讀心術──運用多元教學提昇參與兩年期訓練課程之護理師異常心律判讀及處理能力

“Arrhythmia Reading'': A Diverse Teaching Approach to Improve the Ability of 2 Year NPGY Nurses to Interpret and Manage Arrhythmias

背景：本單位為內科重症病房，專案期間護理新血都是參加二年期護理師訓練課程（nurse post graduate year）學員。護理知能、儀器操作、危急狀況之預測、緊急處置能力、病人問題評估與處理能力是應具備的重症護理能力，心律判讀更是將能力串連及整合的表現，卻又是此階段學員最無法勝任的重症情境。目的：本專案目的為提升參與兩年期訓練課程之護理師異常心律判讀認知、異常心律判讀與處理評量正確率及異常心律照護自信程度。解決方法：自2018年4月5日至6月18日，依現況調查為改善依據，教學改善策略有：（一）異常心律臨床情境教學；（二）建構多媒體教學互動式電子書；（三）規劃記憶策略；（四）心智繪圖。結果：學員異常心律判讀認知正確率由52.5%提升至92.5%、技能評量正確率由56.3%提升至92.5%、異常心律個案照護自信程度由5.5分提升至9.1分，達設定目標。結論：藉由多元教學的介入，不僅加強學員學理記憶和技能，對於異常心律的情境不再慌張，更能發揮問題解決能力，奠定重症護理角色及職業信心。

Background: The author of this paper works in the critical care ward of an internal medicine department. During the study period, current trainees in a nurse post graduate year (NPGY) program joined our nurse team. While at our ward, they were required to demonstrate clinical nursing competencies in intensive care units in the facets of nursing knowledge, equipment use, prediction of emergencies, emergency response, and patient evaluation and management. The ability to interpret arrhythmias is critical to connecting and coordinating these competencies. However, arrhythmia interpretation is usually the most difficult skill for nurses to master. Purpose: This study was developed to improve the knowledge of NPGY trainees regarding arrhythmia interpretation, the accuracy of their arrhythmia interpretation and management, and their confidence in caring for patients with arrhythmia. Resolution: The period of this study spanned from April 5^(th) to June 18^(th), 2018. After surveying the current capabilities of the NPGY trainees to provide a reference for improvement, several teaching strategies were adopted. These strategies included: (1) provision of arrhythmia clinical scenarios; (2) establishment of multimedia teaching and interactive e-books; (3) development of memory strategies; and (4) mind mapping. Results: The accuracy of the trainees' knowledge regarding arrhythmia interpretation increased from 52.5% pretest to 92.5% posttest, while their arrhythmia interpretation skill improved from 56.3% pretest to 92.5% posttest. Furthermore, their caring-for-patients-with-arrhythmia confidence score increased from 5.5 to 9.1. All of the objectives of this study were achieved. Conclusions: The diverse teaching approach employed in this study enhanced the ability of trainees to remember and recall relevant theories as well as improved their related practical skills. Furthermore, posttest, the trainees were significantly less nervous during encounters with patients with arrhythmia and demonstrated improved problem-solving abilities. Participation in this intervention significantly improved the confidence of trainees to serve as critical care nurses and to pursue a career in critical care nursing.