人體護理問題關聯圖對臨床實習護生學習成效之探究

Utilizing the Nursing Care Concept Map on Learning Effect among Nursing Students during Their Clinical Practice

背景：因應全球照護複雜度提升，臨床教學也逐漸運用圖像式思考輔助工具協助學生整理思考脈絡。人體護理問題關聯圖是以病人為中心，將病人問題圖像化引導護生看到核心問題及整體性需求。
目的：以人體護理問題關聯圖為臨床實習教學策略，引導觀看病人整體問題及個別照護，來探討介入前、中、後的學習成效。
研究方法：採混合性研究設計，研究對象為方便取樣，以南部某科技大學護理系學生為主，透過介入「人體護理問題關聯圖」的教學，進行教學前、中、後整體性評估能力量表（最高分為100）、學習滿意度（每題得分範圍為1-5分）及質性「反思週誌」評值。以重複測量變異數分析（Repeated measured ANOVA）分析，介入人體護理關聯圖前中後整體能力量表以及學習滿意度的差異，並以質性內容分析護生的反思週誌歷程。
研究結果：共98位學生參與，平均21.4歲，主要以女性佔78.6%。介入人體護理問題關聯圖前、中、後學生於整體性能力量表呈顯著上升，分別為31.88分、48.34分、73.19分（p < .001），學習滿意度整體平均得分為4.79分，得分最高依序為「提升批判性思考」、「利於推論病人可能的健康問題」、「對病況邏輯更清楚」。
結論：人體護理問題關聯圖能顯著逐步提升護生在整體性評估能力，且也有利於提升批判性思考、並推論病人可能的健康問題以提供個別性的照護，此實證結果可作為臨床實習教學策略的參考。

Background: The increasing number of patients with complex care requirements underscores the necessity of integrating image instruction tools into clinical practice teaching. The nursing care concept map serves as a valuable cognitive aid and promotes a patient-centered approach to care. It helps develop nursing students' critical thinking skills by encouraging information processing for comprehensive understanding.
Objectives: This study aims to explore the impact of a nursing care concept map on the learning outcomes of nursing students during clinical practice teaching.
Methods: Employing a mixed-method study design, 98 nursing students from a science and technology university in Southern Taiwan participated. Data were gathered at three time points during the initiation of clinical practice, utilizing a structured holistic assessment capability test (with a maximum score of 100), assessing learning satisfaction (on a scale of 1-5), and eliciting students' reflections. Repeated measures ANOVA was employed to evaluate the effects of the nursing care concept map on enhancing clinical capability and satisfaction among nursing students. Students' journals were reviewed to understand the depth and extent of reflection.
Results: The study revealed a significant improvement in the holistic assessment capability scores of nursing students, which were 31.88, 48.34, and 73.19 (p < .01) before, during, and after the implementation of the nursing care concept map. The mean learning satisfaction score was 4.79 points, with the top three aspects being enhancing critical thinking (mean: 4.85), identifying healthcare problems (mean: 4.83), and understanding the mechanisms underlying disease processes (mean: 4.81).
Conclusions: The nursing care concept map appears to be an effective teaching strategy, not only improving students' holistic assessment capabilities but also fostering critical thinking and the ability to deduce potential diseases, thereby facilitating personalized care. This empirical evidence serves as a valuable reference for refining clinical practice teaching strategies.