融入批判思考策略與工具之網路學習環境對護生臨床實習之影響

The Effects of the Web-based Learning Environment with Critical Thinking Strategies and Tools on Nursing Students' Clinical Learning

10.6173/CJSE.2013.2102.02

賴錦緣(Chin-Yuan Lai)；陳勝美(Sheng-Mei Chen)

批判思考 ； 網路學習 ； 臨床實習 ； 護理教育 ； Critical Thinking ； Web-Based Learning ； Clinical Practicum ； Nursing Education

科學教育學刊

21卷2期（2013 / 06 / 01）

163 - 188

繁體中文

本研究旨在建構一個融入護理批判思考策略的web-based網路學習環境，來輔助學生在臨床護理的實習。研究主要以Tanner的臨床判斷模式為架構，結合網路教學的特性，發展出培養護生臨床批判思考的網路教學模式，並探討其對學生批判思考和護理能力成長之影響。研究參與者為8位修習99學年度某一梯次「精神科護理實習」課程之二專二年級學生，實習指導教師是一位從事護理臨床與教學工作超過25年之資深教師，實驗情境為中部某精神科醫院。研究蒐集量化與質化的資料，透過前、後測瞭解學生批判思考和護理能力之成長。研究結果發現：一、學生經過三週的實習後，其批判思考分數和護理能力分數皆顯著進步；二、整體來說，不管是批判思考分數，或是護理能力分數，教師評和學生自評分數之一致性皆達到顯著水準；三、從學生瀏覽系統各項功能的次數分析，發現本研究所開發的系統可提供學生有系統地建立專業e-portfolio（數位化學習歷程檔案）；學生也大致認為使用系統對其臨床實習是有幫助的。可見結合護理批判思考策略和工具的網路教學模式對護生批判思考能力的培養是有效的。後續研究可以針對學生的其他瀏覽行為進行分析，以提供適性的網路教學。

The purpose of this study is to explore the effects of the web-based learning environment with critical thinking strategies and tools on students' learning in nursing clinical practicum. Based on Tanner's clinical judgment model, we developed critical thinking activities for a threeweek nursing clinical practicum session. The participants are eight female students enrolled in a psychiatric nursing practice course in 2010 from a two-year nursing college. The instructor is a senior lecturer who has worked in nursing teaching and practice for more than 25 years. The clinical practicum setting in the study was a private middle-size mental hospital located in central Taiwan. The analysis from quantitative and qualitative data showed that students' critical thinking and nursing competence improved significantly. As to the overall assessment scores of critical thinking and nursing competence, the agreement between instructor and student self-assessment was significant. The analysis of frequency of visits on each functions appeared that the web-based learning environment provided students with professional e-portfolios to allow them to construct their learning systematically. Furthermore, students admitted that using the system is helpful to their clinical practicum. The results showed that the web-based learning environment with clinical reasoning strategies and tools is effective for the development of critical thinking among nursing students. Future research may explore students' other browsing behaviors to provide adaptive web-based learning.

