提昇護理人員執行非藥物疼痛處置介入研究—自我效能融入翻轉教學策略之應用

Abstract

背景：研究證實結合藥物與非藥物疼痛處置在處理病人疼痛有很好的成效，但在台灣尚未將非藥物疼痛處置納入護理的正規教育中。目的：本研究目的乃發展自我效能融入非藥物疼痛處置之翻轉教學訓練課程，探討運用此課程對護理人員非藥物疼痛處置的知識、技能、態度、自我效能與行為之成效。方法：以準實驗研究設計(Quasi-experimental design)，採方便取樣，樣本來自台灣某醫療體系二家醫院之護理人員，對照組及實驗組各 40人。實驗組接受5小時的自我效能融入非藥物疼痛處置之翻轉教學課程，對照組無特殊介入，僅與實驗組同時間點接受後測。二組於介入措施前後皆填寫非藥物疼痛處置的知識、態度、自我效能量表與執行非藥物疼痛處置行為之情況調查，及M手法按摩與坐姿拉筋運動技能測驗，另外實驗組增加課程學習滿意度的調查。採用 GEE 分析檢驗翻轉教學介入對於非藥物疼痛處置知識、態度、技能、自我效能、行為之成效。結果：二組在前測的知識、態度與自我效能得分皆無顯著差異。在「自我效能融入非藥物疼痛處置之翻轉教學訓練課程」介入後，結果顯示能提升護理人員非藥物疼痛處置的知識、態度、技能與自我效能。實驗組在執行非藥物疼痛處置的種類與執行天數改變也顯著優於對照組。故翻轉教學訓練課程介入能提升非藥物疼痛處置的行為表現。此外實驗組的課程學習滿意度為96分，認同翻轉教學課程介入能增強其執行非藥物疼痛處置行為的自信心，而且在技能的學習也較有深刻記憶。結論／建議：本研究證實翻轉教學有助於護理人員學習非藥物疼痛處置，建議未來可以再持續追蹤護理人員於臨床實務的執行，及對於病人照護的影響。也建議台灣的護理學校教育能將這二種非藥物疼痛處置(芳香療法與M手法按摩)列入課程內容，讓護理學生能及早接觸相關的知識，當進入臨床時能運用在病人個別性的照護。Background: Studies have confirmed that a combination of pharmacological and non-pharmacological pain management is effective in controlling patients' pain but non-pharmacological pain management has not been incorporated into formal nursing education in Taiwan. Objective: The purpose of this study was to develop a flipped teaching training course integrating self-efficacy in nonpharmacologic pain management and to explore the impact of the curriculum on the knowledge, skills, attitudes, self-efficacy, and behaviors of nursing staff in nonpharmacologic pain management. Methods:This study used a quasi-experimental design with a convenience sample of nurses from two hospitals in a Taiwanese healthcare system, recruiting 40 for each of the control and experimental groups. The experimental group received a 5-hour flipped teaching training course that integrated self-efficacy for nonpharmacologic pain management. The control group was post-tested at the same time point as the experimental group and did not receive any specific intervention. Before and after the intervention, both groups were required to complete the knowledge, attitude, and self-efficacy scales, behaviors for nonpharmacologic pain management, and take skills test for M Technique and stretching exercises. The experimental group also received a survey on satisfaction with course learning. GEE analysis was used to examine the effects of the flipped teaching intervention on knowledge, attitudes, skills, self-efficacy, and behaviors in nonpharmacologic pain management.Results: There were no significant differences in the knowledge, attitude, self-efficacy scores, and behaviors between the two groups in the pretest. After the intervention of the flipped teaching training course integrating self-efficacy in nonpharmacologic pain management, the results showed that the knowledge, attitude, skills, and self-efficacy of nursing staff on nonpharmacologic pain management improved. The experimental group also significantly outperformed the control group in terms of the types of nonpharmacologic pain management and the changes in the number of implementation days, indicating that the intervention of flipped teaching training courses could improve the behavioral performance of nonpharmacologic pain management. In addition, the experimental group had a course learning satisfaction score of 96, indicating that the participants agreed that the intervention of the flipped teaching course could enhance their self-confidence in performing nonpharmacologic pain management behaviors and strengthen their skill learning memory.Conclusion／Suggestion: This study demonstrates that flipped teaching helps nurses learn nonpharmacologic pain management. In the future, the nursing staff's clinical practice performance and the impact on patient care should be continuously tracked. Also, it is recommended that nursing school education in Taiwan should incorporate these two nonpharmacologic pain management treatments (aromatherapy and M Technique) in the curriculum so that nursing students can be exposed to the knowledge early and apply it to individual patient care in clinical practice.