一位冠狀動脈疾病繞道手術術後個案的護理經驗

[[abstract]]接受冠狀動脈繞道手術(CABG)的病人會產生身、心及社會各方面的不適，加強對病人術後健康照護需求的了解及照顧，有助於術後的恢復。本研究之目的主要是探討一位冠狀動脈心臟疾病患者，在住院期間接受冠狀動脈繞道手術術後的護理經驗。筆者從92年12月08日至12月10日護理此個案，護理期間藉由觀察、會談的方式來收集個案相關資料，並使用改良式適應模式的評估來進行護理評估，在照護的過程中，歸納出個案有急性疼痛、心輸出量不足、焦慮...等健康問題，藉由照顧此個案的經驗，期望有助於提升照顧此類患者的護理照護品質，以增加病患在生活上的舒適感

Study on the Use of Competency for the Examination and Selection of Civil Servants

摘要 　　美國哈佛大學教授David McClelland(1973)認為職能是影響工作績效好壞的主要因素。執行業務的績效（performance）和在校成績，沒有必然的正相關因果關係，在判斷一個人是否符合特定資格條件時，宜採用潛藏於個人平日行為背後的特質，做為取決之準則，而強調以職能為核心之考試取才方式。本研究蒐集考選部推動職能分析結果表件，進一步精進研究。主要使用內容分析法及三角檢核法，發現初任薦任公務人員應具備之職能有13大類52個職能項目，包括：一、知識及技術；二、規劃執行及判斷應變；三、表達及溝通協調；四、理解及邏輯分析；五、創造及學習力；六、領導及監督能力；七、資料分析運用及調查研究；八、團隊運作與目標管理；九、友善關懷及人際互動；十、誠信正直及負責可信度；十一、嚴謹性；十二、情緒穩定性；十三、體能條件等十三大類。依需求程度之重要性來看，最重要職能項目包括：「專業知能」、「資訊電腦」、「基本法律知能」、「執行力」、「計畫力」、「溝通能力」、「表達能力」、「邏輯能力」、「分析性思考」、「資料蒐集、分析與運用」、「專注細節」。對於職能分析於公務人員考選之應用，經本研究深度訪談結果，各受訪專家咸認為教育、考選、訓練、任用之應用，均以應職能分析結果為基礎。於教育方面，可據此規劃設計課程及排定社團活動等非正式教育課程。於考選方面，可用以規劃考試制度、檢討考試類科設置、設計共通科目、多元考試方式選擇與塔配運用等，其中，多元考試方式之選擇與結合運用，可據職能分析結果編製心理測驗試題，對應考人施以心理測驗，測驗結果不列考試成績計算，但可作為結構化口試命題之參考。於訓練方面，可為公務人員錄取人員基礎訓練及實務訓練課程規劃及考核評鑑之參據。於任用方面，則可作為初任薦任公務人員試用階段培育及考評之參據。如此，教、考、訓、用環環相扣，有助於甄拔優秀之初任薦任公務人員進入政府部門服務，提升公務人力素質，增進政府施政效能，進而提高國家總體競爭力。Abstract Professor David McClelland from Harvard University (1973) considers that competency is the primary factor in affecting job performance. Even though there is no positive correlation between execution performance and schooling results, in the course of determining if an individual meets certain criteria, it is suitable to be adopted as a hidden characteristic behind the routine behavior of an individual in the deciding criteria, and emphasizes on competency as the core examination and talent selection method. This study collected the analysis sheets on diving competency from the examination board to further research in details. The content analysis method and triangulation method were used primarily to perceive that there are 13 categories and 52 competency items that a beginner civil servant being appointed is required to possess, including: 1. Knowledge and technique; 2. Planning execution and adaptation of judgment; 3. Expression and communication for coordination; 4. Comprehension and logic analysis; 5. Creativity and learning ability; 6. Leadership and supervision capability; 7. Analysis and utilization of data and investigative research; 8. Team operations and target management; 9. Friendly, caring and interaction with people; 10. Has integrity and accountability; 11. Stringent; 12. Emotional stability; 13. Physical conditions, adding up to a total of 13 categories. Based on the degree of importance regarding the requirements, the most important competency items include: “Professional competency”, “IT and Computing”, “Basic legal knowledge”, “Execution ability”, “Planning capability”, “Communication capability”, “Expression Ability”, “Logic capability”, “Analytical thinking”, “Data collection, analysis and utilization” and “Focus on details”. With regards to the competency analysis being used for the examination and selection of civil servants, results from in-depth interviews conducted by this study show that the respective professionals being interviewed consider the use of education, examination and selection, training and appointment should all be based on the results of competency analysis. On the aspect of education, the design planning of course programs, arrangement of activities by social groups and other informal education programs can go along this basis. On the aspect of examination and selection, it may be used for the planning of the examination system, and review of the establishment and design of common topics and diversified examination choices as well as use of examination categories. Among which, the selection and integrated use of diversified examination methods may formulate the psychological test questions based on the results of competency analysis. The test results are not incorporated into the examination results, but could be used as a reference for structural oral examination questions. On the aspect of training, it could be used as a reference basis for the planning of foundational training program, practical training program and performance appraisals of hired civil servants. On the aspect of utilization, it can be used as a reference basis for the initial appointment of civil servants for their training and evaluation during the probation stage. Hence, teaching, examination, training and use are all closely correlated, it helps to identify and cultivate exemplary associate civil servants initially appointed to serve in government departments, enhance the quality of civil servants, improve the execution efficiency of the government and thereby enhancing the overall competitiveness of the country

