護理臨床教師對操作技能直接觀察評量法的看法

過去操作技能直接觀察評量法＂（DOPS）主要運用在評量住院醫師的臨床訓練成效，但卻極少運用在護理人員的訓練。故本文希望透過工作坊的坊的方式，了解護理臨床教師對DOPS評量法的看法及其臨床護理運用的適應性。研宄對象為北部某醫學中心的護理臨床教師。工作坊訓練內容包括DOPS課到教學與胰島素技能操作影片賞析，共四小時。之後，分別以舊有之檢核表（checklist）及DOPS評量表進行評分，然後再安排小分享及全體討論，以建立共識。最後以訓練之滿意度問卷表進行成效之評值；並以卡方檢定、t-tset、ANOVA等進行資料之推論性統計分析。在成效方面，55位䕶理臨床教師對訓練之整體滿意度達93.38分（總分100），對課程平均滿意度達4.37分（總分5分）。而在質性結果的分析，正向觀點多認為DOPS評量法較傳統技術評量法重視整體表現及病人溝通，且著重教師與學員間的互動回饋；而負向觀點則有88%的䕶理臨床教師認為評量者標準不一會影響臨床之運用結果。但隨著護理專業能力進階層級增加，則其整體滿意度及對課程之滿意度也隨之提高（P＜0.05）。本研究的結果將可提供未來教育訓練者在導入DOPS評量法於護理技能訓練中的參考，以提升護理人員的技術操作能力及整體的服務品質。

Direct observation of procedural skills (DOPS) had been commonly used to assess the effectiveness of training outcomes for physicians, but it seldom applied in nursing training programs. The aims of this study were to use workshop to understand the perceptions of DOPS among clinical preceptors and to demonstrate its clinical applications. Clinical preceptors were recruited from a medical center in northern Taiwan. The 4-hour training workshop consisted of DOPS lectures and insulin injection video appreciation. After that, a previous used checklist and DOPS evaluation form were used to assess clinical preceptors. Finally, a group sharing and discussion was done to reach consensus among clinical preceptors. Data were analyzed using Chi-square test, t-test, and ANOVA. The overall satisfaction about the training workshop was 93.38 points (out of a 100-point scale). The average satisfaction with the lecture was 4.37 points (out of a 5-point scale). For the qualitative results, most clinical preceptors felt the DOPS was better in the assessment of overall performance, patient communication and interaction between teachers and students than the traditional skill assessment method. For negative viewpoints, about 88% of clinical preceptors thought that discrepancies in standard of evaluation would affect the clinical application outcomes. We also found that with the higher level of clinical ladder, the overall satisfaction and satisfaction with lecture also improved (p<0.05). The findings of this study can serve as references for nursing educators to implement the DOPS in future nursing clinical skills training programs to improve nursing skills competency and improve the quality of nursing services.