運用多元化教學策略提升兒科NPGY學員對川崎症照護之正確率

Using Diversified Teaching Strategies to Promote the Accuracy of Kawasaki Disease Care for Pediatric NPGY Students

10.6386/CGN.202209_33(3).0007

陳彥羽(Yen-Yu Chen)；翁珮珊(Pei-Shan Wen)；廖婉君(Wan-Chun Liao)；洪嘉玟(Chia-Wen Hung)

多元化教學策略 ； 兒科NPGY學員 ； 川崎症 ； multiple training strategies ； pediatric NPGY students ； kawasaki disease

長庚護理

33卷3期（2022 / 09 / 01）

76 - 87

繁體中文

川崎症病童容易誘發有冠狀動脈血管擴張及動脈瘤之併發症而有致死的危險性或終身心臟病影響生活品質，故護理人員需具備正確的川崎症照護的知能。現況兒科病房發現兩年期護理師（士）訓練計畫中的學員（Nurse Post graduate Year；NPGY）對川崎症照護正確率低之主因為學員對川崎症照護認知及照護能力不足、缺乏照護之輔助工具、未辦理川崎症照護教育訓練，及單位間輔導訓練計畫項目不一致等。經分析及討論後結合川崎症醫療團隊實施解決方案包括1.製作川崎症照護的多媒體影片及電子書輔助；2.運用「團隊導向學習」（TBL）及「翻轉教學」教學策略共同執行川崎症照護之團隊導向學習的教育訓練；3.建置川崎症評估及照護指引，讓臨床護理人員可以遇到疑似個案時可以做為評估及臨床照護之依據；4.重整NPGY學員輔導訓練計畫，使護理臨床教師能一致性進行教導及評核。結果顯示1.NPGY學員對川崎症照護認知的正確率由36.1%提升至96.6%；2.川崎症照護能力由未達標準的2.5分提升至一般標準以上的7.6分。因成效卓越，已擴大分享於兒科門診及兒童內科部，並進一步建置川崎症照護電子書置於本院數位學習網站，提供院內醫護人員參閱使用，以提升川崎症照護品質。

Children with Kawasaki disease are at risk of coronary artery vasodilation and aneurysm death or lifelong heart disease affects quality of life. Therefore, nursing staff need to have the correct knowledge and skills of Kawasaki disease care. With an in-depth analysis, reasons leading to low accuracy in delivery proper nursing intervention of KD children were two years PGY nurses have had a lack of standards of professional competence and fewer experiences in KD care, without effectiveness tool of assessment, inadequate Kawasaki care on-the-job training and an unclear evaluation process or standard in nursing care. Therefore, the solution was implemented in conjunction with the Kawasaki medical team: first, product multimedia videos and e-book as assistance tool for Kawasaki disease care; second, use ＂team- based learning ＂ (TBL) and ＂ flipped classroom ＂ teaching strategies to joint Kawasaki disease care plan; third, establish Kawasaki disease assessment and care guidelines for nursing staff to use for assess and clinical care when encountered suspected cases. And fourth, reorganize the NPGY trainer training program for nursing clinical teachers to conduct teaching and evaluation on a basis. The results showed that the accuracy rate of NPGY trainees' awareness of Kawasaki disease care increased from 36.1% to 96.6%; the Kawasaki disease care ability improved from 2.5 points (below the average) to 7.6 points (above the average). Due to more efficient in learning. Therefore, we shared this wonderful result in pediatric clinic and the Department of Children's Internal Medicine; and Kawasaki disease care e-book was also set up in our hospital's digital learning website as a reference for medical staff in the hospital to promote Kawasaki disease nursing quality.

1. 王英偉, Y. W.,謝至鎠, J. G.(2010)。團隊導向學習簡介。醫學教育，14(1)，79-89。
   連結：
2. 黃盈慈, Y. T.,林建宏, C. H.,孫文榮, W. J.(2017)。川崎氏症發燒合併呼吸道症狀：個案報告。台灣家醫誌，27(1)，57-64。
   連結：
3. Gilboy, M. B.,Heinerichs, S.,Pazzaglia, G.(2015).Enhancing student engagement using the flipped classroom.Journal of Nutrition Education and Behavior,47(1),109-114.
4. Lue, H. C.,Chen, L. R.,Lin, M. T.,Chang, L. Y.,Wang, J. K.,Lee, C. Y.,Wu, M. H.(2014).Epidemiological features of kawasaki disease in Taiwan, 1976-2007: Results of five nationwide questionnaire hospital surveys.Pediatrics and Neonatology,55,92-96.
5. Rowley, A. H.(2015).The complexities of the diagnosis and management of kawasaki disease.Infectious Disease Clinics of North America,29(3),525-537.
6. Saguil, A.,Fargo, M.,Grogan, S.(2015).Diagnosis and management of kawasaki disease.American Family Physician,91(6),365-372.
7. Uehara, R.,Belay, E. D.(2012).Epidemiology of kawasaki disease in Asia, Europe, and the United States.Journal of Epidemiology,22(2),79-85.
8. 史美瑤, M. Y.(2012)。以學員學習為中心的教學：團隊導向學習法。評鑑雙月刊，38，29-32。
9. 台灣護理學會=Taiwan Nurses association(2013).護理臨床教師教學教案設計指引.台灣護理學會=Taiwan Nurses association.
10. 林鈺庭, Y. T.,林燕縫, Y. F.,林怡攸, I. Y.,林瓊君, C. C.,陳寶純, P. C.,謝凱生, K. S.,郭和昌, H. C.(2018)。川崎症與疫苗的進展。台灣醫界，61(4)，15-19。
11. 孫旻暐, M. W.(2018)。劍橋取經分享─談主動式學習與團隊導向學習法。評鑑雙月刊，71，39-42。
12. 張雅玲, Y. L.,蔡佳純, C. C.,何秀玉, H. Y.(2014)。照顧一位川崎症學齡前病童及家屬之護理經驗。領導護理，15(2)，73-74。
13. 郭瓊文, C. W.,李忠成, C.,謝正芳, C. F.(2016)。難治型川崎病治療的回顧。南台灣醫學雜誌，12(1)，1-10。
14. 陳月枝（校閱）, Y. C.(Ed.)(2017).實用兒科護理.華杏=Farseeing.
15. 湯麗君, L. C.(2018)。影視教學於護理教育之應用，個案分析。澳門護理雜誌，17(1)，1-6。
16. 詹紹華, S. H.,王凱欣, K. H.,王靜枝, J. J.,林為森, W. S.,張嘉蘋, J. P.(2014)。多媒體影音光碟於筆型胰島素注射護理指導之效益以南部某醫學中心為例。護理暨健康照護研究，10(2)，123-133。
17. 劉淑如, S. R.,蔡淑玲, S. L.,劉秀珍, H. C.,鄭靜瑜, C. Y.(2014)。TBL教學策略之成效探討：以護理導論課程為例。長庚科技學刊，21，63-74。
18. 鄭雅君, Y. C.(2013)。以畫護你─從概念圖到人形圖。志為護理─慈濟護理雜誌，12(1)，30-32。
19. 顧雅利, Y. L.,郭倩琳, C. L.,李碧玉, P. Y.,程紋貞, W. J.,郭世明, S. M.(2014)。迷你臨床演練評量(mini-CEX) 於護理領域之運用。長庚護理，21(3)，283-290。