護理人員參與擬真情境放射線治療皮膚照護工作坊之學習成效研究

The Learning Effectiveness of Nurses Participating in a Simulated Radiation Therapy Skin Care Workshop

背景：接受放射線治療者中，有60-95%出現皮膚反應，易造成病人身心不適與治療延長。針對護理人員的皮膚照護教學，多以講授法而少實際操作，導致護理人員於臨床照護時無法處理多變的情境。目的：本研究探討護理人員參與擬真情境放射線治療皮膚照護工作坊的學習成效。方法：本研究採類實驗單組前測、後測及後後測（介入6週後）的研究設計，以北區某醫療體系有照護放射線治療病人經驗的護理人員（N = 34）為研究對象。於擬真情境放射線治療皮膚照護工作坊中，運用Ausubel的直接教學法及擬真豬皮傷口照護演練等教學策略，並以「放射線治療皮膚照護問卷」及「直接觀察臨床技術評量表」評量其學習成效。結果：擬真情境放射線治療皮膚照護工作坊介入後，以廣益估計方程式（generalized estimating equation）進行分析，結果在知識方面，後後測及後測比前測分別增加了3.14分（p ＜ .001）及2.64分（p ＜ .001）；在態度方面，後後測及後測比前測分別增加2.06分（p ＜ .05）及2.24分（p ＜ .001）；在技術方面，後後測及後測比前測分別增加2.79分（p ＜ .001）及1.68分（p ＜ .001）。結論：擬真情境放射線治療皮膚照護工作坊可顯著提升護理人員於放射線治療皮膚照護的學習成效，建議未來可多利用擬真情境演練作為臨床護理人員教育訓練之策略。

Background: The skin reaction rate is 60-95% in cancer patients that receive radiation therapy. This therapy is likely to cause physical and mental discomfort and prolong treatment for patients. The current emphasis on lectures rather than practice to help nurses learn proper skin care practices likely imposes difficulties for nurses to handle various clinical situations. Purpose: To investigate the learning effectiveness of a simulated radiation therapy skin care workshop for nurses. Method: A total of 34 nurses at a hospital in one health system in northern Taiwan who had never used radiation therapy to provide care to patients were enrolled in this quasi-experimental study. A single group pretest, posttest and post-posttest (6 weeks after intervention) approach was used. At the simulated radiation therapy skin care workshop, we used teaching strategies including Ausubel's direct instruction teaching method and practice on simulated wounds on pig skins. Outcomes were evaluated using ＂the questionnaire of radiation therapy skin care＂ and ＂direct observation of procedural skills checklist＂. Results: The results from the simulated radiation therapy skin care workshop were analyzed using GEE (generalized estimating equation). The post-posttest and posttest scores increased significantly; knowledge mean score 3.14 (＜ .001) vs 2.64 (＜ .001), attitude mean score 2.06 (p ＜ .05) vs 2.24 (p ＜ .001), and skill mean score 2.79 (p ＜ .001) vs 1.68 (p ＜ .001). Conclusion: The simulated radiation therapy skin care workshop demonstrated significant and positive effects on learning outcomes. Therefore, we recommend incorporating this workshop into clinical nursing education and training strategies in the future.