運用核心能力導向醫學教育（CBME）手法提升心導管檢查照護正確率

Use CBME to Design Lesson Plans to Improve the Accuracy of Cardiac Catheterization Care

10.6582/JTSSH.202212_9(2).0003

鄭景蓮(Cheng-Lien Chang)

CBME ； 心導管檢查 ； EPA ； CBME ； Cardiac Catheterization Care ； EPA

台灣擬真醫學教育期刊

9卷2期（2022 / 12 / 01）

36 - 46

繁體中文;英文

背景與目的：心導管檢查護理，與預防合併症及病人安全有密切關係，若衛教指導及照顧不完備可能造成檢查時間延遲、穿刺部位出血、血腫、麻痛、假性血管瘤等合併症，延長住院天數，導致病人和家屬焦慮情況增加。核心能力導向醫學教育（Competence Based Medical Education，簡稱CBME）為近年來醫學教育改革趨勢，根據受訓者所需核心能力設計課程或學程，強調訓練結果，藉此達成以學員為中心的教學與評估，教學結果也可落實在實務操作與表現，可信任專業活動（Entrustable Professional Activity，簡稱EPA），透過觀察學員獨立執行的過程與結果來決定其勝任能力，故適合用來決定學員是否具備「可信任」核心能力。本單位為心臟科病房，執行心導管檢查的病人佔40%，且單位內有1/3為一年內的新人，對於心導管檢查護理照護常有遺漏且傷口突發狀況無法處理，故特此改善。研究方法：一、教材與評量工具設計：1.制定心導管檢查護理教材，提供教學及閱讀。2.製作心導管檢查護理數位模擬影片。3.制定心導管檢查前及檢查後護理EPA。二、學習成效評核：運用EPA進行新人勝任能力認證。研究結果：運用CBME理念，進行人員實務教育訓練、數位影片模擬練習與EPA技術評核等，不僅提高人員知識與技能，增加照護品質，維護病人安全，同時也提升滿意度。每位新人皆通過心導管檢查前後護理照護之勝任能力第4級以上認證，心導管檢查護理照護正確性達100%，傷口照護佳，112年病房護理服務滿意度達90%以上。

Objective: Cardiac catheterization care is closely related to the prevention of complications and patient safety. Insufficient health education guidance and care may cause delays in examination time, bleeding at the puncture site, hematoma, numbness, pseudoaneurysm and other complications, and extend the length of hospitalization, leading to increased anxiety among patients and family members. Competence Based Medical Education (CBME) is a trend in medical education reform in recent years. It designs courses or courses based on the core competencies required by trainees and emphasizes training results, thereby achieving student-centered teaching and evaluation, the teaching results can also be implemented in practical operations and performance. Entrustable Professional Activity (EPA), which determines the competency of students by observing the process and results of independent execution, so it is suitable to be used to determine whether students have " Trustworthy" core competencies. This unit is a cardiology ward, with 40% of patients undergoing cardiac catheterization examinations, and 1/3 of the units in the unit are newcomers within one year. Nursing care for cardiac catheterization examinations is often omitted, and wound emergencies cannot be handled, so we hereby improve it. Methods: 1. Design of teaching materials and assessment tools: (1) Develop cardiac catheterization nursing teaching materials and provide teaching and reading. (2) Make a digital simulation video of cardiac catheterization care. (3) Develop a pre- and post-cardiac catheterization care EPA. 2. Learning effectiveness assessment: Use EPA to certify newcomers' competency. Result: Using the CBME concept to conduct practical personnel education and training, digital video simulation exercises and EPA technical assessments not only improves personnel knowledge and skills, increases care quality, maintains patient safety, but also improves satisfaction. Each newcomer has passed the level 4 or higher competency certification for pre- and post-cardiac catheterization care. The accuracy of cardiac catheterization nursing care is 100%, and the wound care is excellent. The ward nursing service satisfaction rate for 112 years is over 90%.