以學習共同體實踐實證護理於臨床實習教學－哈伯馬斯批判理論的應用

Learning Community to Implement Evidence-Based Nursing Practice in Clinical Practicum: The Application of Habermas' Critical Theory

10.6530/YYN/2016.5.2

羅翊邦(Yi-Pang Lo)；周汎澔(Fan-Hao Chou)；蔣立琦(Li-Chi Chiang)

學習共同體 ； 臨床實習 ； 實證護理 ； 哈伯馬斯 ； learning community ； clinical practicum ； evidence-based nursing ； Habermas

源遠護理

10卷1期（2016 / 03 / 01）

5 - 13

繁體中文

為了促使以學習者為中心的教學，臨床實習是淬鍊護理學生精熟學理知識技能於實務工作中的重要教學場域。然而，教師與學生之間非對等關係存在著階級差距，臨床教師要訓練學生具備批判性思考，卻常常在言詞上否定學生的想法與意見，又常常無意間限制了學生發言的權利，排除其他人的思辨與想法。理性的溝通行動是導向社會主體相互理解的行動，而且是以達到意見一致為目標。師生間理性討論必須建構於相互尊重與平等發言機會的基礎上。因此，筆者建立臨床實習教學之學習共同體模式，並運用哈伯馬斯（Habermas）溝通行動理論，在臨床實習教學時運用師生共同體的概念與實踐，若能立基於理性溝通理念上，有望提升學生獨立自主的思辨能力。使師生於臨床實習場域及過程中能共同探究、合作、表達、運用與反饋，真正落實以病人為中心的實證護理教學，達到護理教育師生教學相長、互惠學習的目標。

To promote learner-centered teaching, clinical practicum is an important learning ground for nursing students to integrate knowledge and skills in substantive work. However, there are hierarchal gaps between teachers and students' non-reciprocal relationship. Clinical teachers often use negative words and opinions to discipline students with the hope to convey critical thinking. The exclusion of other's ideas often unintentionally limits students' right of expression. Communicative rationality is a subject-oriented social action to reach mutual understanding and consensus of goals. Communicative rationality discussion between teachers and students should be based on mutual respect and equal opportunity. The authors propose the clinical practicum teaching model, constructed on the Habermas' Theory of Communicative Action, to enhance students' independent critical thinking competency. Both teachers and students learn equally from each other by the process of discovery, cooperation, expression, practice and feedback. Implement patient-centered and evidence-based nursing in clinical practicum to achieve the goals of reflective teaching and learning for mutual cultivation.

