A Study of Medical Center Nurse's Self-assessment in Performance of Advanced Cardiac Life Support Skills

[[abstract]]護理人員在醫療團隊中常常是病人發生突發狀況，需要急救的目擊者或者為最先到達的專業人員。因此，護理人員是否有能力處理緊急狀況，往往關係著病人的預後。本研究目的在探討北部某醫學中心一年內曾接受高級心臟救命術課程之護理人員，自評執行急救能力之狀況，及不同基本屬性對其自評執行急救能力之影響。採橫斷性調查相關性研究，以Cronbach's α為.95的自擬「護理人員自我評估執行急救能力量表」進行資料收集，發出223份問卷，回收187份，有效問卷數為176份，有效問卷回收率達78.9%。護理人員自我評估執行急救能力整體平均得分為4.13分（SD=0.46），另利用探索式因素分析建構出六個因素命名為：呼吸道及循環之維持、急救評估及初步處置、團隊合作和異常處理、病患與家屬之溝通協調、護理急救角色功能之展現以及異常心律之判讀及處置，合計共解釋61.72%變異量。年齡愈大、護理進階層級較高、臨床工作年資愈久，急救能力得分顯著較高。建議醫院管理者針對年齡較小、初階護理層級、工作年資較短的新手醫療人員，規畫並安排其接受急救相關訓練課程，若能將護理進階訓練課程目標與本研究發現護理人員所應具備的急救能力結合，搭配相關認證制度，將有效提昇對病人之服務品質。 As nurses often discover patients who have a critical situation at first, they should be trained and be able to perform resuscitation skills adequately. This study aims to investigate medical center nurses who received advanced cardiac life support courses within a year and their self-assessment of the performance of ACLS skills, and to examine the association between demographic data and their self-evaluated ability of emergency.This descriptive and correlational study used a cross-sectional survey of clinical nurses from a medical center in northern Taiwan. We use ”nurse's self-assessment and performance of ACLS skills in medical center” scale as an instrument. Cronbach's α was .95. The study distributed 223 questionnaires of which 187 questionnaires were returned, giving an effective return rate of 94.1%. The mean self-rating score of ACLS competence was 4.13 (SD = 0.46) for all subjects. By using item analysis and explorations as well as exploratory factor analysis, they were extracted into six factors, named for: ”competence in proper care of respiratory and cardiovascular systems,” ”competence in pre-ACLS assessment and initial treatment of patients,” ”competence in teamwork and exception handling,” ”competence in communication with patients and their families,” ”competence in ACLS nursing,” and ”competence in nursing diagnosis and treatment of abnormal heart rhythm.” Six factors in total explained 61.72% of the variance. Subjects who were older, possessing higher level qualifications on the nursing clinical ladder, and who were more experienced in clinical nursing practice were found to achieve significantly higher mean scores in the self-assessment of ACLS competence.Hospital management should provide effective ACLS training for younger, elementary level qualifications on the nursing clinical ladder. In addition, advanced nursing training should include ACLS certification to enhance the overall quality of nursing care

Group Perspective: Group Structure and Effectiveness of Quality Control Circles in Hospitals

