Roots of Competency, Setbacks and Hardship, and Growth Opportunities-Clinical Nursing Practice of New Nursing Students

[[abstract]]背景：護理系學生實際接觸臨床實務的基本護理學與實習課程是銜接各護理核心科目實習之重要基礎。目的：為能提升教學成效，期望透過學生學習之回饋中，明瞭學生實習之經驗，以做為教學精進之參考。方法：採質性研究焦點團體訪談法，以半結構式訪談指引進行深入訪談。研究對象以技職體系某大學護理系已完成基本護理學實習學生為對象，以隨機抽樣方式進行招募，共有40位學生參與訪談。結果：研究結果經分析後共歸納出三大主題，包括：一、能力的紮根，二、挫折困頓的經驗，三、成長的歷程等；其中涵蓋有十一個次主題。結論：從門外漢至新手護生的實習經驗中，真實反應學生的心境，其中包含正向與負向經驗。學生之專業能力紮根的過程中，經歷挫折、困頓，嘗試運用自我調整的模式，學習如何因應多變化的實習情境。針對學生正負向學習經驗的轉化，須仰賴實習教師們的敏感度及同理心，深入瞭解及評估學生在初次實習之壓力情境與感受，並能識別學生個別狀態，運用不同的教學策略，因材施教。實務應用：研究結果提供學生實際臨床實習經驗、對實務的看法以及教學輔導方式的體驗，可以作為未來護理教育中臨床教學方法改進之參考。 Background: Fundamental nursing and practicum courses that provide nursing students direct exposure to clinical practice are important foundations that facilitate core nursing internships. Purpose: In order to enhance learning outcomes, the study sought understand the internship experience of students via student feedback and use the feedback as a reference to improve teaching. Methods: For this qualitative research, the study interviewed subjects through a focus-group. The study used semi-structured interviews to gain deep comprehension of the students' experience. Study subjects were nursing interns who had completed fundamental nursing courses at the nursing department of a vocational university. The study recruited subjects through random sampling. A total of 40 students participated in the interviews. Results: After analyzing the research results, the study derived three main themes: 1) the establishment of competencies, 2) the experience of setbacks and fatigue, and 3) the process of growth; the study also included eleven sub-themes. Conclusions: The study accurately reflected the students' state of mind during their internship experience that transformed them into new nursing students. However, students reported both positive and negative experiences. While establishing professional competencies, students experienced setbacks and fatigue but made efforts toward self-regulation and learned how to react to the ever-changing situations of their internships. Varying with the students' positive and negative learning experiences, teachers of the interns should be sensitive and empathetic to fully understand and evaluate the students' individual circumstances and feelings under the stressful situation of their first internship. Teachers can then develop different teaching strategies and teach students according to their individual aptitudes. Applications: The results of this study reveal the actual experiences of students in clinical internships, their perspectives on the practicum and their insights as subjects of the teaching methodology, all of which can serve as references for improving clinical teaching in nursing education in the future

照顧一位周邊動脈阻塞性疾病導致雙腿截肢患者之護理經驗

[[abstract]]本篇個案報告在呈現一位因週邊動脈阻塞性疾病導致雙腿截肢患者之護理經驗。筆者於民國93年4月28日至93年5月14日護理此位個案，於照護期間應用羅氏護理適應模式以觀察、會談等方式，並依據各項身體評估技巧，收集到與此位個案相關之資料，而發現個案現存之護理問題有:「身體活動功能障礙」、「自我照顧能力缺失」、「睡眠型態紊亂」、「排便型態改變-便秘」、「皮膚完整性受損」、「現存性感染」、「性生活型態改變」、「身體心像紊亂」、「無望感」、「角色扮演改變」、「個人因應能力失調」等護理問題。筆者於護理期間除對其殘肢傷口提供適當的護理措施外，亦始于術後相關之護理指導，且協助個案滿足其基本生理需求，如:身體清潔等。同時並針對個案面對殘疾後身體心像紊亂及失落，給予個別的陪伴、傾聽及心理支持等護理措施，使個案得以在住院期間，在身、心、靈三方面獲得良好且具品質的照護。期望藉由此篇個案報告，分享照護之相關護理經驗

[[alternative]]An Intensive Care Experience of a 950 gm Extreme Low Body Weight Prematurity Complicated with Respiratory Distress

