| 摘要: | 本研究開發一套具有靜脈注射專業知識教學與臨床技術訓練的「靜脈注射數位學習系統」，並應用此系統於國內護理人員靜脈注射教學上，以改善傳統教學與訓練的不足，提高護理人員執行靜脈注射的品質。 靜脈注射數位學習系統包含多媒體與虛擬實境兩部分。首先，以數位攝影器材、影音編輯軟體、影像處理軟體製作多媒體教學素材，並以互動式網頁的方式開發「靜脈注射多媒體教學系統」，並規劃系統驗證實驗，驗證其是否具有教學性質；再規劃學習成效實驗，評估其對於臨床護理人員的學習成效與臨床應用成效。接著，利用虛擬實境技術開發可提供護理人員進行靜脈注射模擬操作的「靜脈注射模擬器訓練系統」，並規劃系統驗證實驗，進行系統穩定性與信度驗證。另外，並規劃學習成效實驗，評估系統對於護理人員的學習成效與臨床應用成效。 於多媒體教學系統驗證方面，研究結果顯示，經過課程內容學習後，對於靜脈注射測驗成績有顯著進步（p = .001）；另外，受試者於課程結束後兩週再進行靜脈注射測驗，兩週後的靜脈注射測驗成績與課程學習前亦有顯著進步（p = .004），並與課程學習後立即測驗無顯著差異（p = 1.000），因此本系統藉由靜脈注射知識層面中學習效果與學習保留兩方面的驗證，證明系統具有教學性質，以建立系統的可用性（Usbility）。 於多媒體教學系統學習成效方面，研究結果顯示，實驗組前測與課程結束後測（p < .001）、前測與課程結束二週後測（p < .001）的得分，皆達統計上顯著差異。而傳統書本教學方式的對照組三次測驗得分交互比較，皆無統計上的顯著差異，因此說明本研究所開發之靜脈注射多媒體教學系統課程，對於護理人員的知識層面幫助明顯優於傳統書本教學方式，且具有一定程度的學習保留效果。另外，實驗組護理人員對多媒體教學課程之意見，就整體的滿意度而言高達90.5%受試者滿意，說明本研究所開發的多媒體教學系統是成功的。 於模擬器訓練系統驗證方面，研究結果顯示，在5次的操作訓練後，任務完成時間已無明顯的變化，且操作錯誤次數亦隨著操作次第而緩慢地下降，顯示反覆操作此系統之表現會越來越好且趨於穩定（Stability）。另外，透過組間相關系數分析，前、後測的任務完成時間與操作錯誤次數具有高ICC值，分別為0.73與0.86，亦即顯示系統具有高的再測信度（Reliability）。 於模擬器訓練系統學習成效方面，研究結果顯示，虛擬實境教學課程之前、後測，及其相較於傳統教學對於靜脈注射知識學習皆未能達到顯著差異的效果，其原因為虛擬實境模擬器的訓練對於護生來說，是一種新奇的教學方式，護生過於重視模擬器操作的技術訓練，而忽略了其他知識層面的學習，因此，模擬器訓練課程內容的組合需要進一步的研究。另外，護理人員對於系統整體而言的滿意度有82.2%受試者滿意，護理人員雖認為模擬器的真實感有待改進，但模擬的情境確實能讓使用者放鬆心情且反覆的學習，因此認同模擬器訓練系統之存在價值。 護理人員在模擬系統的任務完成表現方面，透過訓練課程中，反覆且多次的操作訓練，由實驗組人員第一次與最後一次的任務完成表現趨勢看來，在每人平均4.79次的操作練習下，任務完成平均時間由216.36秒進步至129.68秒；操作錯誤次數表現也由3.64次進步至1.75次，亦皆顯示經過訓練課程後對於完成虛擬靜脈注射任務的表現，皆有明顯的進步。 The purpose of this study is to develop an “Intravenous injection e-Learning system (IELS)” containing nursing domain knowledge and clinical techniques, and apply the system to instruction in novice nurses to improve the effectiveness of traditional education and the quality of implementing intraneous injection. The IELS includes both multimedia and virtual reality parts. First, the “Multimedia instruction system (MIS)” is developed by interactive web pages with teaching materials made by digital camera, digital vedio, vedio editing and photo editing applications. The usability validation of MIS is carried out by questionnaires before and after the teaching courses. Second, a “Simulator training system (STS)” is developed with virtual reality technology and can provide a simulated intraneous injection circumstance. The validation of stability and reliability of STS is evaluated by task time and error frequency that are recorded in a computer during the courses. The accessment of learning effects of the STS is measured by the task performance and questionnaires. In the validation of MIS, there are statistically significant differences between pretest and 1st posttest (p=0.001), pretest and 2nd posttest (p=0.004) taken on two weeks after the course. The test results indicate that there is good usability proving by learning effectiveness and retention in the MIS courses. As the results of the effect on intravenous injection’s knowledge through the MIS courses, for experimental group, the difference between the scores from pretest and the 1st posttest is statistical significant (p<0.001), and the difference between the scores from pretest and the 2nd posttest is statistical significant (p<0.001), too. On the other hand, there is no statistical difference (p>0.05) for control group between the scores from pretest and any posttest. From the results it can be concluded that the training courses have a significant effect on the intravenous injection’s knowledge. Besides, a high rate of satisfaction (90.5%) for the MIS courses shows the self-developed program is successful. In the validation of STS, the change of task time is not obvious in each trial and the error frequency decreased slightly with more trials. The results show that good and stable performances are obtained after about five trials (Stability). The ICC values of task time and error frequency are 0.73 and 0.86, respectively. High ICC values from the test-retest assessment shows that the VR-based intravenous injection simulator can offer highly reliable simulation (Reliability). As the results of the effect on intravenous injection’s knowledge through the STS courses, there are no statistical difference (p>0.05) for the scores of the three data accessments between experimental group and control group. From the results, it is found that the virtual reality based simulation is novel for novices, and they pay too much attention to operating the simulator instead of learning of knowledge. Therefore, the combination of STS course needs further study. Besides, the scenes of STS can still achieve the function of relaxed and repeated learning although the realism of simulator needs to be improved. Nurses approve that the simulator is worth existing and a high rate of satisfaction (82.2%) for the STS course shows the self-developed program is successful. As the result of the performance on operation of simulator through the STS course, the average count of trials is 4.79 through this course. In the average peoformance of first and last trial, the task time decreases from 216.36 seconds to 129.68 seconds and the error frequency decreased from 3.64 to 1.75. The results indicate that the performances of virtual intravenous injection task will obviously progress through the STS course. |