[[abstract]]目標：探討台北地區區域級以上醫院之品管圈團體結構（團體規模、團體合作規範、團體任務規範及團體任務凝聚力）與團體效能之相關性。方法：採橫斷式問卷調查法，台北地區已推行品管圈之醫院共19家，有16家醫院品管圈圈員同意接受調查，共收集263個有效品管圈樣本，包括1,914位品管圈圈員，團體回收率達86.80%。以團體為分析單位，每個團體內的個人層級之資料將聚合代表該團體的分數，以內部相關係數(Intraclass correlation coefficients, ICCs), eta squared (η^2)，及單因子變異數分析(one-way analysis of variance)檢定，確定個人層級資料可聚合後代表團體層級之資料，再以迴歸模式進行四個與團體相關之研究假說檢定。結果：團體合作規範、團體任務規範、團體任務凝聚力與團體效能呈正相關之三個假說獲得支持，共解釋51%團體效能的變異量，但團體規模與團體效能則無顯著的正相關，該假說未獲支持。結論：品管圈具有較高的團體合作規範、團體任務規範及團體任務凝聚力的特質時，會有較好的績效表現，因此建議未來可積極建立團體合作規範、團體任務規範及團體任務凝聚力來促進良好的團體互動，以提昇團體效能。 Objectives: This study aimed to investigate the relationship between group structures (group size, cooperation norms, task norms, and task cohesion) and group effectiveness of the quality circles of hospitals in Taipei area. Methods: A cross-sectional research design was adopted for data collection. Two hundred and sixty-three quality circle groups with 1,914 individuals from the 16 of the 19 hospitals in the Taipei area were enrolled for analysis. The groups' response rate was 86.8%. Because the unit for analysis was the quality circle group, the aggregated individual-level data in a single group were used as the representative values for the group. Results of intraclass correlation coefficients (ICCs), Eta-squared (η^2), and one-way analysis of variance showed that aggregated individual-level data were capable of representing the group level data. Multiple regression analysis was adopted to test four hypotheses. Results: Groups with higher levels of cooperation norms, task norms, and task cohesion had greater feeling of group effectiveness as perceived by the members. In spite of this group size was not considerably associated with group effectiveness. The cooperation norms, task norms, and task cohesion accounted for 51% of the variance in group effectiveness. Conclusions: It was concluded that the group members having better feeling of cooperation norms, task norms, and task cohesion demonstrated highe

Self-Evaluation of Core Competencies and Related Factors among Baccalaureate Nursing Students

[[abstract]]背景 高等教育的評鑑開始注重以學習者為本位，重視學習成果與核心能力的評量，而台灣護理教育評鑑委員會亦訂定大學護理系特有的八大核心素養；然而，先前研究鮮少探討大學護理學生核心能力的影響因素。目的 本研究目的在於了解護理學生核心能力、探討個人背景與學習經驗對其護理核心能力之影響，以及分析護理學生核心能力之預測因子。方法 以橫斷性調查之描述性及相關性研究進行資料收集，以北部某私立科技大學二技護理系一年級學生為研究對象；以護理學生核心能力量表為研究工具，發出290份問卷，有效問卷279份，回收率96.2%。結果 護理學生自評核心能力之平均得分為5.23（SD=0.49），各向度得分由高至低依序為：倫理素養、克盡職責、關愛、溝通與合作、終身學習、一般護理臨床技能、批判性思考，以及基礎生物醫學科學。於差異性分析方面，對護理有興趣、有明確的生涯規劃、想繼續朝護理相關科系升學、畢業後最想至醫學中心服務、已決定畢業後最想服務的單位、曾參加校內活動、課堂討論及發言頻率較高、經常認真完成作業與準備考試、及在校成績較高的護理學生，其核心能力得分顯著較高。核心能力預測因子方面，畢業後的生涯規劃、畢業後最想服務的... Background: Evaluations of higher education programs are increasingly centered on the learner and designed to assess learning effectiveness and core competencies. Although the Taiwan Nursing Accreditation Council (TNAC) has established eight core competencies for college nursing departments, little research has been done to identify the most salient contributors to undergraduate nursing students' perceived competency levels.Purpose: This paper investigates the influence of student demographic factors and learning experience on students' development in terms of a selected sample of core nursing competencies and then identifies factors that significantly predicts such development.Methods: This is a cross-sectional descriptive correlational study. We collected data from a sample of freshmen students currently enrolled in a two-year nursing bachelor degree program at a private vocational university in Taipei, Taiwan. Participants self-assessed abilities in designated core nursing competencies using the Competency Inventory of Nursing Students (CINS). A total of 279 of 290 distributed que..

