運用ADDIE教學模式提升手術室護理師執行脂肪移植手術準備作業之正確率

Improving the Fat Grafting Surgical Preparation Accuracy of Operating Room Nurses Using the ADDIE Instructional Model

背景：手術安全為病人安全核心目標。本院手術室護理師在脂肪移植手術準備作業之正確率僅55.4%，操作不當可能導致麻醉時間延長、脂肪污染及注射比例錯誤等嚴重問題。分析主因包括依賴口述經驗教學、對流程與複雜器械不熟悉、缺乏操作手冊與核對清單、在職教育不足及欠缺標準化作業規範。
目的：建立系統化教育訓練與標準化流程，以提升手術室護理師脂肪移植手術準備作業之正確率。
解決方案：依ADDIE（analysis，design，development，implementation，and evaluation）教學模式規劃並推動介入，包括編製作業手冊與心智圖、規劃結構化在職教育、製作互動式電子書與辦理擬真工作坊；以準備作業正確查核表與認知測驗掌握20名護理師之成效，擬真課程中採客觀結構式技能評量提供即時回饋，並於2025年4–9月進行維持性追蹤。
結果：介入後，作業正確率由55.4%提升至96.5%；認知正確率由45.0%提升至94.5%；維持性追蹤期間作業正確率維持100%。
結論：結合ADDIE教學模式與多元策略，可有效提升護理師術前準備之正確性與專業能力。建議後續以固定週期之跨專業共識會議進行作業流程滾動修訂，並據此發展手術照護指引，作為臨床作業依循，以強化護理品質與病人安全。

Background & Problems: Surgical safety is a core patient-safety goal. In our hospital, the rate of accuracy among
operating room nurses in preparing for fat grafting surgeries was only 55.4%. The main factors found to influence this
issue were: reliance on verbal, experience-based teaching; unfamiliarity with processes and complex instruments; lack
of operating manuals and checklists; inadequate in-service education; and lack of standardized operating protocols.
Purpose: This project was developed to establish a systematic education and training program and standardized
workflow to improve the accuracy of operating room nurses in preparing for fat grafting surgeries.
Resolution: Following the ADDIE (analysis, design, development, implementation, and evaluation) instructional
model, the interventions implemented in this project included: compiling a preparation manual and mind map,
planning structured in-service education, producing an interactive e-book, and holding simulation workshops. Also, a
preparation-accuracy checklist and knowledge test were used to track outcomes in 20 nurses. In addition, the Objective
Structured Assessment of Technical Skill instrument was used to provide real-time feedback during the simulation
courses, and maintenance follow-up was conducted from April through September 2025.
Results: After the intervention, the preparation accuracy rate increased from 55.4% to 96.5% and the knowledge
accuracy rate increased from 45.0% to 94.5%. Notably, the preparation accuracy rate was 100% during the
maintenance follow-up period.
Conclusions: Combining the ADDIE instructional model with multiple strategies may be an effective strategy
for improving preoperative preparation accuracy and professional competence in nurses. Regular interprofessional
consensus meetings should be held to allow rolling revisions to be made to the workflow and, accordingly, develop
surgical care guidelines as references for clinical practice to further strengthen nursing quality and patient safety.