比較不同心肺復甦術暨自動體外心臟電擊去顫器教學策略之成效

A Comparison of the Effectiveness of Two Instructional Strategies in Teaching Cardiopulmonary Resuscitation and Automatic External Defibrillator

背景：應用錄影帶教學於急救訓練教學之學習成效不一，也少有相關研究應用階梯式分段教學法於急救訓練課程中；再者，自動體外心臟電擊去顫器逐漸在台灣各地設置，是緊急醫療到院前救護很重要的急救措施，護理人員透過不同教學模式所獲得的知識及日後執行的成效上可能將會有所不同。
目的：探討護理人員接受不同CPR 暨AED 的教學策略與工具，在知識得分及技術執行能力之差異與變化情形。
方法：採類實驗前後測研究設計，立意取樣自參加某醫院與中華民國急救技能推廣協會舉辦之CPR 暨AED 訓練課程的護理人員，依報名梯次分派為實驗組和控制組，先就控制組收案，之後為實驗組。控制組65 人接受CPR 暨AED 之「傳統講述教學法」，實驗組65人則接受「錄影帶輔助分段教學法」。本研究以CPR 暨AED 之知識得分量表及技術執行能力檢核表進行施測，並採用SPSS 17.0 統計軟體進行資料處理與分析。
結果：實驗組與控制組在CPR 暨AED 知識得分方面，從組間效應來看，後測得分皆優於前測(p < .001)；技術執行能力方面，實驗組(mean = 2.42, SD = 0.83) 與控制組(mean = 2.22, SD= 0.89) 無顯著差異；而組間效應方面，知識得分量表為實驗組顯著高於控制組(b = 1.95, p= .002)，技術執行能力則無組別之顯著差異(b = 0.11, p = .927)，但技術執行能力整體表現則實驗組顯著高於控制組(b = 0.36, p = .033)。
結論：錄影帶輔助分段教學可於課程中進行觀察學習與重複練習，其教學方式於知識的學習效果比傳統講述教學顯著；但技術執行能力仍須靠課後持續學習才能維持。建議發展與推廣CPR 暨AED 錄影帶，供曾學習過之對象於家中反覆模擬練習使技術保留，以維持學習者執行急救技術的專業性。

Background: Video-aided instruction has been applied in a number of first-aid training sessions, with mixed results, and very few studies have addressed the issue of effectiveness of step-by-step first-aid instructional strategies. Automated external defibrillators (AEDs) are now becoming readily available in public places all over Taiwan as an essential tool for first-aid care before ambulance arrival. Different instructional strategies might make different impact on knowledge and competency acquisition of nurses.
Purpose: This study aims to investigate the impact of different forms of educational intervention on nurses’ knowledge and competencies in CPR and AED.
Methods: A quasi-experimental pre-test post-test design was adopted. A purposive sample of nurses receiving CPR and AED training jointly organized by a hospital in Taiwan and the Society of Resuscitation Medicine Taiwan was recruited, and assigned to the experimental or control group depending on when they had signed up for the training. The control group received the educational intervention before the experimental group did. Sixty-five nurses in the control group received a traditional lecture on CPR and AED, while another 65 nurses in the experimental group were given step-by-step video-aided instructions on CPR and AED. Data were collected using “CPR and AED Knowledge Scale” and “CPR and AED Competencies Checklist,” and then processed and analyzed using the SPSS statistical software package for Microsoft Windows (version 17.0).
Results: The within-subjects effects indicated increases in CPR and AED knowledge from pre-test to post-test (p < .001) in both groups. However, no significant differences in CPR and AED competencies between the experimental group (mean = 2.42, SD = 0.83) and the control group (mean = 2.22, SD = 0.89) were observed. The between-subjects effects indicated that the experimental group had significantly higher CPR and AED knowledge scores (b = 1.95, p = .002). No significant differences in CPR and AED competencies (b = 0.11, p = .927) were observed, but the experimental group was found to have significantly greater overall competencies in CPR and AED than the control group (b = 0.36, p = .033).
Conclusion: Video-aided, step-by-step instruction is useful in classroom teaching because learners can observe and practice repeatedly. It was found to be a more effective means of knowledge acquisition than traditional lecture. However, it is still important for nurses to practice constantly after the intervention to maintain a high level of competencies. Video-aided instruction should be widely applied in CPR and AED training as a way of facilitating repeated practice to maintain a level of competencies appropriate for conducting first aid medicine.