A Study on the Efficacy of LOHAS / Low-Carbon Lifestyles

[[abstract]]目的：透過樂活減碳行動策略讓技術學院學生從真實情境，親自體驗樂活族的綠生活哲學，進而探討其學習成效。方法：本研究為單組前後測設計（One-group pretest-posttest design），以北部某技術學院73名學生為研究對象，參與樂活減碳行動策略之「綠生活資訊網絡」、「綠生活綠色植栽」及「綠生活作品記事」的體驗課程，並於行動策略介入前後接受前後測，比較學生節能減碳認知、節能減碳態度與個人減碳足跡狀況。結果：樂活減碳行動策略介入前後：（1）研究對象節能減碳認知前後測得分達顯著進步（p＜ .001），食（p＝ .038）與行（p＜ .001）二構面達顯著差異；（2）研究對象節能減碳態度未達顯著差異（p＝ .153），住、行與休閒則呈現退步情形；（3）研究對象個人減碳足跡達顯著進步（p＝ .002），衣（p＝ .001）與「住」（p＝ .003）二構面達顯著差異；（4）技術學院學生的節能減碳態度與學習滿意度呈顯著關係（p＝ .001）。結論：技職院校應開設或辦理節能減碳相關課程與活動，增加高等教育學生接觸節能減碳議題之機會，並於課程與研習中帶入體驗活動，更能引發學生對節能減碳相關議題的學習興趣、動機與成效，經由全面性、系統性、融貫性與長期的介入措施與自然薰陶，有助於技職院校學生提升節能減碳認知、態度與行動。 Objective: A low-carbon lifestyle program was administered to a group of vocational college students in Taiwan as a simulated green lifestyle philosophy experience. This study assessed the learning outcome of this group. Methods: A one-group pretest-posttest design was used on a study sample of 73 undergraduate students from a vocational college in northern Taiwan. A low-carbon life program was administered to the students by asking them to make use of a green lifestyle portal website, grow green plants, and chronicle their green lifestyle initiatives. Pretest and posttest questionnaires were administered before and after the program to assess participant knowledge and attitudes toward a low-carbon lifestyle and their attained carbon footprint reduction results. Results: A comparison of pretest and posttest results demonstrated that, after the program: (1) the sample achieved significantly higher test scores (p ＜ .001) in their knowledge of low-carbon life and achieved significantly different scores regarding their knowledge of low-carbon food (p = .038) and low-carbon transportation (p ＜ .001). (2) No significant difference was observed in scores related to participant attitudes toward low-carbon lifestyles (p = .153). Participants achieved significantly lower scores related to attitude toward lowcarbon housing, low-carbon transportation, and low-carbon recreation and leisure. (3) Participants achieved significantly higher carbon footprint reduction scores (p = .002) and significantly varying scores in terms of carbon footprint reduction scores related to clothing (p = .001) and housing (p = .003). (4) There was a significant correlation between participant attitudes toward a low-carbon lifestyle and overall satisfaction with the program (p ＜ .001). Conclusions: Courses and activities designed to promote a low-carbon lifestyle should be introduced into the vocational college curriculum to raise student awareness of low-carbon issues. Courses and activities should allow students to experience lowcarbon lifestyles to inspire greater learning motivation and enhance learning performance. A comprehensive, systematic, and long-term low-carbon lifestyle program that blends theory with practice should be effective in instilling awareness, attitude, and motivation necessary to encourage students to adopt behaviors appropriate to a low-carbon lifestyle

The Effect of a Scenario-Based Communications Course on Self-Confidence in Novice Nurse Communications

[[abstract]]Background: Nurses are expected to have keen observation skills to monitor inpatient conditions and good communication skills to facilitate doctor-inpatient communications. Communication skills are thus a core attribute required of professional nurses.Purpose: This study explored the effectiveness of a scenario-based communication course on increasing the self-confidence of novice nurses in communicating with inpatients. Methods: This study used a quasi-experimental pre-test and post-test study design based on non-random cluster sampling and tests were administered on 118 novice nurses with less than one year of clinical experience at one of three training hospitals in Taipei City. The control group (nurses working at hospitals A and B) received a two-hour standard course in communications; The experimental group (nurses working at hospital C) received a three-hour scenario-based communications course. Data was provided by subjects via a self-rated scale that assessed respondent self-confidence in communicating with inpatients. Statistical analyses were performed using the SPSS statistical software package for Microsoft Windows (version 17.0).Results: Results of a dependent paired t-test show that average posttest scores for both groups were significantly higher (p＜.001) than average pretest scores. This demonstrated that both interventions were effective raising nurse confidence with inpatient communications. An ANCOVA showed no significant difference (p=.14) in average self-rated Confidence in Communication Scale scores between the two groups (experimental: 48.92, SD=5.04; control: 48.18, SD=5.14).Conclusions: Findings suggest the positive effect of both courses in increasing nurse confidence in communicating with inpatients. The scenario-based communications course was no more effective than the ordinary classroom communications course in making nurses more confident in communicating with inpatients

