神經系統護理案例概念圖教學對學生認知成效評量之研究

A Study on the Cognitive Learning Effectiveness of Scenario-Based Concept Mapping in a Neurological Nursing Course

10.6224/JN.62.6.57

潘惠情(Hui-Ching Pan)；謝素英(Suh-Ing Hsieh)；許麗齡(Li-Ling Hsu)

神經系統護理 ； 案例概念圖 ； 認知學習 ； neurological nursing care ； Scenario-based concept mapping ； cognitive learning

護理雜誌

62卷6期（2015 / 12 / 01）

57 - 67

繁體中文

背景：神經系統因知識內容層次多，學生於學習時易感到恐懼，加上複雜不定的醫療情境，使護生難以適應及展現基本照護知能。案例概念圖教學有助於複雜資料的整合與概念釐清並提升認知學習成效。目的：探討以案例概念圖教學策略融入神經系統護理單元，對學生神經系統護理認知成效及學習態度情形。方法：採類實驗性研究，方便取樣某護理科技大學四技二年級學生為研究對象，以SPSS 17.0進行4班級集群隨機。實驗組2班採案例概念圖教學，對照組2班採傳統課室教學，認知成效評量是以神經系統認知測驗前後測得分之差異分析之。結果：案例概念圖及傳統課程介入，兩組在神經系統護理認知測驗後測得分皆有顯著進步（p＜.001），但未達統計上顯著差異（p=.51）。課後質性回饋於開放性問題陳述意見，實驗組的正向回饋（59%）多於對照組（49%），對照組多認為學習內容太多且難懂；實驗組對案例概念圖教學多持正向學習態度，希望增加神經相關解剖生理及病理授課時數並融入概念構圖活動，以提升學習成效。結論：以傳統課室教學或案例概念圖介入神經系統護理課程教學，皆可提升神經系統護理認知，學生對案例概念圖的教學介入多表達正向學習態度。

Background: The multiple levels of knowledge related to the neurological system deter many students from pursuing studies on this topic. Thus, in facing complicated and uncertain medical circumstances, nursing students have difficulty adjusting and using basic neurological-nursing knowledge and skills. Scenario-based concept-mapping teaching has been shown to promote the integration of complicated data, clarify related concepts, and increase the effectiveness of cognitive learning. Purpose: To investigate the effect on the neurological-nursing cognition and learning attitude of nursing students of a scenario-based concept-mapping strategy that was integrated into the neurological nursing unit of a medical and surgical nursing course. Methods: This quasi-experimental study used experimental and control groups and a pre-test/post-test design. Sophomore (2^(nd) year) students in a four-year program at a university of science and technology in Taiwan were convenience sampled using cluster randomization that was run under SPSS 17.0. Concept-mapping lessons were used as the intervention for the experimental group. The control group followed traditional lesson plans only. The cognitive learning outcome was measured using the neurological nursing-learning examination.Results: Both concept-mapping and traditional lessons significantly improved post-test neurological nursing learning scores (p＜.001), with no significant difference between the two groups (p=.51). The post-test feedback from the control group mentioned that too much content was taught and that difficulties were experienced in understanding mechanisms and in absorbing knowledge. In contrast, the experimental group held a significantly more positive perspective and learning attitude with regard to the teaching material. Furthermore, a significant number in the experimental group expressed the desire to add more lessons on anatomy, physiology, and pathology. These results indicate that this intervention strategy may help change the widespread fear and refusal of nursing students with regard to neurological lessons and may facilitate interest and positively affect learning in this important subject area. Conclusion: Integrating the concept-mapping strategy and traditional clinical-case lessons into neurological nursing lessons holds the potential to increase post-test scores significantly. Concept mapping helped those in the experimental group adopt views and attitudes toward learning the teaching material that were more positive than those held by their control-group peers. In addition, while 59% of the experimental group and 49% of the control group submitted opinions related to learning attitude in the open-ended questions, positive feedback was greater in the experimental group than in the control group.