[[abstract]]本文旨在描述一位妊娠26^(+1)週出生體重950公克之極低體重早產兒，因呼吸窘迫於新生兒加護病房之護理經驗。自2010年8月4日至12月2日護理期間，運用系統性視察進行個案生理、行為變化、環境和家庭評估，確立個案有氣體交換障礙、無效性保護能力、低效性嬰兒哺餵型態、混亂性嬰兒行為、潛在危險性父母/嬰兒依附關係改變等護理問題。筆者擬定個別性護理：維持通氣穩定促進氧合功能，監測凝血機制與預防出血，施行口腔動作發展訓練促進吸吮協調，減少環境過多刺激促進自我統整行為，施行寧握護理與教導袋鼠式護理以增進親子情感連結，並與家庭成員共同訂定出院照護計畫，使個案獲得完整性、持續性的護理。期許本篇報告的護理經驗，能在早產兒整體性照護中達到經驗分享。[[abstract]]This article reported the intensive care experience of an extreme low body weight premature baby of 950 grams and a gestation age of 26^(+1) weeks complicated with respiratory distress. During the period of August 4 to December 2 of 2010, we assessed the physiology, the behavior, the environment. and the family of the case by systemic observation and established the nursing care problems of impaired gas exchange, ineffective protection, inefficient infant feeding pattern, disorganized infant behavior, and risk for impaired parent/infant attachment. The authors provided a nursing care plan for the patient, including maintaining the ventilation to stabilize the gas exchange, monitoring the function of coagulation to prevent bleeding, training the motion of mouth to promote coordination of sucking and swallowing, decreasing the hyper-stimulation of environment to intensify behavior of self-integration, performing containment, and educating the family members about kangaroo care to improve the bonding between the baby and parents. We also discussed with the family to establish a discharge care plan to ensure continuous nursing care. We expected that we could share this experience of integrative nursing care of extreme low weight prematurity

[[alternative]]Symptom Burden, Functional Status and Quality of Life in Patients with Lung Cancer: A Follow Up study

