運用情境模擬教學提升手術室護理人員對心臟手術認知與技能之學習成效

How Situational Simulation Teaching Improves Learning Outcomes of Perioperative Nurses in Acquisition of Knowledge and Nursing Skills in Cardiac Surgeries

心臟手術之護理師要有敏銳的觀察力、應變力及具備專業知能及技術，尤其是面對緊急狀況時，必須迅速做判斷及處理，以維持病人的生命徵象，所以心臟手術之護理師具備有相當的認知與技能是非常重要的。本單位人員在完訓後仍對於心臟手術相關知識、步驟與流程仍無法精熟，以致手術當中因人員不熟悉而手術必須暫停，更甚至影響到病人術中之安全，故引發改善動機。本專案旨在提升手術室護理人員對心臟手術認知與技能之學習成效。現況發現：刷手護理師訓練期短而經驗不足、無提供用物準備清單，且無練習用之教具、未建立學習目標，亦無受訓前的課室教學規劃，以致人員對心臟手術認知正確率59.4%、技能僅73.4%。透過舉辦情境模擬教學工作坊、製作心臟手術之心智圖與心臟手術用物準備手冊、增設練習用之教具、建構學習目標及評核表後，認知提升至95.8%，技能增加至93.2%，提升效果顯著，建議未來可將情境模擬教學工作坊平行推廣至流程複雜或學習難度較高的手術，取代傳統的課室講習，增加新訓人員術前預習與術後複習的學習機會，以提升手術室護理人員專業知能且增進臨床實務技能。

A cardiac operation nurse must be equipped with professional knowledge and techniques, a keen observation and the ability to respond to any challenges during an operation. When faced with an emergency situation, they have to make judgments and handle the situation promptly, in order to maintain the stability of the vital signs of patients. Hence it is essential that a cardiac operation nurse should possess considerable knowledge and nursing techniques. The staff of this unit was not familiar with the basic knowledge and procedures of a cardiac surgery after the training was completed. This lack of mastery of nursing skills has led to surgery suspension and even affected the safety of the patient during an operation. This inspires motivation to improve the situation. The aim of this project was to improve the learning outcomes of surgical nursing team's knowledge and nursing skills that are required of a cardiac surgery. We discovered that scrub nurses were generally inexperienced due to shorter period of training. The accuracy rate of their knowledge of cardiac surgeries was only 59.4%, and their nursing skills were at 73.4% because of lack of provision of a surgical items list and teaching tools (for repetitive practice), not to mention that learning objectives and classroom teaching plans were not set and arranged before training. Through conducting situational simulation teaching workshops, creating a mind map of cardiac surgeries, providing a manual for provision of surgical items and a range of teaching tools, and establishing learning objectives and an assessment scale, we found that the accuracy rate of their knowledge reached 96%, and nursing skills reached 93%. A remarkable progress has been made. Therefore, we suggest that situational simulation teaching workshops should be held to replace traditional classroom instructions, so as to help the staff members helping with surgeries of complex medical procedures. This may well increase the learning opportunities of newly trained staff before and after surgeries, so that surgical nursing teams may be able to sharpen their professional knowledge and clinical nursing skills at the same time.