1. Atay, S.,Karabacak, Ü.(2012).Care plans using concept maps and their effects on the critical thinking dispositions of nursing students.International Journal of Nursing Practice,18(3),233-239.
2. Atkinson, R. C.,Shiffrin, R. M.(1968).Human memory: A proposed system and its control processes.The psychology of learning and motivation,New York, NY:
3. Caton-Richards, M.(2010).Assessing the neurological status of patients with head injuries: A guide on using the Glasgow Coma Scale in emergency departments to assess patients who have sustained head injuries.Emergency Nurse,17(10),28-31.
4. Chabeli, M. M.(2010).Concept-mapping as a teaching method to facilitate critical thinking in nursing education: A review of the literature.Journal of Interdisciplinary Health Sciences,15(1),70-76.
5. Chen, S. L.,Liang, T.,Lee, M. L.,Liao, I. C.(2011).Effects of concept map teaching on students’ critical thinking and approach to learning and studying.Journal of Nursing Education,50(8),466-469.
6. Cook, L. K.,Dover, C.,Dickson, M.,Colton, D. L.(2012).From care plan to concept map: A paradigm shift.Teaching and Learning in Nursing,7(3),88-92.
7. Daley, B. J.,Torre, D. M.(2010).Concept maps in medical education: An analytical literature review.Medical Education,44(5),440-448.
8. Dawes, E.,Lloyd, H.,Durham, L.(2007).Monitoring and recording patients’ neurological observations.Nursing Standard,22(10),40-45.
9. Flanagan, E.,Walsh, C.,Tubridy, N.(2007).‘Neurophobia’– Attitudes of medical students and doctors in Ireland to neurological teaching.European Journal of Neurology,14(10),1109-1112.
10. Gerdeman, J. L.,Lux, K.,Jacko, J.(2013).Using concept mapping to build clinical judgment skills.Nurse Education in Practice,13,11-17.
11. González, H. L.,Palencia, A. P.,Umaña, L. A.,Galindo, L.,Villafrade, M. L. A.(2008).Mediated learning experience and concept maps: A pedagogical tool for achieving meaningful learning in medical physiology students.Advances in Physiology Education,32(4),312-316.
12. Hsu, L. L.(2004).Developing concept maps from problem-based learning scenario discussions.Journal of Advanced Nursing,48(5),510-518.
13. Lewis, S. L.,Dirksen, S. R.,Heitkemper, M. M.,Bucher, L.,Camera, I.(2010).Medical-surgical nursing: Assessment and management of clinical problems.St. Louis, MO:Mosby Elsevier.
14. Lindsay、 K. W.,Bone, I.,曾峰毅（譯）, F. I.(Trans.)(2008).圖解神經醫學及神經外科學.台北市=Taipei City, Taiwan, ROC:合記=Ho Chi.
15. Lukas, R. V.,Adesoye, T.,Smith, S.,Blood, A.,Brorson, J. R.(2012).Student assessment by objective structured examination in a neurology clerkship.Neurology,79(7),681-685.
16. Moore, F. G. A.,Chalk, C.(2009).The essential neurologic examination: What should medical students be taught?.Neurology,72(23),2020-2023.
17. Novak, J. D., & Cañas, A. J. (2008). The theory underlying concept maps and how to construct and use them. Retrieved from http://cmap.ihmc.us/docs/theory-of-concept-maps.php
18. Novak, J. D.,Gowin, D. B.(1984).Learning how to learn.New York, NY:Cambridge University Press.
19. O’Connor, A. B.(2006).Clinical instruction and evaluation: A teaching resource.Sudbury, MA:Jones and Bartlett.
20. Roop, K. M.(2002).Wilmington College.
21. Safdieh, J. E.,Lin, A. L.,Aizer, J.,Marzuk, P. M.,Grafstein, B.,Storey-Johnson, C.,Kang, Y.(2011).Standardized patient outcomes trial (SPOT) in neurology.Medical Education Online,16,5634.
22. Schunk, D. H.(2011).Learning theories: An educational perspective.Upper Saddle River, NJ:Merrill Prentice Hall.
23. Schuster, P. M.(2000).Concept mapping: Reducing clinical care plan paperwork and increasing learning.Nurse Educator,25(2),76-81.
24. Wilgis, M.,McConnell, J.(2008).Concept mapping: An educational strategy to improve graduate nurses’ critical thinking skills during a hospital orientation program.the Journal of Continuing Education in Nursing,39(3),119-126.
25. Youssef, F. F.(2009).Neurophobia and its implications: Evidence from a Caribbean medical school.BMC Medical Education,9(3),39-45.
26. 台灣腦中風學會（2012）．腦中風危險因子防治指引：心房纖維顫動．取自http://www.stroke.org.tw/download/guideline/guideline_001.pdf [Taiwan Stroke Society. (2012). Prevention and control guidelines for stroke risk factors: Atrial fibrillation. Retrieved from http://www.stroke.org.tw/download/guideline/guideline_001.pdf]
27. 余民寧, Y. M.,戴玉慈, Y. T.,張媚, M.(2010)。我國護理教育、考試制度與專業核心能力—從國際接軌角度探討。護理雜誌，57(5)，5-11。
28. 余民寧, M. N.(2002).有意義的學習—概念圖之研究.台北市=Taipei City, Taiwan, ROC:商鼎文化=Shang Ding.
29. 余民寧, M. N.(2012).教育測驗與評量：成就測驗與教學評量.台北市=Taipei City, Taiwan, ROC:心理=Psychological.
30. 李坤崇, K. C.(2004)。修訂Bloom認知分類及命題實例。教育研究月刊，122，98-127。
31. 李選, S.,張婷, T.(2012)。台灣護理專業對教考用失衡議題之省思。護理雜誌，59(5)，16-23。
32. 李選, S.,盧瑛琪, Y. C.,顏文娟, W. J.,林淑琴, S. C.(2004)。由邁入全球化，談台灣護理教育之衝擊與未來發展。護理雜誌，51(4)，27-32。
33. 林明珍, M. C.,黃秀雲, S. Y.,陳芳巧, F. C.(2003)。護理系在職專班學生學習概念圖之態度與成效。志為護理—慈濟護理雜誌，2(1)，42-52。
34. 林明珍, M. C.,潘妮妮, N. N.,姜秋玲, C. L.(2005)。運用概念圖於五專新生護理學導論之教學。實證護理，1(2)，101-111。
35. 林麗娟, L. C.,柯薰貴, H. K.,林淑媛, S. Y.(2009)。比較某護理系學生在概念圖教學介入後概念圖學習態度的差異。長庚護理，20(4)，441-449。
36. 金繼春, C. C.(2010)。護理核心素養的培育—從理念到實踐。護理雜誌，57(5)，24-26。
37. 劉雪娥（校閱）, H. R.(Ed.)(2012).成人內外科護理學.台北市=Taipei City, Taiwan, ROC:華杏=Farseeing.
38. 衛生福利部（2015，6月）．103年國人死因統計結果．取自http://www.mohw.gov.tw/CHT/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=5313&doc_no=49778 [Ministry of Health and Welfare, Taiwan, ROC. (2015, June). Cause of death statistics: 2014. Retrieved from http://www.mohw.gov.tw/CHT/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=5313&doc_no=49778]

1. 蘇梅鳳,黃雅祺,黃雅芳(2023)。探討個人發展地圖提升Z世代護理學生之學習成效－以中部某科技大學人類發展學科目為例。弘光學報，91，131-150。