透過「同儕評鑑」與「自我評鑑」評估營養師學程學生對病患的營養狀況訪談及諮商輔導技巧的學習需求

Assessing Nutrition and Dietetic Students' Learning Needs in Nutrition Counseling Skills through Peer-Evaluations and Self-Reflection

背景：研究顯示，營養系的學生需要加強諮詢與輔導技巧的訓練。主修營養師學程要成為營養師的學生，在進入營養師實習課程成為「實習營養師」後，針對需要營養輔導的病患提供專業諮詢服務時，呈現出諮商與輔導的專業能力不足的現象。本研究的目的在透過營養師學程學生的「自我」及「同儕」評鑑的過程與評鑑的結果，評估學生對「諮商輔導」技巧的學習需要。方法：對象為美國德州中大型的州立大學營養師學程四年級修習「營養評估和輔導」(Nutrition Assessment and Counseling)課程的學生。在學期結束前，進行營養評估與諮商輔導的實務演練。演練時，學生做不同的角色扮演，包括了由學生角色扮演成高血酯、高血壓、糖尿病與肥胖症等不同疾病患者（客戶），再由扮演營養師的學生與他們訪談，進行營養狀況評估、並提供營養需求與飲食諮商輔導。每一個營養師輪調訪談四個不同的客戶，每次諮詢時間為20分鐘。訪談結束以後，每個客戶需填寫一個評量表，評量營養師訪談過程中的優點和缺點。同時，每個學生對自己作為營養師，訪談客戶與提供諮商輔導的表現做出自我評鑑。結果：學生認為「營養評估和輔導」的實務演練是一個非常有價值的經驗，讓他們更了解基礎的專業知識對他們未來執行營養師工作的重要性。同時，經由同儕的評鑑及自我評鑑的結果，學生們指出他們需要更進一步學習的方向：1)改善溝通的技巧，2)需要加強自身對食物及用餐計畫的專業知識，才能向客戶提出更適當的建議，3)在訪談與諮商輔導時，必須準備更多有關食物的視覺輔助教材、模型、道具、或講義。結論：實務演練的過程，為學生提供了一個他們未來作為專職營養師會遇到的情境的實務體驗。同時讓學生更深切的了解溝通技巧、營養知識、和知識的實務應用的重要性。營養師養成教育的工作者可以運用這項研究的發現，設計與規劃能有效滿足學生對溝通與諮商技巧，營養專業知識與應用的教材與教學活動，以滿足學生的學習需要和改善其諮商能力。

Background: Dietetic students often show limited counseling skills when they enter internship programs. Research has shown that dietetic students need more training in counseling skills. This study was developed to assess students' learning needs in counseling skills through peer-evaluations and self-reflection. Methods: Students who registered in the senior Nutrition Assessment and Counseling course from a mid-sized university in southeast Texas, United States, performed a counseling practicum at the end of the semester. Students role-playing as clients were given scenarios of common disease conditions (e.g., hyperlipidemia, hypertension, diabetes, and obesity), and students playing as counselors would interview and counsel the client with the specific condition. Each counselor rotated to four different clients, with each session lasting about 20 minutes. Each client filled out an evaluation and noted the strengths and weaknesses of each counselor they met. Each student also evaluated their own performance as the counselor. Results: Students rated the counseling practicum as a highly positive experience that made them more aware of the importance of the foundation knowledge they learned. Through evaluations and selfreflection, students identified 1) the need to improve communication skills, 2) the need for more knowledge of diet and meal plan to make better suggestions, and finally 3) the need to prepare more visual aids, props, handouts. Conclusions: The practicum provides students with an experience that mimics what they will encounter as professionals. Students were more aware of the importance of communication skills, nutrition knowledge, and applications. Nutrition educators can use the results of this study to develop educational activities aimed at meeting students' learning needs and improve their counseling competency.