The Professional Learning Website Needs of Hospital Nursing Stations:A Needs Assessment

[[abstract]]背景：健康照護已走進資訊化時代，受到醫療環境變遷及疾病的複雜化下，國際網路上有許多護理專業網站供護理人員學習。然而此類網站國內不多且多有缺失，國外網站又因語言隔閡和文化差異，而無法全盤適用，因此國內護理專業學習網於護理人員之需求評估為刻不容緩。目的：旨在評估護理站專業學習網之內容需求，以及探討護理人員對護理站專業學習網內容需求之影響因素。方法：本研究為描述性研究設計，採隨機集束抽樣自北部某一醫學中心同意參與的70個病房抽出43單位之橫斷式調查（cross-sectional survey），以結構式問卷進行資料收集，發出600份問卷，有效回收571份，回收率96%。結果：護理人員對護理站專業學習網之整體需求平均為4.03（SD = 0.70），得分最高的前三項依序為疾病照護常規注意事項、藥物查詢及檢查準備事宜，得分最低的三項依序為網站目的、學習後測驗及網路論壇的功能。年齡、婚姻、教育程度、服務科別、進階層級及工作年資對於護理站專業學習網內涵需求有顯著差異。結論：由研究結果可將受試者對於護理站專業學習網自覺最需求之項目，作為未來進行網站規劃之參考；亦可根據不同背景之護理人員，設計最符合其需求之功能，如內外科可著重於護理業務規範說明，以減少資訊搜尋時間，提升病人照護安全。 Background:Healthcare must face the challenges of the information era. Changes in the medical sciences and increasing disease complexity have given rise to many professional learning websites designed to aid nurse learning.However, nurses in Taiwan have only a few poorly designed websites from which to choose. Language barriers and cultural differences often prevent nurses from making the best use of learning websites designed outside of Taiwan.This situation necessitates an investigation into the type of learning website content most needed by professional nurses in Taiwan.Purpose:This study aimed to investigate the types of content in a professional learning website most needed by a group of nurses and to examine factors affecting nurses’ content demand.Methods:Researchers used descriptive and correlational study designs. Random cluster sampling was used to select 43 of the total 70 nursing wards at one hospital in northern Taiwan. Subjects agreed to participate in a cross-sectional survey using a self-structured questionnaire. A total 571 questionnaires (96%) were returned out of 600 sent.Results:The average professional learning website demand score was 4.03 (SD = 0.70). The top three content categories were, respectively, instructions on nursing routines for common diseases, common medication information, and instructions on preparing for common physical examinations. The bottom three content categories were, respectively,description of website purpose, post-learning tests, and online forum. Subject age, marital status, education, hospital department, Clinical Nursing Ladder status, and work experience all significantly affected subjects’ content demand profile.Conclusions / Implications for Practice:Study findings identified the content categories in highest demand from professional nurses, which can help guide professional learning website design work in the future. Different website versions may be developed to suit different nurse needs and help nurses save time searching for information on such topics as nursing procedures and standard introductions to medical-surgical wards

The Use of OSCE to Evaluate the Competency of Discharge Nurses

[[abstract]]Background: Clear directions and explanations from nurses related to health behaviors and discharge procedures have been shown to effectively reduce the risk of patient readmission. Nurses thus need to develop good communication skills in order to ensure that their communications help patients become better-informed and less anxious about discharge procedures. Purpose: This research evaluates the communication skills of nurses following two different education interventions. Methods: Experimental design principles for education interventions were followed in this research. Medical nurses certified at the N to N2 level in a municipal hospital in Taipei City were enrolled as participants (N = 78) and divided into an experimental group and control group using stratified purposive randomization. The experimental group received clinical scenario-based simulation education for communication. The control group received standard class-based education for communication. Both groups received a pre-test evaluation and an OSCE post-test evaluation. Results were analyzed using SPSS 17.0 software. Results: Independent t-test results revealed significant increases in communication skills (t = 3.406, p ＜ .05) in both groups, with the increase in the experimental group (M = 5.00, SD = 0.82) significantly greater than the increase in the control group (M = 4.11, SD = 1.41). However, the mean scores from the post-test standardized patient survey found no significant differences between the two groups in terms of communication skills. Conclusion: The results indicate that the clinical scenario-based simulation education intervention is more effective than traditional class-based education in enhanc\ng the communication skills of nurses

