基層公衛護理人員在職進修教材設計與實驗介入—自學式「社區健康計畫DIY手冊」介入研究
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2006
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本研究主要目的在於發展一適用於公共衛生護理人員在職進修之自學式教材，並探討其介入後的教育成效及使用者對該手冊的評價。
本研究採「實驗組控制組前後測設計」，以台北市10所健康服務中心之公共衛生護理人員為研究對象，實驗組接受三週自學式「社區健康計畫DIY手冊」以及兩次e-mail提醒，對照組則未接受任何教育介入。研究工具包括前後測成效評價問卷與過程評量問卷，所取得的資料以t檢定、卡方檢定、配對t檢定、共變數分析(ANCOVA test)、詹森內曼(Johnson-Neyman test)等方法進行分析。
由統計分析結果可知，本研究以自學式「社區健康計畫DIY手冊」介入公共衛生護理人員擬訂社區健康計畫之知識、技巧與自我效能，介入效果在控制前測分數與婚姻狀況的前提下，實驗組於整體擬訂社區健康計畫知識後測得分並未顯著高於對照組，僅於「計畫評價」次向度實驗組後測顯著高於對照組(F=6.325，P<0.05)。而整體擬訂社區健康計畫技巧部份實驗組後測得分亦未能顯著高於對照組，僅有零星單題達顯著差異。而整體擬訂社區健康計畫自我效能實驗組後測得分則顯著高於對照組(F=5.134，P<0.05)，有整體性的提升效果，且於「診斷與分析」(F=5.196，P<0.05)、「計劃」(F=5.209，P<0.05)等次向度亦達顯著差異。而在過程評價方面，半數以上的使用者表示手冊有助於其瞭解擬訂社區健康計畫之相關知識、技巧與提升執行上的自信，而高工作負荷量與工作時間的緊縮則是造成無法仔細閱讀手冊以及實際執行擬訂社區計畫上的困難。
整體而言，本自學式手冊介入計畫於公共衛生護理人員擬訂社區健康計畫整體知識、技巧以及相關次向度內涵之提升效果不佳，但能有效提升擬訂社區健康計畫自我效能。綜合文獻與研究結果，推論本研究介入成效可能受到「實驗介入情境控制」、「研究對象學習動機」、「工作環境支持度」等因素之干擾，以及「評量指標」、「研究樣本數」等限制而無法確切測量出可能成效。
本研究依循以學習者為中心之原則，以文獻探討、需求評估為藍本，以行為科學理論作教育策略，轉化學術理論於實務使用之手冊發展過程，可供未來發展自學式教材相關研究之參考。本手冊經使用者評定為易讀且符合實務需求之教材，雖介入後未能於擬訂社區健康計畫知識、技巧有全面性的效果，但能有效提升自我效能，故可作為公共衛生護理人員在職教育之自學教材，提升公共衛生護理人員對於擬訂社區計畫的把握程度。建議未來研究上能進一步克服手冊使用上的限制，激發學習動機、增加研究樣本數、以多元、長期追蹤的方式評量效果，以使本自學手冊能於公共衛生護理人員在職教育中發揮更大的成效。
The purpose of this research is to develop a self-instructional material for public health nurses upon their work and to discuss the educational efficiency after the intervention, including users’ evaluation regarding to the handbook. This research uses pretest-posttest control group design method, targeting public health nurses within ten health care centers in Taipei city. The experimental group received three weeks of self-instructional “DIY Handbook in redacting community healthcare plan” as well as two-times e-mail reminders as the intervention. The control group didn’t receive any other types of education methods as the intervention. The research tools include the efficiency and the process evaluation questionnaire of the pretest-posttest. After data were collected, statistic methods such as t-test, Chi-square test, paired-t test, ANCOVA test, and Johnson-Neyman test were applied to make the analysis. According to the outcome of the data analysis, this research intervened public health nurses’ knowledge, skills, and self-efficacy in redacting community healthcare plans by using this DIY handbook. By controlling scores in the pretest and marital status, the posttest score on redacting community healthcare plan of experimental group has not significantly higher than that of control group. The experimental group has only one subscale called “evaluation” that appeared higher score then the control group (F=6.325, P<0.05). The experimental group’s skills of redacting community healthcare plans in a whole has showed non-significant higher than that of the control group and only couple of questions achieved statistical significance. The posttest score of self-efficay experimental group was significantly higher than that of control group (F=5.134, P<0.05), which has the effect on escalating outcome as a whole. The subscales in “diagnosis and analysis” (F=5.196, P<0.05) and “planning” (F=5.209, P<0.05) have also reached statistical significance. During the part of process evaluation, over half of the users expressed that the handbook had indeed helped them promote knowledge and skills of redacting community healthcare plans and elevate confidence when execute the plan. It is, however, due to the high volume of work load and the shrinkage of working time, the users often found that they lacked sufficient time to read the handbook thoroughly and faced difficulties when it comes to execute the plan as well. The interventional research plan of this DIY handbook, in a whole, has unsatisfied outcome in elevating public health nurses’ knowledge, skills, and related contents of subscales to redact community healthcare plans. It has, on the other hand, increased the users’ self-efficacy in redacting the plan. Combining findings from literature reviews and research outcomes, the outcome of the intervention is estimated to be interfered by the control of scene during experiment intervened, motivations of targets, and level of support from the working environment; restrictions on indicators of evaluation and the sample size intervened were also some facts that impeded accurate outcome measurement. The research follows the principle of learner-centered; using the adaptation of literature reviews and demand assessment as the prototype, transforming educational strategies into theories in behavior sciences, and converting those theories into practical uses during the developmental process of the handbook, it provides reference materials for the oncoming relevant researches of DIY-learning handbooks. This Handbook was defined as an easy-read and practical teaching material by its users. Although it did not lead to a full-scale outcome in the knowledge and skills aspects of redacting community healthcare plans, it promoted the users' self-efficacy after the intervention. Consequently, it surly serves as the self-instructional material of public health nurses' occupational educations and enhances their comprehension and manipulation while redacting community healthcare plans. In order to bring this handbook into more effective in the manipulation of public health nurses' occupational educations, we suggest to overcome and eliminate limitation when using it and to arouse motivations, enlarge sample size, and evaluate the outcomes in more diversified and long-term tracing ways.