[[alternative]]Design and Implementation of a Multimedia Education System for Nursing Physical Examination

[[abstract]]護理身體評估是所有護理學生都必須學習的一門課程，學理與實務並重，以評估問診的方式來達到收集患者健康情形的相關資訊，在教學的過程中，通常需要配合圖片及影片的示範講解，才能夠讓學生徹底了解。目前市面上雖然已經有身體評估相關的書籍與教材，但是都屬於靜態的說明，學生自行閱讀的成效不佳。近年來由於資訊及網路科技的進步，多媒體線上教學系統的製作越來越容易，網路教材可以打破時空限制，具備許多傳統教材的優點，利用網路線上的學習，可以將加強學習者的記憶，也可以使學習者方便且挑選配合自己的時問做最佳的學習，多媒體介面的活潑生動性，更吸引學習的的注意，進而提高學習者的學習效率。 本文是針對身體評估的教材區分為呼吸、循環、神經及腸胃等系統，建立了資料庫，加入多圖片及影片等多媒體資料，並建置了資料庫伺服器、應用系統伺服器及影音串流伺服器，提供網路學習的環境。使用者只要使用一般的電腦連結上網，就可以依照身體的各部位逐一閱讀檢視教材，也可以透過全文資料系統，迅速的由資料庫尋找所需的資料，在各章節之後，並加入了互動式的練習題，以檢測使用者了解的程度。本系統製作的經驗，可以作為將來開發網路相關教材的參考。[[abstract]]Physical examination is one of the required classes in nursing. This course is designed to emphasize both theory and hand-on experiences. To let students thoroughly understand the course content, a teacher prefers to use multimedia to teach students the correct way of collecting a patient's medical data. However, current teaching materials on the market are mostly based on printed texts and have very limited benefits to student learning. With the rapid progress of computer and Internet, multimedia based education has become widely available. In addition to having all the advantages in traditional education, the computer and Internet based teaching scheme also offers flexibility in the time and location of a learning process. For example, a student can easily refresh his or her memory after class, as long as computer and Internet are available to the student. Furthermore, the multimedia teaching is a multi-dimensional learning environment. The interactive function of a multimedia tends to catch a student's attention and makes a learning process more efficient. This paper describes a multimedia based database for teaching physical examination. The scope of the database covers the breathing, circulation, neurotics, and abdomen systems. The course materials are stored into a database chapter by chapter Pictures and videos can be presented through an Internet browser. A distance learning environment can be constructed through the implementation of the database, application, and video-stream servers. When a user is on-line, he or she can learn through the materials by following the sequence of the systems or can locate the materials of a particular subject from the database. There are also review questions in each chapter for self-evaluation. In this paper, we would like to share our experience in implementing a multimedia teaching environment through computer and Internet. This experience could be valuable for developing Internet courses in the future

髖部骨折與腦中風相關風險之研究

[[abstract]]髖部骨折不僅造成病人活動受限、日常生活獨立性減低、喪失信心，甚至導致失能及死亡，而腦中風病人容易發生髖部骨折。本研究目的在探討不同腦中風類型（缺血性腦中風、非缺血性腦中風）病人發生髖部骨折的相關風險，採病例對照性研究，樣本來自2007年國家衛生研究院發行的全民健康保險研究資料庫，選擇第一次發生髖部骨折的住院病人877位為病例組，控制年齡、性別與影響骨質疏鬆的藥物（抗心律不整和毛地黃、雙磷酸鹽、利尿劑、荷爾蒙、β-阻斷劑、鈣通道阻斷劑、硝酸鹽、抗糖尿病藥物、類固醇）。依病例組性別及年齡層別1比5頻率匹配，選擇4,385位病人為對照組，研究對象總共5,262人。採SAS 9.1統計套裝軟體，以次數、百分比、平均值及標準差呈現資料，邏輯式迴歸進行資料分析。結果顯示腦中風病人發生髖部骨折的勝算比為1.35；缺血性腦中風者更高。女性腦中風病人發生髖部骨折的風險高，71-80歲腦中風病人發生髖部骨折的風險高於18-70歲腦中風病人。本研究證實腦中風病人發生髖部骨折的風險高於沒有腦中風病人；建議腦中風病人需預防發生髖部骨折，定期監測骨質密度，加強預防跌倒及病理性骨質疏鬆的護理指導，更要鼓勵女性及年長腦中風病人適當曬太陽、步行及鈣質攝取