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系統識別號 U0026-2212201514000600
論文名稱(中文) 建構文化照護能力課程藍圖-課程發展、評價與成效追蹤
論文名稱(英文) A Course Blueprint of Culturally Competent Care in Nursing: Development, Evaluation, and Follow-up
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 104
學期 1
出版年 104
研究生(中文) 林佳蓉
研究生(英文) Chia-Jung Lin
學號 TA8971050
學位類別 博士
語文別 中文
論文頁數 287頁
口試委員 指導教授-黃美智
口試委員-陸偉明
口試委員-陳益源
口試委員-馬瀰嘉
口試委員-王秀紅
口試委員-謝秀芳
中文關鍵字 護理學生  文化照護能力  課程  文化照護能力評估量表-中文版 
英文關鍵字 nursing students  cultural competence  course  Cultural Competence Assessment Instrument-Chinese Version (CCA-CV) 
學科別分類
中文摘要 研究背景:有感國內護理學生欠缺文化照護能力,而與文化適切性相關的照護課程仍處於起步的階段,尚無一致性課程的規劃,故設計一門獨立及具備專業特色的文化照護能力課程並探究其成效是刻不容緩。
研究目的:探討文化照護能力課程的介入對護理學生在文化照護知識、文化照護態度、文化照護技巧及文化照護行為的影響。
研究方法:以實驗與對照組之縱貫性準實驗設計(Quasi-Experimental Study),於實驗措施介入前、後與間隔6至8個月再次追蹤共三次測量。研究對象採立意取樣(Purposive Sampling)於南部兩所科技大學日二技護理系學生共230人(實驗組108人,對照組122人),能配合研究時程開課者列為實驗組學校,另一則為對照組。實驗組接受18週、每週2小時共36小時的課程介入,對照組則未介入任何措施。課程共有四個領域:「Ⅰ:文化照護-基本知識(basic knowledge)」、「Ⅱ:文化照護-倫理與資源(ethics and resources)」、「Ⅲ:刻板印象與醫療決策(stereotype and medical decision)」及「Ⅳ:臨床實務技巧(clinical practices skills)」,教學策略則涵蓋講述法、小組討論、價值澄清、個人分享、角色扮演、欣賞影片、團體報告及填寫學習單等。
研究結果:以t檢定和廣義估計方程式(GEE)進行統計分析,研究結果顯示如下:(1)課程介入前,兩組在各項文化照護能力具備中等程度;(2)課程介入後的短期效應,實驗組在「文化照護知識」、「文化照護態度」及「文化照護技巧」皆有短期成效(p<.05),「文化照護行為」雖較課程介入前顯著進步(p<.05),但兩組整體比較未達顯著差異。(3)課程介入後6至8個月追蹤的長期效應,實驗組在「文化照護知識」、「文化照護態度」及「文化照護技巧」隨時間的增長亦較課程介入前有顯著進步(p<.05),但其效果不如短期效應好,而在「文化照護行為」雖亦比課程介入前有顯著進步(p<.05),但兩組整體比較仍同樣未達顯著差異。(4)課程對四個領域皆有短期成效(p<.05),但隨時間的增長雖較課程介入前有顯著進步(長期效應),但其效果不如短期效應好。(5)質性方面,依據課程四個領域歸納共9個主題及20個次主題,領域I有主題4個:「文化照護緒論」、「文化照護概念與理論」、「健康、疾病與文化」及「認識及察覺自我」,領域Ⅱ有主題3個:「多元族群的文化照護」、「民俗醫療與文化照護」及「文化照護的倫理議題」,領域Ⅲ和IV的主題分別有1個,分別是「刻板印象對健康照護的影響」與「評估及溝通協調技巧」。
結論:本研究的「文化照護能力課程」是以護理學生為對象所特定精心策畫,具札實及完整架構的課程,文化照護能力已證實能降低因文化因素造成健康照護的差距,同時亦能提升照護品質。建議未來護理的養成教育中,理應將文化照護能力課程規劃列為必修學分及將文化照護納入臨床實務實習的學習目標,才能延展護理學生持續對文化照護的學習而體驗成長的滿足感及意義。
英文摘要 SUMMARY
This study evaluates the effects of a culturally competent care course for nursing students. Using a quasi-experiment with longitudinal study design, 230 participants were assigned to an intervention group (108 participants) and control group (122 participants) on school basis. Students in the intervention group received a two-credit course of culturally competent care. Using the Cultural Competence Assessment Instrument-Chinese Version (CCA-CV) and Questionnaire for Assessing Culturally Competent Care (QACCC), data were collected between 2012 and 2014 at three time points at before and after the course and again six to eight months later after the participants had completed at least a clinical practicum. The results of t test and generalized estimating equation (GEE) analysis indicate that the cultural competence of all participants had improved at the posttest assessment, with the intervention group showing a significantly (p<.05) better improvement over the control group, except cultural competent behavior. However, the overall effectiveness of the training diminished with time. Study results illustrate that taking the course of culturally competent care effectively enhances the cultural competence of nursing students in a limited period of immediately following the course. These results support the benefits of incorporating a culturally competent care course in clinical practice should be considered in the future. Furthermore, healthcare institutions should be encouraged to provide greater support and consideration to cultural competence issues in the nursing workplace in order to reinforce and extend the benefits of culturally competent care course provided at nursing schools.
論文目次 目錄
摘要 III
ABSTRACT V
致謝 XII
目錄 XIII
表目錄 XV
圖目錄 XVII
附錄 XVIII
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的、問題與假設 5
第三節 名詞釋義 7
第二章 文獻探討 10
第一節 文化照護能力的起源與發展 10
第二節 文化照護能力的內涵與評量 17
第三節 相關於文化照護能力課程之研究 27
第三章 研究方法 53
第一節 研究架構 53
第二節 研究設計與流程 54
第三節 研究場所及研究對象 61
第四節 文化照護能力課程 63
第五節 課程評量架構 69
第六節 統計分析 88
第七節 倫理考量 90
第四章 研究結果 91
第一節 研究對象之人口學特性 91
第二節 文化照護能力課程之成效 100
第三節 課程學習目標的質量性評價 114
第五章 討論 157
第一節 文化照護能力課程之設計 157
第二節 文化照護能力課程之成效 163
第三節 文化照護能力課程之學習目標 172
第四節 研究者反思 180
第六章 結論、建議與研究限制 186
第一節 結論 186
第二節 建議 189
第三節 研究限制 195
參考資料 196

