about pressure ulcers among critical care and medical-surgical nurses. J Contin Educ Nurs, 42(2), 71-78. doi:10.3928/00220124-20100802-03
Coyer, F., Miles, S., Gosley, S., Fulbrook, P., Sketcher-Baker, K., Cook, J.-L., & Whitmore, J. (2017). Pressure injury prevalence in intensive care versus non-intensive care patients: A state-wide comparison. Australian Critical Care, 30(5), 244-250. doi:https://doi.org/10.1016/j.aucc.2016.12.003
Dale, E. (1969). Audiovisual methods in teaching.
Dalvand, S., Ebadi, A., & Gheshlagh, R. G. (2018). Nurses’ knowledge on pressure injury prevention: a systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. 11, 613.
Dellafiore, F., Arrigoni, C., Ghizzardi, G., Baroni, I., Conte, G., Turrini, F., . . . Caruso, R. (2019). Development and validation of the pressure ulcer management self‐efficacy scale for nurses. Journal of clinical nursing, 28(17-18), 3177-3188.
Delmore, B., Ayello, E. A., Smart, H., & Sibbald, R. G. (2018). Assessing Pressure Injury Knowledge Using the Pieper-Zulkowski Pressure Ulcer Knowledge Test. Advances in Skin & Wound Care, 31(9).
Delmore, B., Ayello, E. A., Smart, H., Tariq, G., & Sibbald, R. G. (2019). Survey Results from the Gulf Region: NPUAP Changes in Pressure Injury Terminology and Definitions. Adv Skin Wound Care, 32(3), 131-138. doi:10.1097/01.ASW.0000553108.70752.f6
Delmore, B., Smith, D. J., Savage, E., & Ayello, E. A. (2020). Evaluating the Impact of an Innovative Educational Program for Skin Care Champions Using the Pieper-Zulkowski Pressure Ulcer Knowledge Test. Advances in Skin & Wound Care, 33(5).
Demarré, L., Vanderwee, K., Defloor, T., Verhaeghe, S., Schoonhoven, L., & Beeckman, D. J. J. o. c. n. (2012). Pressure ulcers: knowledge and attitude of nurses and nursing assistants in Belgian nursing homes. 21(9‐10), 1425-1434.
Doyle, W. (1986). Classroom organization and management. 3, 392-431.
Ebi, W. E., Hirko, G. F., & Mijena, D. A. (2019). Nurses’ knowledge to pressure ulcer prevention in public hospitals in Wollega: a cross-sectional study design. BMC Nursing, 18(1), 1-12.
Ebi, W. E., Menji, Z. A., & Hunde, B. M. (2017). Nurses’ knowledge and perceived barriers about pressure ulcer prevention for admitted patients in public hospitals in Addis Ababa, Ethiopia. American Journal of Internal Medicine, 5(4-1), 1-6.
Ekama Ilesanmi, R., & Morohunfoluwa Oluwatosin, O. (2016). A Quasi-experimental Study to Assess an Interactive Educational Intervention on Nurses' Knowledge of Pressure Ulcer Prevention in Nigeria. Ostomy Wound Manage, 62(4), 30-40.
Ellis, A. (1996). Belief, Attitude, Intention and Behaviour: An Introduction to Theory and Research. Educational Studies, 2(6), 243-254.
Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing, 17(1), 14.
European Pressure Ulcer Advisory Panel (2019). 2019 Guidelines & QRG. Retrieved from https://www.epuap.org/pu-guidelines/
European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide 2019. Retrieved from https://www.internationalguideline.com/static/pdfs/Quick_Reference_Guide-10Mar2019.pdf
Fishbien, M., & Ajzen, I. (1975). Belief, attitude, intention and behaviour. An introduction of theory and research reading: Massachusstts: Addision-Wesley publishing.
Garza Hernández, R., Méndez, M., Concepción, M., Fang Huerta, M. d. l. Á., González Salinas, J. F., Castañeda-Hidalgo, H., & Argumedo Pérez, N. E. J. C. y. e. (2017). Conocimiento, actitud y barreras en enfermeras hacia las medidas de prevención de úlceras por presión. 23(3), 47-58.
Ghanee, R., Gavami, H. J. N., & Journal, M. (2010). Bed sore in ICU. 8(2), 0-0.
Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: theory, research, and practice: John Wiley & Sons.
