OMP與ISBAR融合設計教案提升護生交班能力之探討

Discussion on integrating OMP and ISBAR for improving nursing student’s handover abilities

護生及臨床新進護理人員對交班備感壓力，不知如何正確及有效地交班，以保障個案的安全及提供連續性的照護。本教案針對四技內外科護理實習之護生，分為創意教學組及對照組，各24名，創意教學組使用一分鐘教學法及ISBAR交班單、人形圖等多項策略，增進護生對個案的了解，提升交班能力。經「交班能力教學成效評量」進行質量性評量分析，結果發現所有護生於實習第一周及第四週自覺交班能力及實習教師對護生交班能力，以配對t檢定，總分及各項之後測皆顯著高於前測（p＜0.00），顯示所有學生經過實習後交班能力有進步。進一步比較兩組護生自評或老師觀察交班進步之幅度，總分及各題如「我能正確說出生命徵象」、「我能正確說出治療結果及評值差異」、「我能正確說出醫師查房重點」、「我能正確說出大夜班交班內容」、「我能正確說出異常狀況或反應」、「我能正確說出異常處置或衛教」、「我能正確說出處置後的評值結果」、「我能正確流暢交班給主護」、「我對整體交班能力感到」，進步情形創意教學組皆顯著高於對照組。彙整護生參與創意教學策略之心路歷程，從每天經歷「有聽沒懂」、「不得要領」、「恍然大悟」，最後「瞭若指掌」，做出正確且流暢的交班；老師及臨床學姊觀察護生能有條理的交班，甚至藉由交班單輔助，運用電子交班作業系統與學姊交班，完整性及流暢性明顯進步，顯示本教案之訓練能提升護生之交班能力，因此建議實習指導教師可應用此創意教學策略於帶實習過程。

Nursing students and novice clinical nurses frequently face challenges during shift handovers. A lack of proficiency in conducting proper and efficient handovers can pose risks to patient safety and the continuity of care. This study aimed to develop a lesson plan tailored for nursing students enrolled in a four-year technical program, specifically those undertaking medical and surgical nursing internships. Nursing students who participated in this study were divided into a creative teaching group and a control group of 24 students each. The creative teaching group received instruction using the oneminute preceptor (OMP) teaching method, ISBAR (Introduction, Situation, Background, Assessment, Recommendation) handover sheets, and humanoid diagram strategies to enhance their understanding of patients and improve their shift handover abilities. This study evaluated the effectiveness of these teaching strategies through a quality assessment using the 'Teaching Effectiveness and Handover abilities Evaluation' questionnaire. The results indicated that all participants reported increased satisfaction with shift handovers in both the first and fourth weeks of their internship. Furthermore, the instructors who oversaw the nursing students' handovers expressed satisfaction with their performance. Paired t -tests showed that post-test scores, both overall and for individual items, were significantly higher than the pretest scores (p < 0.001), demonstrating an improvement in all students' shift handover abilities following their internship. When comparing both groups in terms of self-evaluation and instructor observation of participants' shift handover abilities, the creative teaching group outperformed the control group, showing significant improvements in overall progress, total scores, and individual item scores. The assessment included the following questionnaire items: ''I can accurately state vital signs.'' ''I can accurately articulate differences in treatment outcomes and evaluations.'' ''I can accurately convey key points from the doctor's ward rounds.'' ''I can accurately summarize the content of the night shift handover,'' ''I can accurately state unusual conditions or reactions.'' ''I can accurately discuss abnormal handling or health education.'' I can accurately describe the evaluation results after patient handling.'' ''I can smoothly and accurately hand over to the head nurse.'' ''I feel satisfied with my overall handover abilities.'' In addition, analyzing the reflections of participants in the creative teaching group, it became evident that they underwent a progressive journey each day. Participants evolved from states of ''not understanding'' and ''missing the key points'' to moments of ''sudden realization'', arriving at a stage of ''comprehensive understanding''. This progression allowed them to execute accurate and seamless shift handovers. Both instructors and senior clinical students observed the participants and noted their ability to conduct well-organized shift handovers. Notably, the participants effectively utilized the electronic shift handover system alongside handover sheets, which significantly improved the comprehensiveness and efficiency of their handovers to senior clinical students. This finding demonstrated that the lesson plan that was implemented in this study bolstered the shift handover abilities of nursing students. Based on these findings, instructors are encouraged to incorporate this creative teaching strategy into their internship programs.