[[abstract]]本研究的目的主要是探討肺癌病人於初診斷(治療前)至接受治療後六個月內症狀困擾、功能狀態與生活品質的變化及其復原的軌跡。研究設計採前瞻性重複測量的方法，以方便取樣方式於台北地區某醫學中心之胸腔內科門診或病房做為收案的場所。資料收集共計4次，包括肺癌病人在初診斷時(即治療前)、治療後第一個月、第三個月與第六個月，以結構性問卷進行資料收集。研究工具包括：病人基本屬性及疾病特性資料表、症狀評估量表(MSAS)、台灣版簡明疲憊量表(BFI-T)、醫院焦慮及憂鬱量表-憂鬱部分(HADS-D)、疼痛視覺量表 (VAS)、功能評估量表(KPS)及中文版生活品質量表-肺癌(FACT-L)。 有105位病人完成資料之收集，研究結果顯示：以男性居多 (59.0%)，平均年齡60.81歲(SD=13.07)，肺癌型態以肺腺癌居多(89.5%)、癌症期別以第四期居多(75.2%)，且多採化學治療(53.3%)。在症狀困擾方面，在治療前最常發生的症狀依序為：咳嗽(67.6%)、缺乏精力(54.3%)、口乾(48.6%)、疼痛(46.7%)、覺得緊張(44.8%)及覺得難過(44.8%)；咳嗽是治療前最常發生、最嚴重、也最干擾之症狀；而治療後一個月的皮膚改變及治療後六個月包括手腳麻刺及發癢的症狀，須特別關注。肺癌病人從治療前至治療後六個月均有生理或心理的症狀困擾存在，但並不明顯；其中以治療後第一個月症狀困擾情形最顯著，但在治療後六個月可逐漸改善。而疲憊方面，治療前疲憊嚴重程度平均為2.56分，於治療後一個月達到最高；治療前疲憊干擾程度平均為1.31分，於治療後六個月達到最高；整體而言，肺癌病人的疲憊嚴重程度及疲憊干擾程度並不明顯。有18.1%之肺癌病人治療前有憂鬱情形，在治療後六個月有38.8%有憂鬱情形。在治療前肺癌病人平均之憂鬱程度不高，而治療後六個月憂鬱程度最高。肺癌病人的疼痛情形，在治療前平均得分為12.42分，顯示肺癌病人在治療前的疼痛並不高；而於治療後三個月疼痛得分最低，但在治療後六個月疼痛得分達到最高。肺癌病人功能狀態在治療前平均得分為88.10分，於治療後六個月得分最低，但亦有85.88分顯示肺癌病人於治療前至治療後六個月大致均有不錯的功能狀態。肺癌病人整體生活品質於治療前為最佳(M=102.47)，於治療後一個月則呈現生活品質得分最低(M=99.15)的情形，而後於治療後六個月又逐漸增加(M=101.15)。 以LGCA探討肺癌病人治療後各指標變項的復原軌跡，結果顯示：肺癌病人症狀困擾之復原模式，包括生理症狀困擾有三組模式的復原軌跡，影響因素為疼痛；心理症狀困擾有三組模式的復原軌跡，而影響因素為疼痛；整體困擾指數有三組模式復原軌跡，影響因素為疼痛及功能狀態；整體症狀總和有四組模式復原軌跡，疼痛及功能狀態為其影響因素。疲憊之復原模式，包括疲憊嚴重程度有四組模式復原軌跡，影響因素有治療方式、整體困擾指數、憂鬱及ALT值；疲憊干擾程度有三組模式復原軌跡，受整體困擾指數、整體症狀總和、憂鬱、疼痛、功能狀態及Ca125值所影響。憂鬱有四組模式復原軌跡，受年齡、教育程度、宗教信仰、經濟來源、經濟收入、工作狀況、整體困擾指數、整體症狀總和、疼痛、功能狀態、HB及WBC值所影響。疼痛有兩組模式之復原軌跡，受年齡、治療方式、整體困擾指數、整體症狀總和、疲憊嚴重程度、疲憊干擾程度及憂鬱所影響。功能狀態有兩組模式之復原軌跡，影響因素為整體困擾指數及疲憊干擾程度；肺癌病人整體生活品質有三組模式之復原軌跡，受整體困擾指數、整體症狀總和、疲憊嚴重程度、疲憊干擾程度、憂鬱、疼痛、功能狀態、Ca125及Ca199所影響。根據本研究結果能提供肺癌病人之症狀困擾、疲憊、憂鬱、疼痛、功能狀態及生活品質的預測因子，及瞭解各變項之復原狀態，並能找出影響病人復原之重要因子，藉以提供醫護相關專業人員作為肺癌病人照護的知識，並有助於未來發展介入性護理措施，以改善肺癌症狀且延緩病人的生命，進而提高病人的生活品質之參考。[[abstract]]The purpose of the study is to explore the following parameters in patients with lung cancer during the initial diagnosis (prior to treatment), during therapy and six months after therapy: symptom burden, functional status, and quality of life, and the recovery trajectory. The study design utilized prospective repeated measurements. For the convenience of the study, the data sampling was performed at the chest-medical department or at the wards, in a medical center located in Taipei, Taiwan. The data was collected at four different stages which include the initial diagnosis (prior to treatment), one month, three months, and six months after cancer therapy. The data used in this study was collected with structured questionnaires. The survey methods included the following systems: patients’ demographic data and disease characteristic chart, memorial symptom assessment scale (MSAS), Taiwanese concise version of brief fatigue inventory (BFI-T), hospital anxiety and depression scale - depression only (HADS-D), visual pain analog scale (VAS), Karnofsky performance status scale (KPS), and functional assessment of cancer therapy-lung cancer (FACT-L). In this study, there were 105 patients that had completed the data collection process. The survey results from this study had shown the following characteristics: patients are mostly male (59.0 %), with a mean age of 60.81 years (SD=13.07), the majority of lung cancers were in the form of adenocarcinoma (89.5 %), the majority of the cancer patients were of stage IV (75.2%), and the majority of the patients received chemotherapy as the treatment method (53.3 %). In symptom burden, the most frequent distresses prior to treatment are listed in the order of decreasing frequency as the following: cough (67.6 %), lack of energy (54.3 %), dry mouth (48.6%), pain (46.7%), feeling nervous (44.8%), and feeling sad (44.8%). Cough is the most common, the most serious, and the most distressing symptom prior to treatment. Patients noticed changes in skin conditions after one month of cancer therapy. One must closely observe these symptoms along with numbness or tingling in the hands or feet, and itching, experienced by the patients, six months after the therapy. There were some, but subtle physiological and psychological symptoms that persisted in lung cancer patients, prior, and up to six months after therapy. The most noticeable symptoms were observed one month after the cancer therapy. However, these symptoms were gradually alleviated, six months after therapy. The study on patient fatigue severity had revealed that the average is about 2.65, prior to therapy. This score risen to a maximum at one month after therapy. The average fatigue interference score was 1.31, and risen to a maximum, six months after therapy. Overall, the fatigue severity and fatigue interference for lung cancer patients were not significant. In depression experienced by patients, there were 18.1 % and 38.8 % of patients experienced depression prior, and six months after therapy, respectively. The average depression score wasn't significant prior to therapy, and the average depression score rises to a maximum at six months after therapy. The average pain experienced by lung cancer patients prior to therapy was 12.41. This indicated that the pain experienced by lung cancer patients prior to therapy were not significant. Three months after therapy, the pain scale dropped to a minimum, but rises again to a maximum at six months after therapy. The average Karnofsky performance status scale (KPS) of patients prior to therapy was 88.10. This score dropped to a minimum at six months after therapy. However, the minimum KPS is 85.88, indicating that the patients’ functional status did not change significantly, between prior to therapy and six months after therapy. The quality of life index for patients with lung cancer was at the highest prior to therapy (M=102.47). And a minimum was observed at one month after therapy (M=99.15). However, the index showed recovery at six months after therapy (M=101.15).Furthermore, we utilized latent growth curve analysis (LGCA) to analyze the recovery trajectory and also the changes of each score in each patient after receiving cancer therapy. The results had shown the following: There were three modes of physical symptom burden recovery trajectories, the affecting factor is pain. There were three modes of psychological symptom burden recovery trajectories, pain is also the affecting factor. There were three modes of global distress index (GDI) recovery trajectories, the affecting factors were pain, and functional status. The total MSAS score (TMSAS) had four modes of recovery trajectories, the affecting factors were pain, and functional status. There were four fatigue (BFI-T) recovery trajectories, including fatigue severity recovery, and the affecting factors were treatment, GDI, depression, and the level of alanine aminotransferase (ALT). There were three recovery trajectories for fatigue interference. The affecting factors for GDI, TMSAS, depression, pain, functional status, and the cancer antigen (Ca)125 level. There were four recovery trajectories for depression. These recovery trajectories were affected by age, patient education background, religion, source of income, income, work situation, GDI, TMSAS, pain, functional status, hemoglobin (HB) level, and white blood cells (WBC) level. There were two recovery trajectories for pain. And the affecting factors for pain recovery were age, treatment, GDI, TMSAS, fatigue severity, fatigue interfernce, and depression. There were two recovery trajectories for functional status. The affecting factors for functional status recovery were GDI, and fatigue interfernce. The overall life quality of lung cancer patients had three modes of recovery trajectories. The affecting factors of quality of life recovery were GDI, TMSAS, fatigue severity, fatigue interference, depression, pain, functional status, Ca125 level and Ca199 level.Our research had provided predictive factors, such as symptom burden, fatigue, depression, pain, functional status, and quality of life, in understanding the projected recovery for each factor, and in determining the most important recovery factor for each of patients. This result can provide a reference for health care professionals in treating lung cancer patients in order to aid in the development of nursing interventions, to improve lung cancer symptoms and prolong the patient's life, and to improve the patient's quality of life