Grešš Halász, B., Bérešová, A., Tkáčová, Ľ., Magurová, D., & Lizáková, Ľ. (2021). Nurses' Knowledge and Attitudes towards Prevention of Pressure Ulcers. Int J Environ Res Public Health, 18(4). doi:10.3390/ijerph18041705
Gunningberg, L., Mårtensson, G., Mamhidir, A. G., Florin, J., Muntlin Athlin, Å., & Bååth, C. (2015). Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden. Int Wound J, 12(4), 462-468. doi:10.1111/iwj.12138
Hamdan, N., McKnight, P., McKnight, K., & Arfstrom, K. M. (2013). The flipped learning model: A white paper based on the literature review titled a review of flipped learning: Flipped Learning Network/Pearson/George Mason University.
Hayes, P. A., Wolf, Z. R., & McHugh, M. K. (1994). Effect of a Teaching Plan on a Nursing Knowledge of Pressure Ulcer Risk, Assessment, and Treatment. Journal for Nurses in Professional Development, 10(4), 207-213.
Hermanns, M., Post, J. L., & Deal, B. (2015). Faculty experience of flipping the classroom: Lessons learned.
Hessler, K. L. (2016). Nursing education: Flipping the classroom. The Nurse Practitioner, 41(2), 17-27.
Hill, L. J. N. t. (1992). Wound care nursing. The question of pressure. 88(12), 76-82.
Hommel, A., Gunningberg, L., Idvall, E., & Bååth, C. (2017). Successful factors to prevent pressure ulcers - an interview study. J Clin Nurs, 26(1-2), 182-189. doi:10.1111/jocn.13465
Hwang, G.-J., & Chen, P.-Y. (2019). Effects of a collective problem-solving promotion-based flipped classroom on students’ learning performances and interactive patterns. Interactive Learning Environments, 1-16. doi:10.1080/10494820.2019.1568263
Jenkins, V., & Fallowfield, L. (2002). Can communication skills training alter physicians’ beliefs and behavior in clinics? Journal of Clinical Oncology, 20(3), 765-769.
Kaddourah, B., Abu-Shaheen, A. K., & Al-Tannir, M. (2016). Knowledge and attitudes of health professionals towards pressure ulcers at a rehabilitation hospital: a cross-sectional study. BMC Nursing, 15(1), 1-6.
Källman, U., & Suserud, B. O. (2009). Knowledge, attitudes and practice among nursing staff concerning pressure ulcer prevention and treatment--a survey in a Swedish healthcare setting. Scand J Caring Sci, 23(2), 334-341. doi:10.1111/j.1471-6712.2008.00627.x
Källman, U., & Suserud, B. O. (2009). Knowledge, attitudes and practice among nursing staff concerning pressure ulcer prevention and treatment–a survey in a Swedish healthcare setting. Scand J Caring Sci, 23(2), 334-341.
Kim, J. Y., & Lee, Y. J. (2019). A study on the nursing knowledge, attitude, and performance towards pressure ulcer prevention among nurses in Korea long‐term care facilities. International wound journal, 16, 29-35.
Kuo, F.-R., & Hwang, G.-J. (2014). A five-phase learning cycle approach to improving the web-based problem-solving performance of students. Journal of Educational Technology & Society, 17(1), 169-184.
Liu, M., Yuan, H.-B., Chen, W.-J., Poon, C., Hsu, M., & Zhang, B. J. C. N. R. (2016). Translation, modification and validation of the Chinese version of a knowledge assessment instrument regarding pressure ulcer prevention. 3(1), 16-23.
Liu, Q., Peng, W., Zhang, F., Hu, R., Li, Y., & Yan, W. (2016). The Effectiveness of Blended Learning in Health Professions: Systematic Review and Meta-Analysis. J Med Internet Res, 18(1), e2. doi:10.2196/jmir.4807
Lyder, C. H., Wang, Y., Metersky, M., Curry, M., Kliman, R., Verzier, N. R., & Hunt, D. R. (2012). Hospital‐acquired pressure ulcers: results from the national Medicare patient safety monitoring system study. Journal of the American Geriatrics Society, 60(9), 1603-1608.
Mallinckrodt, B., & Wang, C.-C. (2004). Quantitative methods for verifying semantic equivalence of translated research instruments: a Chinese version of the experiences in close relationships scale. Journal of Counseling Psychology, 51(3), 368.
Maylor, M., & Torrance, C. (1999). Pressure sore survey part 3: locus of control. Journal of wound care, 8(3), 101-105.
McCluskey, A., & Lovarini, M. (2005). Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study. BMC medical education, 5(1), 1-12.
McCutcheon, K., Lohan, M., Traynor, M., & Martin, D. (2015). A systematic review evaluating the impact of online or blended learning vs. face-to-face learning of clinical skills in undergraduate nurse education. J Adv Nurs, 71(2), 255-270. doi:10.1111/jan.12509
McDonald, K., & Smith, C. M. (2013). The flipped classroom for professional development: part I. Benefits and strategies. The Journal of Continuing Education in Nursing, 44(10), 437-438.
