護理臨床教師自評教學能力之研究

[[abstract]]護理臨床教師指導護生實習的情況越來越普遍，經由研究者與多位護理臨床教師的訪談結果發現，多數的護理臨床教師都是在醫院的指派下擔任護理臨床教師的角色，大部分的護理臨床教師有豐富的臨床經驗和學識，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，同時也深感護理在職教育課程中缺乏敎與學相關概念，以及臨床指導員教育訓練的不普及，使得從護理人員在轉換成教師的角色有所困難。 本研究旨在瞭解護理臨床教師自評教學能力情形與影響因素。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)，自擬「護理臨床教師教學能力自評表」，其內在一致性Cronbach’s α為0.99，進行專家內容效度檢定，題項內容效度(Item-Content validity index, CVI)為0.95與量表內容效度(Scale-CVI, S-CVI)為0.75；調查北部地區某家醫學中心及區域級醫院各科別之護理人員，總共發出154份問卷，回收147份問卷(有效回收率95.4％)。將回收的資料以SPSS 17.0進行資料分析，採用次數分配、百分比、平均數、標準差、單因子變異數分析(One-Way ANOVA)、無母數分析(Mann-Whitney test或Kruskal-Wallis test )、線性複迴歸(multiple linear regression)等方法進行推論性統計。研究結果發現: (一) 護理臨床教師自評教學能力平均單題得分範圍介於4.45分到3.67分（最高為5分），依平均數得分排序最高的前3個變項依序為「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」。(二) 護理臨床教師自評教學能力分數，會因個人背景因素之不同而有所差異；年齡越大、護理工作總年資越資深、進階層級為N3層級或N4層級、區域醫院的護理臨床教師、認為高薪資影響擔任護理臨床教師者、高度行政主管支持度者，其自評教學能力分數較高。(三) 經由複迴歸分析發現，在控制婚姻、教育程度、醫院等級及進階層級下，只有年齡及護理行政主管支持度是護理臨床教師教學能力之顯著獨立預測因子；換言之，年齡組別中41-58歲相較於21-30歲的護理臨床教師，其教學能力提高14.81分；護理行政主管支持度為高支持度者，其教學能力較普通支持度者高12.80分，此模式可解釋21.4%護理臨床教師教學能力之變異量。本研究結果期望能提升護理臨床教師教學能力及發展完整、客觀臨床教學能力之評值工具，可作為護理臨床教師自評教學能力之參考。[[abstract]]An increasing number of veteran nurses are trusted with the task of training student nurses. Interviews between the author of this study and many clinical nurse trainers revealed the fact that the majority of clinical nurse trainers were given the role of nurse trainer by the hospital at which they work. The vast majority of clinical nurse trainers are well-versed and well-experienced in clinical practice, but many perceive themselves as lacking the skills and the confidence to pass their knowledge to student nurses, and feel anxious and stressed about their role as nurse trainer. Many of them believe that existing in-service nursing education does not provide enough guidelines for the transfer of knowledge between nurse trainer and nurse, and educational training opportunities for clinical nurse trainers have been scarce. Consequently, many nurse trainers have difficulty switching to the role of teacher. The purpose to this study was to investigate the teaching competencies of self-assessment and the related influencing factors among clinical preceptors. This is a descriptive and correlational study design using cross-sectional survey. There were 154 structural questionnaires sent out in a medical center and a regional educational hospital and 147 questionnaires were returned completed for data analysis. The return rate was 95.4%. The research instrument used in the study was the, questionnaire on teaching competencies of self-assessment among clinical preceptors with the Cronbach's α 0.994, Item-Content validity index (I-CVI) 0.95 and Scale-CVI(S-CVI) 0.75 valued by experts. Data was analyzed by using SPSS 17.0 with descriptive, one-way ANOVA, Mann-Whitney test and multiple linear regression analysis. The results disclosed: (1) The mean teaching competencies of self-assessment scores among the subjects was range from 4.45 to 3.67 (5-point Likert Scale); Order of the first three items of highest mean score was as the following: "Asking students to demonstrate preceptor teaching, "Providing a safe practice environment", and "Having good relationship with patients". (2) The teaching competencies of self-assessment among clinical preceptors appeared to be related to personal background. The following ones had higher scores: the older, the more years of nursing experience, the N3 and N4, working in regional hospital, the benefits or rewards-oriented, the higher supportive level of nursing administrators. (3) Multiple regression analysis showed that the influencing factors including age, marital status, education, class of working, clinical nursing ladder, and supportive level of nursing administrators explained 21.4% of total variance. (4) In controlling for the variances of age, marital status, education, class of working, clinical nursing ladder, and supportive level of nursing administrators, only the variances of age and supportive level of nursing administrators were as significant independent predictors. Compared with the groups of 21-30 years-old, when the groups of 41-58 years-old older each additional year-old, the mean score increased by 14.81 points. The mean score among the higher supportive level of nursing administrators was 12.80 points less than that of common ones. We hope this study to be able to benefit the teaching competencies of clinical preceptors, and to be an intact and objective instrument for clinical practices

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