運用客觀結構式臨床測驗以評量出院準備護理人員溝通能力之研究

The Use of OSCE to Evaluate the Competency of Discharge Nurses

背景：良好的出院準備照護指導，能有效改善病人的健康和減少再入院率。護理人員的溝通能力於出院準備照護指導至關重要，其有助於病人出院照護需求評估，提供清晰、合宜的照護指導及技能，改善其認知、減少焦慮和增強返家照護的信心。目的：本研究探討情境模擬溝通課程介入後以客觀結構式臨床測驗評量護理人員溝通能力之學習成效。方法：本研究為實驗性研究設計，採方便取樣，以北市某醫學中心N2以下護理人員（N = 78）為研究對象，透過分層區組隨機分派，實驗組接受「情境模擬溝通教學課程」，對照組則接受「案例討論溝通教學課程」；並以「客觀結構式臨床測驗」評量課程介入後之成效，研究資料使用SPSS 17.0 Windows套裝軟體進行各項統計分析。結果：溝通教學介入後，以獨立t檢定比較對照組與實驗組客觀結構式臨床測驗考官評量得分，呈現統計上顯著差異（t = 3.406, p < .05），且實驗組（M = 5.00, SD = 0.82）得分高於對照組（M = 4.11, SD = 1.41）；而標準化病人評量得分則無顯著差異。結論：以「客觀結構式臨床測驗」評量兩組教學課程之介入，顯示情境模擬教學課程之介入，於護理人員出院準備溝通能力之提升，優於案例討論教學課程。

Background: Clear directions and explanations from nurses related to health behaviors and discharge procedures have been shown to effectively reduce the risk of patient readmission. Nurses thus need to develop good communication skills in order to ensure that their communications help patients become better-informed and less anxious about discharge procedures. Purpose: This research evaluates the communication skills of nurses following two different education interventions. Methods: Experimental design principles for education interventions were followed in this research. Medical nurses certified at the N to N2 level in a municipal hospital in Taipei City were enrolled as participants (N = 78) and divided into an experimental group and control group using stratified purposive randomization. The experimental group received clinical scenario-based simulation education for communication. The control group received standard class-based education for communication. Both groups received a pre-test evaluation and an OSCE post-test evaluation. Results were analyzed using SPSS 17.0 software. Results: Independent t-test results revealed significant increases in communication skills (t = 3.406, p ＜ .05) in both groups, with the increase in the experimental group (M = 5.00, SD = 0.82) significantly greater than the increase in the control group (M = 4.11, SD = 1.41). However, the mean scores from the post-test standardized patient survey found no significant differences between the two groups in terms of communication skills. Conclusion: The results indicate that the clinical scenario-based simulation education intervention is more effective than traditional class-based education in enhancing the communication skills of nurses.