提升新進護理師協助腰椎脊髓鞘內注射化學藥品認知、技術與自信

Enhancing New Nurses' Knowledge, Skills, and Confidence in Assisting Lumbar Intrathecal Chemotherapy Administration

腰椎穿刺併脊髓鞘內注射化學藥品（intrathecal injection, IT）執行程序繁瑣，護理師需於時效內，協助醫師執行。新進護理師協助操作此技術之完整率前測為43.7%，原因包括對流程不熟悉、練習不足、自信心低、無完整用物清單和教育訓練等。經由製作技術寶典及拍攝教學影片、推動翻轉教學、舉辦情境模擬考、建立用物清單、及納入新進護理師必學項目等解決方法。前後採用魏克生符號等級檢定（Wilcoxon signed-rank test），結果顯示新進護理師協助醫師操作此技術之流程完整率，由43.7%提升至98.0%（p=0.0003）；新進護理師之認知正確率，由64.3%提升至100%（p=0.017），新進護理師自評執行自信心程度，由6.7分提升至9.0分（p=0.011）。此教學模式可有效提升新進護理師的知能與自信心，建議推廣至其他需執行腰椎穿刺併IT注射之單位，以提升整體照護品質。

Lumbar puncture combined with intrathecal chemotherapy administration is a complex procedure. Nurses must ensure that medications are administered within the prescribed time frame while assisting physicians during the procedure. The pre-test completion rate for new nurses assisting with this technique was 43.7%. The low completion rate was attributed to factors such as unfamiliarity with the procedure, insufficient practice, low self-confidence, absence of a comprehensive list of required materials, and inadequate education and training. Proposed solutions included developing technical manuals and instructional videos, implementing flipped learning strategies, incorporating simulation-based assessments, establishing comprehensive material lists and including mandatory training requirements for new nurses. The Wilcoxon Signed-Rank Test was employed to evaluate the outcomes, revealing a significant improvement in performance metrics. The process completion rate for new nurses assisting physicians with this procedure increased from 43.7% to 98.0% (p =0.0003). Additionally, the knowledge accuracy rate improved from 64.3% to 100% (p = 0.017) and self-rated confidence scores (on a 10-point scale) increased from 6.7 to 9.0 (p = 0.011). These strategies have demonstrated the capacity to enhance both the knowledge and operational confidence of new nurses. The success of this project provides a valuable framework for other healthcare institutions and suggests its applicability to units requiring lumbar punctures with intrathecal chemotherapy administration. Ultimately, this supports the learning of new nurses and improves the quality of patient care.