表目錄
表1-1 內文所用之英文、縮寫與中文對應表 9
表2-1 美國護理大學學會的五項文化照護能力、主題探討與教學策略 31
表2-2 美國護理大學學會的六項文化照護核心能力 35
表2-3 美國護理大學學會文化照護核心能力與照護能力之比較 39
表2-4 美國醫學大學學會的文化照護能力課程之五個領域 40
表3-1 三個階段及五個步驟一覽表 54
表3-2 測量變項與評值方法 59
表3-3 文化照護能力課程架構一覽表 65
表3-4 評量工具及測量面向 69
表3-5 前測「文化照護能力評估量表-中文版(CCA-CV)」之高分與低分組在各 項目的平均數及標準差(N=230) 73
表3-6 前測「文化照護能力評估量表-中文版(CCA-CV)」之信度(N=230) 74
表3-7 「文化照護能力評估量表-中文版」的KMO及BARTLETT檢定 76
表3-8 「文化照護能力評估量表-中文版(CCA-CV)」轉軸後的成份矩陣 77
表3-9 兩種評量工具在前測時「文化照護態度」平均得分之相關性(N=230) 79
表3-10 「文化照護能力課程自評表(QACCC)」題目編號一覽表 80
表3-11 前測「文化照護能力課程自評表(QACCC)」之高分與低分組在各項目 的平均數及標準差(N=230) 81
表3-12 前測「文化照護能力課程自評表(QACCC)」之信度(N=230) 83
表3-13 前測「文化照護能力課程自評表」之KMO及BARTLETT檢定 85
表3-14 前測「文化照護能力課程自評表(QACCC)」轉軸後的成份矩陣 86
表3-15 資料分析方法 88
表3-16 質性資料編碼 89
表4-1 兩組研究對象基本屬性之同質性分析(前測N=230) 93
表4-2 自評文化照護能力與認知(前測N=230) 96
表4-3 兩組受試者基本屬性之同質性分析(追蹤N=203) 97
表4-4 自評文化照護能力與認知(追蹤N=203) 99
表4-5 課程介入前兩組在各項文化照護能力的得分(N=230) 101
表4-6 兩組各項文化照護能力三次組內及組間平均差異之比較(N=230) 104
表4-7 以GEE分析各項文化照護能力的成效(N=230) 105
表4-8 兩種評量工具在「文化照護態度」平均得分之相關性(N=230) 107
表4-9 兩組在課程介入前課程各領域平均得分和組間比較(N=230) 115
表4-10 四個領域之三次平均得分、組內及組間平均差異比較(N=230) 116
表4-11 以GEE分析課程四領域學習成效(N=230) 117
表4-12 課程之領域、主題及次主題 119
表4-13 兩組在課程介入前四個課程領域在知識、態度與技巧之三次的平均得分 及組間平均差異(N=230) 140
表4-14 兩組以「文化照護能力課程自評表(QACCC)」測得的文化照護知識、 態度與技巧與四個課程領域間三次組間平均差異之比較(N=230) 141
表4-15 兩組以「文化照護能力課程自評表(QACCC)」測得的文化照護知識、 態度與技巧與課程四個領域間三次組內平均差異之比較(N=230) 143
表4-16 GEE分析以「文化照護能力課程自評表(QACCC)」測得的文化照護 知識、態度與技巧與課程四個領域間的成效(N=230) 144
表4-17 教學策略與課程各領域學習的收穫 150
表4-18 教學單元在兩間學校實際執行的比較 154