The purpose of this research is to develop a self-instructional material for public health nurses upon their work and to discuss the educational efficiency after the intervention, including users’ evaluation regarding to the handbook. This research uses pretest-posttest control group design method, targeting public health nurses within ten health care centers in Taipei city. The experimental group received three weeks of self-instructional “DIY Handbook in redacting community healthcare plan” as well as two-times e-mail reminders as the intervention. The control group didn’t receive any other types of education methods as the intervention. The research tools include the efficiency and the process evaluation questionnaire of the pretest-posttest. After data were collected, statistic methods such as t-test, Chi-square test, paired-t test, ANCOVA test, and Johnson-Neyman test were applied to make the analysis. According to the outcome of the data analysis, this research intervened public health nurses’ knowledge, skills, and self-efficacy in redacting community healthcare plans by using this DIY handbook. By controlling scores in the pretest and marital status, the posttest score on redacting community healthcare plan of experimental group has not significantly higher than that of control group. The experimental group has only one subscale called “evaluation” that appeared higher score then the control group (F=6.325, P<0.05). The experimental group’s skills of redacting community healthcare plans in a whole has showed non-significant higher than that of the control group and only couple of questions achieved statistical significance. The posttest score of self-efficay experimental group was significantly higher than that of control group (F=5.134, P<0.05), which has the effect on escalating outcome as a whole. The subscales in “diagnosis and analysis” (F=5.196, P<0.05) and “planning” (F=5.209, P<0.05) have also reached statistical significance. During the part of process evaluation, over half of the users expressed that the handbook had indeed helped them promote knowledge and skills of redacting community healthcare plans and elevate confidence when execute the plan. It is, however, due to the high volume of work load and the shrinkage of working time, the users often found that they lacked sufficient time to read the handbook thoroughly and faced difficulties when it comes to execute the plan as well. The interventional research plan of this DIY handbook, in a whole, has unsatisfied outcome in elevating public health nurses’ knowledge, skills, and related contents of subscales to redact community healthcare plans. It has, on the other hand, increased the users’ self-efficacy in redacting the plan. Combining findings from literature reviews and research outcomes, the outcome of the intervention is estimated to be interfered by the control of scene during experiment intervened, motivations of targets, and level of support from the working environment; restrictions on indicators of evaluation and the sample size intervened were also some facts that impeded accurate outcome measurement. The research follows the principle of learner-centered; using the adaptation of literature reviews and demand assessment as the prototype, transforming educational strategies into theories in behavior sciences, and converting those theories into practical uses during the developmental process of the handbook, it provides reference materials for the oncoming relevant researches of DIY-learning handbooks. This Handbook was defined as an easy-read and practical teaching material by its users. Although it did not lead to a full-scale outcome in the knowledge and skills aspects of redacting community healthcare plans, it promoted the users' self-efficacy after the intervention. Consequently, it surly serves as the self-instructional material of public health nurses' occupational educations and enhances their comprehension and manipulation while redacting community healthcare plans. In order to bring this handbook into more effective in the manipulation of public health nurses' occupational educations, we suggest to overcome and eliminate limitation when using it and to arouse motivations, enlarge sample size, and evaluate the outcomes in more diversified and long-term tracing ways.
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Keywords
公共衛生護理, 在職進修, 自學式教材, public health nurse, in-service training, self-instructional material