Hsu Li-Ling, Chang Wen-Hui, Hsieh Suh-Ing
Professor, Graduate Institute of Health Allied Education, National Taipei University of Nursing and Health Sciences, Taipei, ROC..
Head Nurse, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC..
J Prof Nurs. 2015 Jan-Feb;31(1):37-49. doi: 10.1016/j.profnurs.2014.05.007. Epub 2014 Jun 4.
Studies have shown that an underappreciation of the importance of person-centered communication and inappropriate communication training could result in unsatisfactory communication performance from nurses. There are a large number of studies about communication training for nurses, but not so many about communication training in early stages of nursing career. The purpose of this study is to compare the effect of a traditional course versus scenario-based simulation training on nurses' communication competency, communication self-efficacy, and communication performance in discharge planning Objective Structured Clinical Examination (OSCE). A randomized controlled trial was used with a pretest and two posttests. The experimental group underwent the scenario-based simulation course, whereas the control group received the traditional course. A convenience sample of 116 nurses with qualifications ranging from N0 level (novice nurses) to N2 level (competent nurses) in Taiwan's clinical nursing ladder system was recruited from a medical center in northern Taiwan. Analysis of covariance was used to determine between-subjects effects on communication competency and self-efficacy, whereas independent t test and Mann-Whitney U test were used to examine between-subjects effects on learner satisfaction and discharge planning communication performance. Paired t test was used to determine communication self-efficacy. In this study, the nurses and independent raters found scenario-based simulation training more effective than traditional communication course. However, standardized patients reported no significant difference in communication performance between the two groups of nurses. Despite that traditional classroom lectures and simulation-based communication training could both produce enhanced communication competency and self-efficacy among nurses, this study has established that the latter may be better than the former in terms of learner satisfaction and communication performance improvement. Therefore, introduction of simulation-based training to in-service nursing education could enhance nurses' communication performance in clinical practice.
研究表明，对以患者为中心的沟通重要性认识不足以及沟通培训不当，可能导致护士的沟通表现不尽人意。关于护士沟通培训的研究有很多，但针对护理职业生涯早期阶段沟通培训的研究却不多。本研究的目的是比较传统课程与情景模拟培训对护士在出院计划客观结构化临床考试（OSCE）中的沟通能力、沟通自我效能感和沟通表现的影响。采用随机对照试验，进行一次预测试和两次后测试。实验组参加情景模拟课程，而对照组接受传统课程。从台湾北部一家医疗中心招募了116名护士作为便利样本，其资质范围涵盖台湾临床护理层级系统中的N0级（新手护士）至N2级（胜任护士）。采用协方差分析来确定组间对沟通能力和自我效能感的影响，而独立t检验和曼-惠特尼U检验则用于检验组间对学习者满意度和出院计划沟通表现的影响。配对t检验用于确定沟通自我效能感。在本研究中，护士和独立评分者发现情景模拟培训比传统沟通课程更有效。然而，标准化患者报告两组护士的沟通表现没有显著差异。尽管传统课堂讲授和基于模拟的沟通培训都能提高护士的沟通能力和自我效能感，但本研究表明，就学习者满意度和沟通表现提升而言，后者可能优于前者。因此，将基于模拟的培训引入在职护理教育可以提高护士在临床实践中的沟通表现。
