護理人員訓練計畫成效之研究

Abstract

護理人員是醫院內重要的人力資源，如何降低護理人員流動率，是每個醫療機構重要的績效指標。本研究修正新進護理人員教育訓練內容，並參考導師制度 (mentorship)，實施「融合技能與態度之師資培育」於護理臨床教師實施師資培育計畫，加強教學能力，訓練成為一位優良護理臨床教師，於帶領新進護理人員時，讓新進護理人員順利由生手成為一位正式的護理人員。 本研究為準實驗研究法，第一階段完成修改護理部新進人員訓練的內容，並完成相關技術錄影帶製作；並規劃「融合技能與態度之師資培育計畫」，包括講授、小組討論及實際演練，培育護理臨床教師之教學能力，以加強教學成效。第二階段將新進人員分為實驗組 (n = 50) 及對照組 (n = 65)，實驗組新進人員於第一個月以技術性學習為主，第二個月開始與護理臨床教師共同照顧病人，第三個月正式獨立照顧病人，工作滿六個月進行臨床技術評量；對照組依過去傳統新進人員訓練計畫。研究中並比較接受「融合技能與態度之師資培育計畫」護理臨床教師之新進護理人員，與未接受相關師資培育計畫之護理臨床教師，分別追蹤實驗組及對照組之新進護理人員三個月試用期對護理臨床教師教學滿意度及自覺學習評量情形。 運用SPSS 17.0版對新進護理人員工作評量等，量性資料進行統計分析，新進人員之個人歷程檔案及護理臨床教師之個人歷程檔案則以質性資料分析。 研究結果完成護理部迷你臨床評量演練 (mini-CEX) - 給藥(止痛藥)、導尿，及護理技能操作觀察（DOPS）評估表-輸血、靜脈抽血，四項臨床常見技術，建立四項技術之信效度，每份評量表信效度 Cronbach’s Alpha 值均可達0.9以上；研究發現運用新的新進人員訓練計畫，ㄧ年後之留任情形，實驗組高於對照組，並較前一年提升10%的留任率。 另發現師資培育計畫提昇護理臨床教師的能力，接受師資培育計畫之護理臨床教師，其新進護理人員對其輔導過程的教學反應滿意度較高，新進護理人員留任率有其影響力；教師的教育程度，亦會影響對新進護理人員的臨床學習，提供不同的教學方法，讓新進護理人員能適應多變的臨床環境，進而留任於職場中；由生手成為一位正式護理人員，以提升新進護理人員留任職率。The purpose of this study was to assess the efficacy of a modified on-board training program for new nurses with an emphasis on the mentorship program that implemented a training-for-trainers program to cultivate both skills and attitudes of clinical preceptors for the purpose of strengthening the preceptors’ teaching ability and achieving better trainees’ performance outcomes. This study used a quasi-experimental design. During the first phase of the study, we modified the content of the on-board training program for new nurses which included the production of nursing skills video tapes and designed the mentorship program which included lectures, group discussion, and practice sessions. . During the second phase of the study, 115 new nurses were divided into an experimental group (n = 50) and a control group (n = 65). The nurses in the experimental group learned the techniques and skills in the first month, practiced under supervision of their precetors in the second month, practiced independently during the third month, and completed their clinical skills assessment at the end of the first 6 months. The control group received usual training program. Both groups were evaluated at the completion of the 3-month trial period for their satisfaction with clinical teaching and perceived learning outcomes. We completed mini nursing clinical assessment exercises (mini-CEX) for administration of analgesics and catheterization, nursing skills to operate observation (DOPS) evaluation forms for blood transfusion and phlebotomy. The Cronbach's Alpha values for each scorecard exceeded 0.9. The results showed that the retention rate of the experimental group was significantly higher in the experimental group than the control group; the retention rate increased by 10% compared with the previous year after the implementation of the new training program. We also found the new nurses in the experimental group had higher levels of satisfaction with clinical teaching than those in the control group which could possibly explained the higher retention rate in the experimental group. The level of education of the preceptors also affect new nurses’ learning outcomes. In light of ever-changing clinical environments, it is important to optimize on-board training programs for new nurses to help them mature from novices to experts.