Moore, Z., & Cowman, S. (2012). Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland. Journal of clinical nursing, 21(3‐4), 362-371.
Moore, Z., & Price, P. (2004). Nurses' attitudes, behaviours and perceived barriers towards pressure ulcer prevention. J Clin Nurs, 13(8), 942-951. doi:10.1111/j.1365-2702.2004.00972.x
Moore, Z., Johansen, E., Etten, M. v., Strapp, H., Solbakken, T., Smith, B. E., & Faulstich, J. (2015). Pressure ulcer prevalence and prevention practices: a cross-sectional comparative survey in Norway and Ireland. Journal of wound care, 24(8), 333-339.
Moore, Z., Johanssen, E., & Etten, M. (2013). A review of PU prevalence and incidence across Scandinavia, Iceland and Ireland (Part I). Journal of wound care, 22(7), 361-368.
National Pressure Injury Advisory Panel (2016). Pressure injury stages. Retrieved from https://npiap.com/page/PressureInjuryStages
National Pressure Injury Advisory Panel (2019). 2019 Guideline. Retrieved from https://npiap.com/page/2019Guideline
Njie-Carr, V. P., Ludeman, E., Lee, M. C., Dordunoo, D., Trocky, N. M., & Jenkins, L. S. (2017). An Integrative Review of Flipped Classroom Teaching Models in Nursing Education. J Prof Nurs, 33(2), 133-144. doi:10.1016/j.profnurs.2016.07.001
Onda, M., & Takagaki, N. (2018). [Approach to Evidence-based Medicine Exercises Using Flipped Teaching: Introductory Education for Clinical Practice for 4th-Year Pharmacy Students]. Yakugaku Zasshi, 138(5), 645-647. doi:10.1248/yakushi.17-00190-3
Osborne, R. J., & Wittrock, M. C. (1983). Learning science: A generative process. 67(4), 489-508.
Padula, W. V., Mishra, M. K., Makic, M. B. F., & Sullivan, P. (2011). Improving the quality of pressure ulcer care with prevention: a cost-effectiveness analysis. 385-392.
Panagiotopoulou, K., & Kerr, S. M. (2002). Pressure area care: an exploration of Greek nurses' knowledge and practice. Journal of Advanced Nursing, 40(3), 285-296.
Panel, N. (2014). Quick Reference Guide.
Petty, R. E., & Cacioppo, J. T. (2018). Attitudes and persuasion: Classic and contemporary approaches: Routledge.
Pieper, B., & Mott, M. (1995). Nurses' knowledge of pressure ulcer prevention, staging, and description. Adv Wound Care, 8(3), 34, 38, 40 passim.
Pieper, B., & Zulkowski, K. (2014). The Pieper-Zulkowski Pressure Ulcer Knowledge Test. Advances in Skin & Wound Care, 27(9).
Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., & Perneger, T. V. (2000). Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. The Lancet, 356(9238), 1307-1312.
Porter‐Armstrong, A. P., Moore, Z. E., Bradbury, I., & McDonough, S. (2018). Education of healthcare professionals for preventing pressure ulcers. Cochrane Database of Systematic Reviews(5).
Rowe, M., Frantz, J., & Bozalek, V. (2012). The role of blended learning in the clinical education of healthcare students: a systematic review. Med Teach, 34(4), e216-221. doi:10.3109/0142159x.2012.642831
Rucker, S. Y., Ozdogan, Z., & Al Achkar, M. (2017). Flipped classroom model for learning evidence-based medicine. Adv Med Educ Pract, 8, 619-625. doi:10.2147/amep.s142233
Saleh, M. Y., Papanikolaou, P., Nassar, O. S., Shahin, A., & Anthony, D. J. J. o. t. v. (2019). Nurses' knowledge and practice of pressure ulcer prevention and treatment: An observational study. 28(4), 210-217.
Samuriwo, R., & Dowding, D. (2014). Nurses’ pressure ulcer related judgements and decisions in clinical practice: a systematic review. International journal of nursing studies, 51(12), 1667-1685.
Sanders, D., & Welk, D. S. (2005). Strategies to Scaffold Student Learning: Applying Vygotsky's Zone of Proximal Development. Nurse Educator, 30(5), 203-207.
