運用多元化教學策略提升兒科NPGY 學員對川崎症照護之正確率

Using Diversified Teaching Strategies to Promote the Accuracy of Kawasaki Disease Care for Pediatric NPGY Students

川崎症病童容易誘發有冠狀動脈血管擴張及動脈瘤之併發症而有致死的危險性或終身心臟病影響生活品質，故護理人員需具備正確的川崎症照護的知能。現況兒科病房發現兩年期護理師（士）訓練計畫中的學員（Nurse Post Graduate Year；NPGY）對川崎症照護正確率低之主因為學員對川崎症照護認知及照護能力不足、缺乏照護之輔助工具、未辦理川崎症照護教育訓練，及單位間輔導訓練計畫項目不一致等。經分析及討論後結合川崎症醫療團隊實施解決方案包括1.製作川崎症照護的多媒體影片及電子書輔助；2.運用「團隊導向學習」（TBL）及「翻轉教學」教學策略共同執行川崎症照護之團隊導向學習的教育訓練；3.建置川崎症評估及照護指引，讓臨床護理人員可以遇到疑似個案時可以做為評估及臨床照護之依據；4.重整NPGY學員輔導訓練計畫，使護理臨床教師能一致性進行教導及評核。結果顯示1.NPGY學員對川崎症照護認知的正確率由36.1%提升至96.6%；2.川崎症照護能力由未達標準的2.5分提升至一般標準以上的7.6分。因成效卓越，已擴大分享於兒科門診及兒童內科部，並進一步建置川崎症照護電子書置於本院數位學習網站，提供院內醫護人員參閱使用，以提升川崎症照護品質。

Children with Kawasaki disease are prone to complications of coronary artery vasodilation and aneurysm, which may be fatal or lead to life-long heart disease, affecting the quality of life. Therefore, nursing staff need to have the correct knowledge and nursing skills for Kawasaki disease care. The pediatric ward found that the trainees in the two-year Nurse Post graduate Year (NPGY) training program had a low accuracy for Kawasaki disease care, mainly due to insufficient knowledge and skills, lack of supportive care tools, and lack of consistent education and training programs across units. After analysis and discussion, the solutions were implemented jointly with the medical team as the followings: first, producing multimedia videos and e-book as educational tool for Kawasaki disease care; second, using ''team- based learning '' (TBL) and '' flipped teaching '' to facilitate team-oriented learning; third, establishing Kawasaki disease assessment and care guidelines for nursing staff; and fourth, reorganizing the coaching training plan for NPGY trainees, so that the nursing clinical teachers can conduct teaching and evaluation consistently. The results showed that the accuracy rate increased from 36.1% to 96.6% and the care ability improved from 2.5 points (below the standard) to 7.6 points (above the standard). Given the excellent results, the program has been expanded to the Pediatric Outpatient Clinic and the Department of Pediatric Internal Medicine. The Kawasaki Disease Care E-book has been posted on the hospital's digital learning website as a reference for medical staff to improve the quality of Kawasaki disease care.