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題名：護專學生臨床實習適應問題及其輔導方案成效之評估研究
作者：簡慶哲
作者(外文)：Chien Ching-Che
校院名稱：國立高雄師範大學
系所名稱：教育學系
指導教授：邱兆偉
學位類別：博士
出版日期：2006
主題關鍵詞：護專學生；臨床實習；適應問題；輔導方案；成效評估；Nursing School Students；Clinical Practicum；Adaptation Problems；Guidance Program；Effects Evaluation
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本研究旨在探討護專學生臨床實習適應問題的一般概況，以及了解不同背景之護專學生實習適應問題之差異情形。另外為了實際解決護生實習過程中，可能遭遇的種種適應問題，因此設計出一個三階段實習輔導方案，並實際驗證此方案對於協助護生，處理實習適應問題的實際效果。最後並比較有無實施輔導方案之班級，其實習適應之差異。
爲了達成上述目的，本研究使用問卷調查法、訪談法，以及輔導方案的實施，以兩所公立護專為對象進行研究。使用的工具包括：研究者自編之「護專學生實習適應問題調查問卷」、「實習經驗訪談表」、「臨床實習適應輔導方案實施回饋問卷」，以及研究者所設計之「臨床實習適應輔導方案」等四種。研究結果得到下列幾項重要結論：
一、護專學生臨床實習的適應問題，主要有實習場所、學理技術、指導人員、人際關係、溝通技巧、護生角色、醫療文化與臨床資源等八類。
二、護專學生在各類實習適應問題的感受程度，以學理技術部份最高。而以人際關係、溝通技巧、護生角色這三類適應問題的感受程度較低。至於實習場所、指導人員、醫療文化與臨床資源等四類適應問題的感受程度，屬於中間程度。
三、不同入學方式之護專學生其實習適應問題並無顯著不同。
四、就讀原因不同之護專學生，在溝通技巧適應上有所不同；實習單位不同之護專學生在臨床資源適應上有所不同。
五、就讀護理意願不同之護專學生在學理技術、指導人員、人際關係、溝通技巧、護生角色、臨床資源以及整體適應上，有所不同；升學護理意願不同之護專學生在臨床資源適應上有所不同；從事護理工作意願不同之護專學生在人際關係、護生角色與臨床資源適應上有所不同。
六、實習前、中、後三階段之輔導效果，整體上學生持肯定的評價，學生在減低壓力、態度改變、困擾減少、增加成就感、適應的增進等項目，回答有幫助的百分比，均明顯高於回答很少幫助的百分比。
七、輔導方案實施與否的差異成效方面，有實施輔導方案之班級，其在實習場所、指導人員、人際關係、溝通技巧、臨床資源與整體適應等六類適應上，均優於未參與輔導方案之學生。
依據上述之結論，提出下列幾點建議：
一、學校應重視學生臨床實習的適應問題
（一）學校對於實習學生會面臨那些適應上的問題應有所了解
（二）學校應加強實習學生學理技術的管控
（三）學校應強化與實習機構的合作關係
二、加強護專學生的生涯輔導
三、學校宜有適當的輔導方案協助學生臨床實習
（一）加強學生實習前的準備活動
（二）提供學生良好的支持系統
（三）加強學生實習後的反省回饋
（四）正視學生臨床實習的困境並協助解決
四、學校應加強學生有關「死亡教育」的課程
五、學校應加強建立學生正確的護理實習概念
六、家庭教育方面--加強學生平常的訓練，增加抗壓性
七、對輔導方案的修正
八、進一步的研究建議
（一）擴大研究對象，以涵蓋不同層級的學生。
（二）增加影響實習適應的變項，使探討的範圍更加廣闊。
（三）進行持續的追蹤研究，以了解輔導方案的實施成效。
A Study of the Adaptation Problems of Clinical Practicum and the Effects of Intevention Program for Nursing Junior College Students
Chien Ching-Che
Abstract
Purpose of this study was to discuss the general adaptation situation of nursing school students during their clinical practices and also to discover the different adaptation problems that nursing school students with different backgrounds might encounter. Besides, to actually solve all kinds of adaptation problems during clinical practices, a 3-phase guidance program was designed and practically tested and verified the actual results for assisting students to deal with problems happening during practical training sessions. Finally the study compared classes that with and without executing the guidance program to understand the differences in students’ adaptation situation in training sessions.
