發展重症單位加護新進人員教育訓練方案－－通往成功的階梯

Development of an Education and Training Program for New Intensive Care Unit Staff: Ladders to Success

背景：隨著新冠疫情發展，護理人力短缺問題更為嚴峻。尤其是應屆畢業生因疫情而減少實質臨床實習時數，使其臨床技能較為不足，再加上重症單位的複雜性，更增加新進人員的壓力、降低自信度，導致離職率上升。
目的：發展一個適切性提升重症單位新進人員臨床照護技能及其自信度之新人「階梯式訓練方案」，並評估其成效。
解決方案依據PDDRO模式概念以計畫（plan）、設計（design）、執行（do）、查核（review）和成果（outcome）來執行，發展以新人為中心、具個別性之階梯式訓練方案。除了新人的共通訓練之外，提供三階段的重症教育訓練，強化技術操作能力、身體評估判斷能力及溝通與團隊合作能力。過程中將以多元評量方式針對新人的臨床技能熟練度及自信度做評值，並依據新人能力個別地調整訓練模式直至達到訓練目標。
結果：重症教育訓練的三階梯方案，50位新人完成三階梯訓練模式，主要效益發現新人平均知能分數由79.3分上升至92.3分，工作能力自信度由1.69分提升為2.53分以上，介於部分自信至很有自信之間，均達顯著差異。新進人員留任率由原本推動前的75%上升至84%，訪談人員表示經由此訓練可提升臨床照護能力熟練度，具有自信度可以勝任照護的工作。
結論：超前部署的階梯式訓練建立醫院護理新人培訓制度，以因應疫情後台灣護理人力體系的復原與再建，本專案足以成為新人訓練的成功模型，有效人力留任以創造穩定優質的工作職場。

Background & Problems: The nursing manpower shortage intensified during the COVID-19 pandemic. Moreover, inadequate clinical internship durations during this period led to recent nursing graduates reflecting insufficient clinical skills. These issues, coupled with the inherent complexity of work in intensive care units (ICUs), have increased stress and decreased self-confidence among new staff, leading to higher turnover rates.
Purpose: This study was designed to develop and then evaluate the effectiveness of a tailored ladderized training program for improving clinical care skills and self-confidence in new ICU staff.
Resolutions: An individualized ladderized training program for new staff was developed based on the conceptual PDDRO (plan, design, do, review, outcome) framework. In addition to the program, a 3-stage critical care training regimen was implemented to strengthen technical, physical assessment and judgment, and communication and teamwork skills. A multivariate evaluation approach was employed to evaluate the level to which participants improved in terms of clinical skills and self-confidence, and a competency-related personalized training model was used to guide their progress until all of the training goals were achieved.
Results: Fifty new staff members completed the 3-stage critical care training program. In terms of program effectiveness, mean scores increased from 79.3 (pretest) to 92.3 (posttest) for awareness and 1.69 to 2.53 for work competency self-confidence. These increases were significant, and indicated the participants had collectively improved from“some self-confidence”to“a lot of self-confidence”. Moreover, the retention rate of new staff increased from 75% before the intervention to 84% afterward. Interviews with the participants found the program had improved their mastery of clinical care skills and confidence in their future ability to perform care tasks.
Conclusions: Advance implementation of ladderized training can facilitate the establishment of a new nursing staff training system in hospitals to improve the post-pandemic recovery and reconstruction of nursing manpower systems in Taiwan. This program may serve as a successful model for training new staff and retaining human resources as part of the ongoing effort to promote a stable and high-quality workplace environment for nurses.