實作導向的個案報告訓練成效評值

Evaluation of the Effectiveness of a Clinical Case Report Training Program through ＂Learning by Designing＂

背景：近年來護理人力嚴重不足，加上輪班的工作特性，影響人員參與個案報告撰寫的動機與成效，台灣基層護理人員臨床能力之進階制度資格，在學術能力上要求晉升需完成個案報告；許多人員有很好的護理經驗，可惜不擅長以文筆呈現，個案報告撰寫亦成為護理人員能力進階制度中的瓶頸。目的：本研究旨在評值實作導向個案報告訓練施行後之成效。方法：採單組時間序列設計之介入性研究，樣本取自於北部某區域教學醫35院位N2以上護理人員，依意願分成7組並給予7個月的貫作導向個案報告訓練。訓練內容包含個案報告講授、各組個案報告內容討論及個案報告實際撰寫的訓練方式，並以過程指標（出席率、作業完成率）及結果指標（台灣護理學會通過篇數、期刊刊登篇數以及訓練前中後學員自我效能）評值。結果：本研究對象平均出席率為94.3%，各組作業完成率100%。訓練結束後共完成35篇個案報告（100%），通過台灣護理學會共18篇（51.4%），期刊刊登共6篇。訓練中與訓練後撰寫個案報告的自我效能得分與訓練前比較皆達顯著差異。結論／實務應用：實作導向的個案報告訓練方式，可增加學員自我效能及增加期刊發表篇數，建議此種實作導向的教學方式可運用在護理行政專案或研究報告訓練課程。

Background: In recent years severe nursing shortages plus rotations in work schedule influence nurses' motivation to take courses for presenting clinical case reports in writing. In Taiwan, academic ability to demonstrate a clinical case report in writing is required for frontline nurses so that they can promote their career development. Many nurses have good clinical nursing experiences without good writing ability to detail a clinical care report. The lack of ability to demonstrate a clinical case report in writing becomes the bottleneck for nurses who want to be promoted in their career development. Purpose: The purpose of this study aims to evaluate the effectiveness of clinical case report training through ＂learning by designing＂. Methods: The study design was a simple-group time-series of intervention. The subjects were 35 stage II staff nurses in a regional teaching hospital in northern Taiwan. They were divided into seven teams and attended a Learning by Designing training program for seven months. The training contents included lecture on case reports, individual team's case report discussion, and actual writing practice on case reports. The evaluation methods were based on process indicators (nurse attendance rate, completion of homework) and outcome indicators (published articles in Taiwan Nurses Association magazines or professional journals and participants' selfefficiency evaluation before, during, and after training). Results: The study subjects' attendance rate was 94.3%, and 100% of all subjects submitted their homework. 18 reports (51.4%) were passed by Taiwan Nurses Association with 6 reports of them published in professional journals. The self-efficacy score in writing a clinical case report before and after training showed significant differences, as well. Conclusions: The findings revealed that the ＂learning by designing＂ training program has a significant impact on nurses' self-efficacy in demonstrating clinical case reports and increases the number of articles published in professional journals. We suggest that such a teaching program be used in nursing administration projects or nursing research training courses.