護理臨床教師對二年期護理師訓練成效之評價

Evaluation of a Two-year Training Program for Nurses by Preceptors

目的：合適的護理人員是提供病人安全照護的關鍵，臨床教育訓練可提升專業知能和技能，進而促進工作效能和品質。本研究旨在比較二年期護理師（護士）訓練制度對護理能力和護理能力進階之差異情形。
方法：本研究採類實驗之兩組（不同時間）後測時間序列設計，使用結構式「護理能力」評量表含照顧、臨床、行政、臨床教學、危急病人處理、研究六大構面共79題，以某醫學中心新進護理人員為對象。於2005年到職者為對照組施行舊訓練制度，2008年到職者為實驗組施行新訓練制度，由護理臨床教師從新進護理人員到職次年連續三年之四月份各追蹤評量一次。
結果：在第一年之照顧、臨床、行政、臨床教學、危急病人處理、研究及總護理能力等7項效果指標，實驗組皆顯著高於對照組。兩組在第二年及第三年相較於第一年7項效果指標皆顯著提升。護理能力之7項效果指標在第二年相較於第一年改變量兩組間無顯著差異，而第三年相較於第一年在照護能力上實驗組顯著低於對照組。兩種訓練制度皆提升了護理能力進階比率，在第二年兩組取得N1及N2之比率未達顯著差異；在第三年則達顯著差異，而以實驗組之護理人員取得N1及N2之比率較高。
結論：本研究結果顯示持續不斷的繼續教育能促進護理能力之成長，另為新進護理人員安排標準化課程及專任、固定、受過訓練的護理臨床教師進行指導，能有效提升護理能力進階之比率。結果期能作為今後實施訓練計畫與修訂學習護照，並加強護理人員能力訓練之參考，以提升照護品質。

Objective: Clinical education can improve professional knowledge and skills, and ultimately improve the quality and efficiency of care. This study compared two training systems in terms of nursing competency and the clinical ladder.Methods: This study used a time series design in which posttest scores were measured in quasi-experimental groups (at different times). Newly employed nurses in 2005 served as the control group as they were trained using the old training system. Newly employed nurses in 2008 served as the experimental group as they were trained using a new training system.Results: The experimental group was significantly better than the control group on the seven indicators in the first year. In the second and third years, the seven indicators were significantly enhanced in both groups. When the second year was compared to the first year, the seven indicators were not significantly different between groups. When the third year was compared to the first year in terms of care skills, the experimental group had significantly lower scores than those of the control group. Based on the clinical ladder as a measure of provision of care, both groups improved in the second year but there was no significant difference between them. In the third year, scores in the experimental group were significantly higher than those in the control group.Conclusions: Clinical education can improve nursing competency. A standardized curriculum and full-time, fixed, trained preceptors guiding clinical care can effectively enhance the clinical ladder. These results may be used as a reference for modifying the nursing training program in order to improve the quality of nursing care.