[[alternative]]Rehabilitation of Intracranial Hemorrhage Patient Following Craniotomy

[[abstract]]本文主旨為描述一位因頭部外傷導致顱內出血患者行開顱手術後復健期之護理經驗，照護過程中（93/12/06至93/l2/29）運用羅氏適應模式進行收集生理、心理、社會之適應行為相關資料，並歸納出個案有身體活動功能障礙、言辭溝通障礙、無望感、潛在危險性廢用症候群等護理問題。於護理過程藉由肢體活動訓練計劃提昇個案活動程度、採個別性之語言訓練增進個案與他人之溝通能力，針對活動受限而泛生之潛在危險性廢用症候群，則採取必要性的預防措施，避免因不活動而產生許多器官的合併症。此外，個案因遭逢意外喪失肢體活動及言辭溝通功能而導致無望感，護理措施則利用與家屬、病患建立良好的治療性人際關係，強化個案目前現有的生理功能，及應用其熟悉的同儕、師生關係給予加強關懷及心理支持，並且運用宗教信仰增進其靈性的安適，而逐步引導患者持續維持希望的結果。[[abstract]]Post-craniotomy rehabilitative nursing care provided to a head injury patient with traumatic intracranial hemorrhage is described. The patient received nursing care from December 6-29, 2004. Roy's adaptation model was used to analyze relevant data regarding the patient's adaptive behavior of physiology, mentality, and society. The following problems were identified: impaired physical mobility, impaired verbal communication, hopelessness and risk for disuse syndrome. A limb activity plan was implemented to promote limb function, and a verbal retraining program was employed to increase communication capability between the patient and the others. Because the restriction of body activity function, we adopted the precautionary measure to avoid risk for disuse syndrome. The patient also presented symptoms of hopelessness after losing verbal communication capability and physical mobility. The nursing measures for treating hopelessness were to build up a good interpersonal relationships between the patient and families and relatives, strengthen existing physical function, to provide concern and mentality support from visiting colleagues and students, and to strengthen spirituality close to quiet and comfort by using religious belief. Gradually leading the patient to continue to maintain hope, the process of rebuilding hope was difficult and arduous, but we finally found the positive adaptive behavior on the patient's body