A Needs Assessment of Nursing Staff AIDS Care Knowledge Needs

[[abstract]]背景　台灣愛滋病毒感染人數直線上升，截至2009年4月底，本國籍愛滋病毒感染人數為17,979人，近五年平均年增加率達18%，不管是全球或國內情況，除了醫療問題外，其他社會、心理問題也隨著愛滋病毒感染人數的增加而日趨複雜化。因此了解護理人員對愛滋病知識及臨床照護的教育需求，辦理相關的在職教育課程，以提升護理人員照顧愛滋病患的照護知識，促進護理人員的自我成長，可有助於專業發展與提升照護品質。目的　探討護理人員對愛滋病照護知識之需求，並探討不同個人背景變項之護理人員在愛滋病照護知識需求之差異性，以提供在職教育課程規劃之參考。方法　本研究為描述性及相關性研究設計(descriptive and correlational study design)，採橫斷式調查方法(cross-sectional survey)，以自擬結構式問卷進行資料收集。發出556份問卷，回收問卷546份，回收率98.2%。結果　護理人員愛滋病照護知識需求方面，依平均分數排序得分最高的前三項為：被害人性侵害後之後續處理、其次是預防傷害與後續處理及伺機性感染症之護理；得分需求最低的三項依序為HIV之流行病學、台灣愛滋病政策與法令及HIV傳染途徑；愛滋病照護知識需求之整體平均分數皆在4分以上。年齡越大對於愛滋病照護知識之需求越高；已婚對於知識之需求相較於未婚者為高，服務年資高者相較於服務年資低者，其知識需求較高。結論　研究結果可作為醫院在HIV/AIDS照護在職教育課程優先順序之安排；政策擬定之參考，例如：可將預防傷害及後續處理列為所有醫療人員必修之課程以及推廣安全針具之使用，以降低臨床工作人員針扎之風險。 Background: The number of HIV infections in Taiwan has been increasingly linear in recent years. At the close of April 2009, Taiwan registered 17, 979 AIDS infections. The average annual infection rate has grown an average 18% during the most recent five year period. Apart from medical problems, the social and psychological problems associated with AIDS are becoming increasingly complicated both in Taiwan and globally with the increasing number of HIV infections. Identifying the knowledge needs of nursing staff members for providing appropriate nursing care to HIV/AIDS patients is important to planning effective in-service nursing education programs. Quality of both patient care and professional development can be promoted.Purpose: This study investigated the HIV/AIDS educational needs of nursing staffs and variations in care knowledge needs by individual background. Results provide a reference for in-service education program planners.Methods: This was a descriptive and correlational study design that used self-structured questionnaires to conduct a cross-sectional survey. A total of 556 structural questionnaires were distributed and 546 completed questionnaires were returned (response rate=98.2%) and used in data analysis.Results: The average knowledge need score for nursing staffs with regard to HIV/AIDS patient care was ＞ 4 points. The highest three mean scores were (in rank order): follow-up treatment for victims after sexual assault, prevention of injury (e.g., sharp objects, exposure to infected body fluids) and subsequent management, and nursing care of opportunistic infection. The lowest three mean scores were (in rank order): HIV epidemiology, Taiwan HIV policies and regulations, and HIV transmission routes. Nurses who were older, married, or held senior nurse positions had more knowledge needs.Conclusion: This study can be a reference for prioritizing the arrangement of in-service HIV/AIDS care education and for formulating hospital policies related to HIV/AIDS patients. Prevention of injury and subsequent management of patients with opportunistic infections should be made mandatory in all health care provider courses. Also, enhancing promotion of safety needles can help reduce needle stick risks for clinical staff