1. Feng, R. C.,Chen, M. J.,Chen, M. C.,Pai, Y. C.(2010).Critical thinking competence and disposition of clinical nurses in a medical center.The Journal of Nursing Research,18(2),77-87.
   連結：
2. 臺灣護理教育評鑑委員會(2010)。評鑑準則。查詢日期：2012年5月24日，檢自http://www.heeact.edu.tw/lp.asp?ctNode=352&CtUnit=118&BaseDSD=7&mp=5。
3. Aduddell, K. A.,Dorman, G. E.(2010).The development of the next generation of nurse leaders.The Journal of Nursing Education,49(3),168-171.
4. Alexander, M. F.,Runciman, P. J.(2003).ICN framework of competencies for the generalist nurses.International Council of Nurses conference,Geneva, Switzerland:
5. Alfaro-LeFevre, R.(1999).Critical thinking in nursing: A practical approach (2nd ed.).Philadelphia:Saunders.
6. American Association of Colleges of Nursing(1998).The essentials of baccalaureate education for professional education.Washington, DC:Author.
7. Ball, E.,Daly, W. M.,Carnwall, R.(2000).The use of portfolios in the assessment of learning and competence.Nursing Standard,14(43),35-37.
8. Bartlett, R.,Bland, A.,Rossen, E.,Kautz, D.,Benfield, S.,Carnevale, T.(2008).Evaluation of the outcome-present state test model as a way to teach clinical reasoning.The Journal of Nursing Education,47(8),337-344.
9. Billings, D. M.(2005).From teaching to learning in a mobile, wireless world.The Journal of Nursing Education,44(8),343.
10. Bittner, N. P.,Tobin, D.(1998).Critical thinking. Strategies for clinical practice.Journal for Nurses in Staff Development,14(6),267-272.
11. Blum, C. A.,Borglund, S.,Parcells, D.(2010).High-fidelity nursing simulation: Impact on student self-confidence and clinical competence.International Journal of Nursing Education Scholarship,7(1)
12. Brunt, B. A.(2005).Models, measurement, and strategies in developing critical thinking skills.Journal of Continuing Education in Nursing,36(6),255-262.
13. Buckenham, M. A.(1988).Student nurse perception of the staff nurse role.Journal of Advanced Nursing,13(5),662-670.
14. Carter, L. M.,Rukholm, E.(2008).A study of critical thinking, teacher-student interaction, and discipline-specific writing in an online educational setting for registered nurses.Journal of Continuing Education in Nursing,39(3),133-138.
15. Chang, M. J.,Chang, Y. J.,Kuo, S. H.,Yang, Y. H.,Chou, F. H.(2011).Relationships between critical thinking ability and nursing competence in clinical nurses.Journal of Clinical Nursing,20(21-22),3224-3232.
16. Chiu, Y. C.(2009).Facilitating Asian students' critical thinking in online discussions.British Journal of Educational Technology,40(1),42-57.
17. Clinton, M.,Murrells, T.,Robinson, S.(2005).Assessing competency in nursing: A comparison of nurses prepared through degree and diploma programmes.Journal of Clinical Nursing,14(1),82-94.
18. Cody, W. K.(2002).Critical thinking and nursing science: Judgment or vision?.Nursing Science Quarterly,15(3),184-189.
19. Conger, M. M.,Mezza, I.(1996).Fostering critical thinking in nursing students in the clinical setting.Nurse Educator,21(3),11-15.
20. Dearnley, C. A.,Meddings, F. S.(2007).Student self-assessment and its impact on learning - A pilot study.Nurse Education Today,27(4),333-340.
21. Ellis, J. R.,Hartley, C. L.(1995).Maintaining competence through staff education. Managing and coordinating nursing care (2nd ed.).New York:Lippincott.
22. Facione, N. C.,Facione, P. A.(1994).Holistic critical thinking scoring rubric.Millbrae, CA:The California Academic Press.
23. Facione, P. A.(1990).Critical thinking: A statement of expert consensus for purpose of educational assessment and instruction. Research findings and recommendations.Newerk, DE:American Philosophical Association.
24. Forneris, S. G.(2004).Exploring the attributes of critical thinking: A conceptual basis.International Journal of Nursing Education Scholarship,1(1)
25. Gubrud-Howe, P. M.(2008).,Porland, OR:Portland State University.
26. Hancock, C.(2004).Unity with diversity: ICN's framework of competencies.Journal of Advanced Nursing,47(2),119.
27. Hickey, G.(1996).The challenge of change in nurse education: Traditionally trained nurses' perceptions of Project 2000.Nurse Education Today,16(6),389-396.
28. Howenstein, M. A.,Bilodeau, K.,Brogna, M. J.,Good, G. J.(1996).Factors associated with critical thinking among nurses.Journal of Continuing Education in Nursing,27(3),100-103.