Simonetti, V., Comparcini, D., Flacco, M. E., Di Giovanni, P., & Cicolini, G. (2015). Nursing students' knowledge and attitude on pressure ulcer prevention evidence-based guidelines: a multicenter cross-sectional study. Nurse Educ Today, 35(4), 573-579. doi:10.1016/j.nedt.2014.12.020
Strand, T., & Lindgren, M. (2010). Knowledge, attitudes and barriers towards prevention of pressure ulcers in intensive care units: a descriptive cross-sectional study. Intensive Crit Care Nurs, 26(6), 335-342. doi:10.1016/j.iccn.2010.08.006
Tallier, P. C., Reineke, P. R., Asadoorian, K., Choonoo, J. G., Campo, M., & Malmgreen-Wallen, C. (2017). Perioperative registered nurses knowledge, attitudes, behaviors, and barriers regarding pressure ulcer prevention in perioperative patients. Applied Nursing Research, 36, 106-110.
Taylor-Piliae, R. E. (2008). The effectiveness of Tai Chi exercise in improving aerobic capacity: an updated meta-analysis Tai Chi Chuan (Vol. 52, pp. 40-53): Karger Publishers.
Tomova-Simitchieva, T., Akdeniz, M., Blume-Peytavi, U., Lahmann, N., & Kottner, J. J. G. (2018). The epidemiology of pressure ulcer in Germany: systematic review. 81(6), 505-512.
Tubaishat, A., Aljezawi, M., & Al Qadire, M. J. J. o. w. c. (2013). Nurses' attitudes and perceived barriers to pressure ulcer prevention in Jordan. 22(9), 490-497.
Tubaishat, A., Anthony, D., & Saleh, M. (2011). Pressure ulcers in Jordan: a point prevalence study. Journal of tissue viability, 20(1), 14-19.
Tubaishat, A., Papanikolaou, P., Anthony, D., & Habiballah, L. (2018). Pressure ulcers prevalence in the acute care setting: a systematic review, 2000-2015. Clinical nursing research, 27(6), 643-659.
Tulek, Z., Polat, C., Ozkan, I., Theofanidis, D., & Togrol, R. E. (2016). Validity and reliability of the Turkish version of the pressure ulcer prevention knowledge assessment instrument. J Tissue Viability, 25(4), 201-208. doi:10.1016/j.jtv.2016.09.001
Tweed, C., & Tweed, M. (2008). Intensive care nurses’ knowledge of pressure ulcers: development of an assessment tool and effect of an educational program. American Journal of Critical Care, 17(4), 338-346.
Uba, M., Alih, F., Kever, R., & Lola, N. (2015). Knowledge, attitude and practice of nurses toward pressure ulcer prevention in University of Maiduguri Teaching Hospital, Borno State, North-Eastern, Nigeria.
Unruh, L. (2003). Licensed nurse staffing and adverse events in hospitals. Med Care, 41(1), 142-152. doi:10.1097/00005650-200301000-00016
Ünver, S., Fındık, Ü. Y., Özkan, Z. K., & Sürücü, Ç. J. J. o. t. v. (2017). Attitudes of surgical nurses towards pressure ulcer prevention. 26(4), 277-281.
Van Gaal, B. G., Schoonhoven, L., Vloet, L. C., Mintjes, J. A., Borm, G. F., Koopmans, R. T., & van Achterberg, T. (2010). The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: a cluster randomised trial. International journal of nursing studies, 47(9), 1117-1125.
VanDenKerkhof, E. G., Friedberg, E., & Harrison, M. B. J. J. f. H. Q. (2011). Prevalence and risk of pressure ulcers in acute care following implementation of practice guidelines: annual pressure ulcer prevalence census 1994–2008. 33(5), 58-67.
Vanderwee, K., Clark, M., Dealey, C., Gunningberg, L., & Defloor, T. (2007). Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract, 13(2), 227-235. doi:10.1111/j.1365-2753.2006.00684.x
Vygotsky, L. S. (2012). Thought and language: MIT press.
Welsh, L. (2018). Wound care evidence, knowledge and education amongst nurses: a semi-systematic literature review. Int Wound J, 15(1), 53-61. doi:10.1111/iwj.12822
Williams, B., Perillo, S., & Brown, T. (2015). What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurse education today, 35(2), e34-e41.
Wood, D., Bruner, J. S., & Ross, G. (1976). The role of tutoring in problem solving. 17(2), 89-100.
Zhou, Q., Yu, T., Liu, Y., Shi, R., Tian, S., Yang, C., . . . Hu, A. (2018). The prevalence and specific characteristics of hospitalised pressure ulcer patients: A multicentre cross-sectional study. J Clin Nurs, 27(3-4), 694-704. doi:10.1111/jocn.14019