A Study of Teaching Competencies of Self-Assessment among Clinical Preceptors

[[abstract]]大部分的護理臨床教師有豐富的臨床經驗和學識，但普遍自覺缺乏教學技巧及信心，對於指導護生備感壓力與焦慮，同時也深感在職教育課程中缺乏教與學相關概念，以及培育其成為護理臨床教師之教育訓練不普及，使得護理人員在轉換教師角色時有所困難。本研究旨在探討不同護理臨床教師背景資料自評教學能力之差異性，以及護理臨床教師自評教學能力之預測因子。本研究採橫斷性問卷調查法，採方便取樣，以北部地區某一醫學中心及區域級醫院中同意參與本研究之護理臨床教師為研究對象，發出154份問卷，有效問卷147份，回收率達95.4％。研究結果顯示，護理臨床教師自評教學能力之單題平均得分為4.06 （SD = 0.39），得分最高的前5項依序為能要求學生回覆示教、提供安全實習環境、能和病人建立良好的關係、在照顧病人方面展現熱忱，及對於學生好的工作表現給予正向回饋；得分最低的前5項依序為教學時能引發學生的興趣、花足夠的時間在學生身上、協助學生尋找相關資料或網站、和學生討論實習的優缺點和限制，以及能要求學生評值護理臨床教師的教學品質。再者，護理臨床教師之年齡、婚姻狀況、教育程度、進階層級、薪資、服務醫院等級、護理工作總年資及護理行政主管支持度的不同，對護理臨床教師自評教學能力有顯著差異；而年齡及護理行政主管支持度是多元線性迴歸模式的顯著預測因子，可解釋26.3％（adjusted R2 = 21.4％）護理臨床教師自評教學能力之變異量。本研究結果可作為護理臨床教師自評教學能力之參考，進而重新按視護理臨床教師之課程設計和教學內容，規劃出具整體性及系統性的課程，促使護理臨床教師在臨床教學時更能得心應手，增加教學信心和教學品質以提升教學能力。 Most clinical preceptors, despite having extensive clinical experience and knowledge, often see themselves as not sufficiently confident and competent to teach nursing skills to students, and as a result tend to suffer a high level of stress and anxiety at work. Many of them have commented that their in-service training failed to adequately prepare them for their role as clinical preceptors, and that clinical preceptor training opportunities have been too scarce. These factors, according to them, have compromised their transition from their old role as nurses to their new role as clinical nursing preceptors. The purpose of this study is to investigate differences in self-rating teaching competence scores among a sample of clinical nursing preceptors of different backgrounds, and identify predictors of the sample's self-rating teaching competence scores. This cross-sectional survey study included a convenience sample of 154 clinical nursing preceptors from a regional hospital and a medical center in northern Taiwan, who gave written consent to participate in the study. 147 valid questionnaires were returned at a valid return rate of 95.4%. The results showed that the mean single-item self-rating score for the sample was 4.06 points (SO = 0.39). The five highest scoring items were related to the sample's abilities to ask students to respond to demo teaching, provide a safe clinical training environment, encourage students to associate positively with patients , motivate students to be enthusiastic about taking care of patients, and give positive feedback to outperforming students. The five lowest scoring items were related to the sample's abilities to inspire learning interest in students, remain sufficiently attentive and accessible to students, assist students in locating learning resources (including online learning resources), discuss advantage, weakness and limitation of practice with students, and ask students evaluate the teaching quality of clinical nursing preceptors. In addition, the factors of the subjects' age, marital status, education, nursing clinical ladder status, salary, type of current hospital, total years of service as professional nurses, and the amount of support from supervisors were found to have caused significant differences in the subjects' self-rating scores. Multiple linear regression analysis was performed to identify significant predictors , namely the subjects' age and amount of support from supervisors, that accounted for 26.3% of variance in the subjects' self-rating scores (adjusted R2 = 21.4%). The questionnaire survey used in this study is a useful tool for clinical nursing preceptors to rate their own teaching competence. Furthermore, an across the- board review of existing clinical nursing preceptor training programs may be conducted, and a more integral and systematic training program devised to enhance overall teaching performance of clinical nursing preceptors by boosting their competence and confidence in teaching is needed