利用情境模擬教學提升臨床人員溝通能力

Using Simulation Teaching to Improve the Communication Skills of Clinicians

背景：護理人員具備良善的溝通能力可減少護病衝突發生。鑒於本單位每月因靜脈注射過程溝通欠佳，平均抱怨件數達20－25件。經調查發現56.25％護理人員自評溝通能力低於整體平均值，故引起專案小組改善動機。本專案透過訪談與實地觀察，發現導致溝通不良的原因為教育訓練課程設計未符合臨床照護需求、人員執行靜脈注射溝通經驗不足及自信度偏低、缺乏溝通實務之影音教材。目的：透過專案設立合宜教學模式，以提升兒科護理人員於靜脈注射過程之溝通能力。解決方案：經專案小組提出改善方案為修訂小兒靜脈注射訓練課程、設計溝通教案、培訓溝通種子教師、溝通實境影片拍攝、定期舉辦案例討論並收錄教戰手冊中。結果：護理人員於靜脈注射過程可運用語言或非語言引導病童及家屬溝通，理解其表達的重點並有條理地做出回應，整體溝通能力由27.25分提升至35.94分（總分8－40分）。結論：本專案結合情境模擬建立溝通教學模式，有效提升護理人員靜脈注射過程之溝通能力，期望藉此專案分享，促使護理人員與病童及家屬建立良善的護病關係。

Background & Problem: Better communication skills improve the ability of nurses to reduce conflicts with patients. In our medical center, complaints related to poor communication skills during the indwelling of venous catheters number as many as 20-25 cases per month. In our survey, we found that over half (56.25%) of nursing personnel in our medical center self-reported as having ''below average'' communication skills. Our project team decided to make improvements using interviews and a field survey. After analysis, the team found that reasons for poor communications skills include: the design of educational training courses do not match clinical care needs; the lack of communicative experience while performing venous catheters indwelling; the low confidence of medical personnel; and the lack of communication-skills-related video teaching materials. Purpose: Establish suitable teaching project modes that improve the communication skills of nursing personnel in the pediatric department during venous catheters indwelling procedures. Methods: The improvement methods proposed by the project team consisted of: modifying the pediatric-venous-catheter-indwelling training course, designing teaching courses to enhance communication skills, training seed teachers to teach communication skills, produce videos clips showing scenarios of communication, holding regular case report discussions, and compiling these discussions into an instruction manual. Results: Nursing personnel utilized language or non-language methods to guide pediatric patients and to communicate with their parents during venous catheters indwelling. They understood what patients and their parents were expressing and responded to their questions and concerns logically. The mean score for overall communication skills increased from 27.25 to 35.94 (range: 8 to 40). Conclusions: Communication teaching modes that combine simulation teaching were established in this project. The communication skills of nurse personnel increased significantly during venous catheters indwelling. We expect to promote a better relationship between nurse personnel, pediatric patients, and their parents by sharing this project.