This study targeted two public nursing schools to be the research objects and used various research measures including questionnaires, interviews and implementation of the guidance program to achieve the above-mentioned purposes. Research tools used included the researcher self-edited 「Questionnaire on Nursing School Student Adaptation Problems during Practical Training Sessions」, 「Interview Chart on Practical Training Experiences」, 「Feedback Questionnaire on Implementation of Clinic Practices Adaptation Problem Guidance Program」and the researcher self-designed 「Clinical Practices Adaptation Problem Guidance Program」. Results of this study showed the following important conclusions:
1.The adaptation problems in nursing school students during their practical training sessions were mostly related to practical training environment, knowledge and techniques, instructors, people relationship, communication skills, roles played as nursing school students, medical culture and clinical resources.
2.For adaptation problems during practical training sessions, nursing school students were the most affected by knowledge and techniques adaptation. They were less affected in adaptation problems in people relationship, communication skills and roles played as nursing school students. And the other four types of adaptation were in medium degree affection for students.
3.Nursing students that had different educational backgrounds actually had no significant differences in adaptation problems.
4.Nursing school students that had different educational backgrounds had different adaptation problems in communication skills; students that were assigned to different practical training environment had different adaptation problems in clinical resources.
5.Nursing school students that had different aspirations in studying nursing had different adaptation problems in knowledge and techniques, instructors, people relationship, communication skills, roles played as nursing school students, clinical resources and overall adaptation; students that had different aspirations in advancing to nursing schools had different adaptation problems in clinical resources; students that had different aspirations to serve in nursing industry had different adaptation problems in people relationship, roles played as nursing school students and clinical resources.
6.For guidance results of the 3-phase (before-, during and after-) guidance program, students gave positive evaluation in the overall performance. Percentage of students to give a “helpful” feedback in areas like to reduce pressures, to adjust attitude, to cut down persecutions, to increase self-accomplishments and to enhance adaptabilities was significantly higher than percentage of students to give a “not much help” feedback.
7.For the different results in implementing and not-implementing the guidance program, it was found that students in classes that implemented the guidance program had better adaptability in practical training environment, instructors, people relationship, communication skills, clinical resources and overall adaptation than students not participated in the guidance program.
According to above conclusions, several suggestions were brought out:
1.Schools should pay much attention to students’ adaptation problems during their practical training sessions.
a、Schools should know what kind of adaptation problems that students might have.
b、Schools should enhance the control in training students’ knowledge and techniques.
c、Schools should strengthen the cooperative relationship with the training institutes.
2.School should enhance the career consulting services for students.
3.School should have appropriate guidance programs to assist students in clinical practices.
a、Enhance the preparation activities before practical trainings.
b、Provide students with good supporting channels.
c、Strengthen students’ self-review and feedbacks after practical training sessions.
d、School should confront students’ persecutions during practical training sessions and provide helps.
4.Schools should enhance 「death education」related courses.
5.Schools should reinforce students’ conception in accurate nursing practices.
6.In the aspect of family education – to enforce students’ daily life training for enhancing their compressive strength.
7.Modification of the guidance program.
8.Suggestions for further research study.
a、To broaden research target ranges to cover students in different levels.
b、To add more variances that might affect students’ adaptabilities during practical training sessions to widen the discussion scope.
c、To carry out continuous tracking, so that to understand the implementation achievements of this guidance program.
Key words: Nursing School Students, Clinical Practicum, Adaptation Problems, Guidance Program, Effects Evaluation
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