Roots of competency, setbacks and hardship, and growth opportunities─Clinical Nursing Practice of New Nursing Students

[[abstract]]背景：護理系學生實際接觸臨床實務的基本護理學與實習課程是銜接各護理核心科目實習之重要基礎。 目的：為能提升教學成效，期望透過學生學習之回饋中，明瞭學生實習之經驗，以做為教學精進之參考。 方法：採質性研究焦點團體訪談法，以半結構式訪談指引進行深入訪談。研究對象以技職體系某大學護理系已完成基本護理學實習學生為對象，以隨機抽樣方式進行招募，共有40 位學生參與訪談。 結果：研究結果經分析後共歸納出三大主題，包括：一、能力的紮根，二、挫折困頓的經驗，三、成長的歷程等；其中涵蓋有十一個次主題。結論：從門外漢至新手護生的實習經驗中，真實反應學生的心境，其中包含正向與負向經驗。學生之專業能力紮根的過程中，經歷挫折、困頓，嘗試運用自我調整的模式，學習如何因應多變化的實習情境。針對學生正負向學習經驗的轉化，須仰賴實習教師們的敏感度及同理心，深入瞭解及評估學生在初次實習之壓力情境與感受，並能識別學生個別狀態，運用不同的教學策略，因材施教。 實務應用：研究結果提供學生實際臨床實習經驗、對實務的看法以及教學輔導方式的體驗，可以作為未來護理教育中臨床教學方法改進之參考

Selecting Methods and Awaiting Growth: The Teaching Experience of Fundamental Nursing Practicum Instructors

[[abstract]]背　景 基本護理學實習是護理專業的入門及基礎，多重因素影響護生臨床實習成效；其中實習教師是整體教學計劃的規劃與執行者，其所採行的教學方法、策略與教學態度極為關鍵。因此透過教師教學的反思，瞭解基本護理實習的教學特性，將有助於實習教師協助學生開發個人潛能，做為專業發展的基石。 目　的 從基本護理學實習教師觀點，探討基本護理臨床實習之教學特質。 方　法 本研究採質性研究法，研究對象為輔導技職院校科技大學四年制護理系基本護理實習之實習教師。資料收集的時間為基本護理實習期間，共進行五次焦點團體會議討論，每次時間約二至四小時。焦點團體主持人為研究主持人，針對學生學習表現，實習教學設計、教學經驗分享等議題，引導老師分享對學生學習表現的觀察與指導經驗，再以內容分析法進行資料分析。 結　果 實習教師所展現之基本護理臨床實習教學特質，共有三大主題，分別為需瞭解學生特質的「新手上路狀況多，慢慢行」，教師對於學生的「能力、心情與困擾需洞悉」，以及教學特質上應展現的「鼓勵支持中選擇方法」。 結　論／實務應用 基本護理實習教師需能了解學生學習特性，運用合宜的教學方法、策略與態度來進行輔導；而過程中，實習單位人員、環境的準備等均是使學生能有良好學習經驗不可或缺的要素。本研究結果，可提供帶領技職院校科技大學護理系基本護理學實習教師教學準備之參考。 Background: A constellation of factors accounts for teaching efficacy in the fundamental nursing practicum. Teachers play a critical role in terms of designing and executing an appropriate teaching plan, choosing effective methods, and holding appropriate teaching attitudes. It is thus extremely important that clinical teachers master the core characteristics of basic nursing practice. Purpose: This study aimed to illuminate the core characteristics of basic nursing practice for students for reference by clinical practicum teachers. Methods: Qualitative research was used to identify the fundamentals of nursing practice by clinical teacher. Five focus group meetings were convened during the practice period. The researchers presided over group discussions held during the normal weekly teaching schedule and lasting approximately 2-4 hours each. The content analysis was adopted to analyze the data. Results: Three major themes were proposed, including (1) student status: “novices were stymied by problems and thus improved slowly”; (2) teacher awareness: “teachers need to be aware of student capabilities, mood, and discomfort”; and (3) teaching style: “a good choice of methods should support and encourage students. Conclusions / Implications for Practice: To cultivate professional nursing knowledge and self-confidence for future professional commitment, clinical teachers must first understand the characteristics and motivations of learning of their students and then select the, skills, and attitudes appropriate to provide step-by-step guidance. Communication with staffs and the preparation of atmosphere prior to nursing practice are also essential for students. Results provide insights into the technical college environment with regard to basic-level clinical nursing practice