29. Jeffries, P. R.(2005).Technology trends in nursing education: Next steps.The Journal of Nursing Education,44(1),3-4.
30. Kuiper, R.(2002).Enhancing metacognition through the reflective use of self-regulated learning strategies.Journal of Continuing Education in Nursing,33(2),78-87.
31. Landers, M. G.(2000).The theory-practice gap in nursing: The role of the nurse teacher.Journal of Advanced Nursing,32(6),1550-1556.
32. Lasater, K.(2007).Clinical judgment development: Using simulation to create an assessment rubric.The Journal of Nursing Education,46(11),496-503.
33. Levett-Jones, T.,Hoffman, K.,Dempsey, J.,Jeong, Y. S.,Noble, D.,Norton, C. A.(2010).The 'five rights' of clinical reasoning: An educational model to enhance nursing students' ability to identify and manage clinically 'at risk' patients.Nurse Education Today,30(6),515-520.
34. Li, K. M.(2009).The effect of a pedagogy model integrated with weblogs on critical thinking skills of students.17th International conference on computers in education,Hong Kong:
35. McCaugherty, D.(1991).The theory-practice gap in nurse education: Its causes and possible solutions. Findings from an action research study.Journal of Advanced Nursing,16(9),1055-1061.
36. Murphy, J. I.(2004).Using focused reflection and articulation to promote clinical reasoning: An evidence-based teaching strategy.Nursing Education Perspectives,25(5),226-231.
37. National League for Nursing Accrediting Commission(1997).Interpretive guidelines for standards and criteria for baccalaureate and higher degree programs (Rev. ed.).New York:Author.
38. Nielsen, A.,Stragnell, S.,Jester, P.(2007).Guide for reflection using the clinical judgment model.The Journal of Nursing Education,46(11),513-516.
39. Orsmond, P.,Merry, S.,Reiling, K.(2000).The use of student derived marking criteria in peer and self-assessment.Assessment and Evaluation in Higher Education,25(1),23-38.
40. Paul, R. W.(1995).Critical thinking: How to prepare students for a rapidly changing world.Dillon Beach, CA:Foundation for Critical Thinking.
41. Paul, R. W.,Heaslip, P.(1995).Critical thinking and intuitive nursing practice.Journal of Advanced Nursing,22(1),40-47.
42. Shin, K. R.,Lee, J. H.,Ha, J. Y.,Kim, K. H.(2006).Critical thinking dispositions in baccalaureate nursing students.Journal of Advanced Nursing,56(2),182-189.
43. Simpson, E.,Courtney, M.(2002).Critical thinking in nursing education: Literature review.International Journal of Nursing Practice,8(2),89-98.
44. Smith, B. E.(1992).Linking theory and practice in teaching basic nursing skills.The Journal of Nursing Education,31(1),16-23.
45. Tanner, C. A.(2006).Thinking like a nurse: A research-based model of clinical judgment in nursing.The Journal of Nursing Education,45(6),204-211.
46. Taylor, P. G.(2006).Critical thinking in and through interactive computer hypertext and art education.Innovate: Journal of Online Education,2(3)
47. Thompson, C.,Dowding, D.(2002).Clinical decision making and judgement in nursing.Sydney, AU:Elsevier Churchill Livingstone.
48. Tzeng, H. M.(2003).Demand and supply for nursing competencies in Taiwan's hospital industry.Nursing Economic,21(3),130-139.
49. Utley-Smith, Q.(2004).5 competencies needed by new baccalaureate graduates.Nursing Education Perspectives,25(4),166-170.
50. Yang, Y. T.(2008).A catalyst for teaching critical thinking in a large university class in Taiwan: Asynchronous online discussions with the facilitation of teaching assistants.Educational Technology Research & Development,56(3),241-264.
51. Yildirim, B.,Özkahraman, Ş.(2011).Critical thinking in nursing process and education.International Journal of Humanities and Social Science,1(13),257-262.
52. 戎瑾如、楊翠媛、劉玟宜、洪翠妹、洪芬芳、蕭淑貞(2008)。探討社區精神衛生護理能力鑑定模式。精神衛生護理雜誌，3(2)，1-9。
53. 林秋芬、盧美秀、康偉玲(2004)。護理能力標準：國際版與臺灣版之比較。新臺北護理期刊，6(2)，11-22。
54. 金繼春(2009)。護理核心素養融入課程設計與評值。護理教育的發展與趨勢研討會，高雄縣:
55. 顏志龍、趙舒禾、王榮春(2008)。影響績效自評的文化及情境因素之探討。教育與心理研究，31(2)，119-142。
56. 蘇惠明、黃瑞美(2000)。應用於臨床推理的批判思考策略。護理雜誌，47(6)，65-70。

1. 歐淑玲,倪麗芬(2021)。運用自我效能提升護生專業知識與技能、批判思考及溝通合作力。長庚護理，32(2)，28-40。
2. 蘇秀娟、黃衍文、邱淑芬(2017)。資通訊科技於護理教育的應用。護理雜誌，64(6)，5-11。
3. 蘇秀娟、黃衍文、邱淑芬(2017)。資通訊科技於護理教育的應用。護理雜誌，64(6)，5-11。
4. 趙莉芬,黃湘萍(2018)。應用資訊科技於護理教學的契機與建置規劃。源遠護理，12(3)，14-19。