神經系統護理案例概念圖教學對學生認知成效評量之研究

A Study on the Cognitive Learning Effectiveness of Scenario-Based Concept Mapping in a Neurological Nursing Course

背景：神經系統因知識內容層次多，學生於學習時易感到恐懼，加上複雜不定的醫療情境，使護生難以適應及展現基本照護知能。案例概念圖教學有助於複雜資料的整合與概念釐清並提升認知學習成效。目的：探討以案例概念圖教學策略融入神經系統護理單元，對學生神經系統護理認知成效及學習態度情形。方法：採類實驗性研究，方便取樣某護理科技大學四技二年級學生為研究對象，以SPSS 17.0進行4班級集群隨機。實驗組2班採案例概念圖教學，對照組2班採傳統課室教學，認知成效評量是以神經系統認知測驗前後測得分之差異分析之。結果：案例概念圖及傳統課程介入，兩組在神經系統護理認知測驗後測得分皆有顯著進步（p＜.001），但未達統計上顯著差異（p=.51）。課後質性回饋於開放性問題陳述意見，實驗組的正向回饋（59%）多於對照組（49%），對照組多認為學習內容太多且難懂；實驗組對案例概念圖教學多持正向學習態度，希望增加神經相關解剖生理及病理授課時數並融入概念構圖活動，以提升學習成效。結論：以傳統課室教學或案例概念圖介入神經系統護理課程教學，皆可提升神經系統護理認知，學生對案例概念圖的教學介入多表達正向學習態度。

Background: The multiple levels of knowledge related to the neurological system deter many students from pursuing studies on this topic. Thus, in facing complicated and uncertain medical circumstances, nursing students have difficulty adjusting and using basic neurological-nursing knowledge and skills. Scenario-based concept-mapping teaching has been shown to promote the integration of complicated data, clarify related concepts, and increase the effectiveness of cognitive learning. Purpose: To investigate the effect on the neurological-nursing cognition and learning attitude of nursing students of a scenario-based concept-mapping strategy that was integrated into the neurological nursing unit of a medical and surgical nursing course. Methods: This quasi-experimental study used experimental and control groups and a pre-test/post-test design. Sophomore (2^(nd) year) students in a four-year program at a university of science and technology in Taiwan were convenience sampled using cluster randomization that was run under SPSS 17.0. Concept-mapping lessons were used as the intervention for the experimental group. The control group followed traditional lesson plans only. The cognitive learning outcome was measured using the neurological nursing-learning examination.Results: Both concept-mapping and traditional lessons significantly improved post-test neurological nursing learning scores (p＜.001), with no significant difference between the two groups (p=.51). The post-test feedback from the control group mentioned that too much content was taught and that difficulties were experienced in understanding mechanisms and in absorbing knowledge. In contrast, the experimental group held a significantly more positive perspective and learning attitude with regard to the teaching material. Furthermore, a significant number in the experimental group expressed the desire to add more lessons on anatomy, physiology, and pathology. These results indicate that this intervention strategy may help change the widespread fear and refusal of nursing students with regard to neurological lessons and may facilitate interest and positively affect learning in this important subject area. Conclusion: Integrating the concept-mapping strategy and traditional clinical-case lessons into neurological nursing lessons holds the potential to increase post-test scores significantly. Concept mapping helped those in the experimental group adopt views and attitudes toward learning the teaching material that were more positive than those held by their control-group peers. In addition, while 59% of the experimental group and 49% of the control group submitted opinions related to learning attitude in the open-ended questions, positive feedback was greater in the experimental group than in the control group.