1. 洪佳慧,林陳涌(2014)。探討問題導向學習在醫學教育臨床實務能力之成效及啟示。科學教育學刊，22(1)，1-32。
   連結：
2. 高聖博,黃金洲,王明誠,蔡育倫,陳志榮(2010)。臺灣醫學教育學會韓國OSCE國考參訪報告與建議—標準化病人篇。醫學教育，14(2)，137-142。
   連結：
3. 潘慧玲,陳玟樺(2015)。教師開展學習共同體的反思性實踐。中等教育，66(1)，40-57。
   連結：
4. Barry, M. J.,Edgman-Levitan, S.(2012).Shared decision making—The pinnacle of patient-cen-tered care.New England Journal of Medicine,366(9),780-781.
5. DiCenso, A.,Cullum, N.,Ciliska, D.(1998).Im-plementing evidence-based nursing: Some mis-conceptions.Evidence Based Nursing,1(2),38-39.
6. Fineout-Overholt, E.,Melnyk, B. M.,Schultz, A.(2005).Transforming health care from the inside out: Advancing evidence-based practice in the 21st century.Journal of Professional Nursing,21(6),335-344.
7. Freire, P.(1973).Education for Critical Conscious-ness.New York:Continuum.
8. Freire, P.(2000).Pedagogy of the Oppressed.New York:The Continuum.
9. Gillespie, M.(2002).Student—teacher connection in clinical nursing education.Journal of Advanced Nursing,37(6),566-576.
10. Habermas, J.(2015).Communication and the Evolu-tion of Society.John Wiley & Sons.
11. Heydari, A.,Yaghoubinia, F.,Roudsari, R. L.(2013).Supportive relationship: Experiences of Iranian students and teachers concerning student-teacher relationship in clinical nursing education.Iranian Journal of Nursing and Mid-wifery Research,18(6),467-474.
12. Hoffmann, T. C.,Montori, V. M.,Del Mar, C.(2014).The connection between evidence-based medicine and shared decision making.The Journal of the American Medical Association,312(13),1295-1296.
13. McLeland, A.,Williams, A.(2002).An emancipa-tory praxis study of nursing students on clinical practicum in New Zealand: Pushed to the pe-ripheries.Contemporary Nurse,12(2),185-193.
14. Murad, M. H.,Alsawas, M.,Asi, N.,Alahdab, F.(2015).The New Evidence Pyramid.Newsletter of the International Society for Evidence-Based Health Care,21,8-9.
15. National League for Nursing. (2012). Core competen-cies of nurse educators. Retrieved from http://www.nln.org/ facultyprograms /competencies/index.htm
16. Satterfield, J. M.,Spring, B.,Brownson, R. C.,Mul-len, E. J.,Newhouse, R. P.,Walker, B. B.,Whitlock, E. P.(2009).Toward a Transdisci-plinary model of evidence-based practice.Mil-bank Quarterly,87(2),368-390.
17. Sidani, S.,Epstein, D.,Miranda, J.(2006).Elic-iting patient treatment preferences: A strategy to integrate evidence-based and patient-cen-tered care.Worldviews on Evidence Based Nursing,3(3),116-123.
18. St,Onge, J. L,Parnell, R. B.(2015).Patient-cen-tered care and patient safety: A model for nurse educators.Teaching and Learning in Nursing,10(1),39-43.
19. Sun, F. K.,Long, A.,Tseng, Y. S.,Huang, H. M.,You, J. H.,Chiang, C. Y.(2016).Undergrad-uate student nurses’ lived experiences of anxiety during their first clinical practicum: A phenome-nological study.Nurse Education Today,37,21-26.
20. United Nations Educational, Scientific and Cultural Organization. (2013). Definition of ESD. Re-trieved from http://www.unescobkk.org/ educa-tion/esd-unit/definition-of-esd/
21. Wagner, E. H.,Bennett, S. M.,Austin, B. T.,Greene, S. M.,Schaefer, J. K.,Vonkorff, M.(2005).Finding common ground: Patient-centeredness and evidence-based chronic illness care.Journal of Alternative and Complementary Medicine,11(1),7-15.
22. Walker, A.,Campbell, K.(2013).Work readiness of graduate nurses and the impact on job sat-isfaction, work engagement and intention to remain.Nurse Education Today,33(12),1490-1495.
23. 佐藤學,黃郁倫,鐘啟泉(2012).學習的革命：從教室出發的改革.台北市:親子天下.
24. 李皎正,鍾聿琳(2012)。談護理臨床教育。護理雜誌，59(5)，5-9。
25. 張媚,余玉眉(2010).護理人力及專科護理師制度：願景與挑戰.苗栗縣:國家衛生研究院.
26. 黃瑞祺(1996).批判社會學.台北:三民.
27. 劉克明(2013)。醫學教育評鑑準則。評鑑雙月刊，43，45-49。
28. 潘慧玲,陳佩英,張素貞,鄭淑惠,陳文彥(2012)。從學習領導論析學習共同體的概念與實踐。北市教育學刊，45，1-28。
29. 潘慧玲,黃淑馨,李麗君,余霖,劉秀嫚,薛雅慈(2015).學習領導下的學習共同體進階手冊2.0版.
30. 蔣立琦(2014)。護理新視界—實證護理的演變與發展。護理雜誌，61(4 特刊)，85-94。
31. 蔣立琦,林佳慧,王桂芸(2013)。實證護理的新時代—全面啟動發展護理科學。護理雜誌，60(5)，11-17。

1. 蔣立琦、廖美南(2017)。以實證為基礎的護理轉型照護。護理雜誌，64(1)，25-31。