感同身受，化礙為愛～應用建構主義於內外科護理實習之經驗

Being Empathetic to Turn Obstacles into Love: The Experience of App Constructivism in the Medical- Surgical Nursing Practice

臨床實習是護理專業課程最關鍵的學習歷程，可以將課室所學的專業知識技能實際應用在臨床實務，但學生在實習時面臨學理不熟悉、溝通技巧不熟練等壓力，面對病人常不知所措，甚至感到害怕，難以感受病人身、心、社會層面的各種不適，常以自我的想法及標準提供自認為具關懷的照護，缺乏由病患角度思考照護內容。
本文乃分享筆者的臨床實習教案，以建構主義為基礎，經由體驗情境促使學生主動察覺病人的問題，再藉由整合同儕之間的合作學習成果，增進學生整體臨床照護能力。教案實施後，「體驗教學組」的各項自我評值成績皆高於「一般教學組」，進一步以t檢定分析，發現『能引導學生應用課室教學之相關概念於病人護理中』的項目達顯著差異。另外分析學生的體驗心得，發現學生經過「我已經不是我」、「進入你的世界」、「原來我不夠好」、「讓我幫幫你」的一連串心理歷程後，除了學習主動性提升、關懷程度改善外，更能為病人設計個別性之護理措施。期望本教案可作為臨床教師教學的參考，增進學生對護理之正向認知，進一步應用於臨床照護中。

Clinical internship is the most important learning stage in the professional curriculum of nursing education; at this stage, all professional knowledge and skills learned in the classroom can be applied to clinical practice. However, during internship, when students are under the stress of practicing unfamiliar procedures or have poor communication skills, they often do not know what to do when facing patients or may even be afraid, thereby being unable to feel patients’discomforts from all perspectives, including those in terms of physical, mental, and social aspects. The students often provide what they believe to be compassionate care according to their own opinions and standards without considering the needs of patients from the patients’perspective.
This article is a teaching plan for clinical internship based on the author’s experiences. Using constructivism, the students are prompted to detect the problems faced by their patients through situated learning. The students’overall ability in clinical care is further improved by integrating the results of cooperative learning among peers. After implementing the teaching plan, the self- evaluation scores in all categories are higher in the situated learning group than in the typica teaching group. Using the t -test for analysis, we found that the category of“teaching students to apply related concepts learned in the classroom to caring for patients”attained significant difference. Additionally, analysis of students’experience revealed that after they went through a series of mental journeys, such as“I am no longer myself,”“Into your world,”“I am not good enough,”and“Let me help you.”Not only were their learning initiatives increased, their extent of caring improved and they could also design individualized nursing activities for patients. It is hoped that this teaching plan can provide a reference for clinical instructors in their teaching strategies to improve students’positive perception of nursing care and be further applied in clinical nursing care.