圖目錄

圖3-1 研究架構圖 53
圖3-2 研究步驟圖 55
圖3-3 研究設計圖 57
圖3-4 「文化照護能力評估量表-中文版(CCA-CV)」的陡坡圖 76
圖3-5 「文化照護能力課程自評表(QACCC)」的陡坡圖 85
圖4-1. 研究對象收案的流程圖 92
圖4-2. 兩組「文化照護知識」三次得分之變化趨勢圖 103
圖4-3. 兩組「文化照護態度」三次測量得分之變化趨勢圖 109
圖4-4. 兩組「文化照護技巧」三次得分之變化趨勢圖 111
圖4-5. 兩組「文化照護行為」三次得分之變化趨勢圖 112
圖4-6. 「文化照護能力課程」的四個領域及九個主題 119
圖4-7. 兩組「領域Ⅰ:文化照護-基本知識」三次得分之變化趨勢圖 121
圖4-8. 「領域Ⅰ:文化照護-基本知識」之質性內容概念圖 125
圖4-9. 兩組「領域Ⅱ:文化照護-倫理與資源」三次得分之變化趨勢圖 127
圖4-10. 「領域Ⅱ:文化照護-倫理與資源」之質性內容概念圖 130
圖4-11. 兩組「領域Ⅲ:刻板印象與醫療決策」三次得分之變化趨勢圖 132
圖4-12. 課程「領域Ⅲ:刻板印象與醫療決策」之質性內容概念圖 134
圖4-13. 兩組「領域Ⅳ:臨床實務技巧」三次得分之變化趨勢圖 136
圖4-14. 「領域Ⅳ:臨床實務技巧」之質性內容概念圖 138
圖5-1. 研究者歸納的文化照護能力模式圖 182
圖5-2. LOVE C U(愛看見你)圖 184


附錄

附錄1. Jeffreys對能力(competence)字詞的定義 210
附錄2. 跨文化護理、文化融合性照護及文化照護能力之關係圖 211
附錄3. 萊林格的日出模式 212
附錄4. Schim and Miller的文化照護能力模式 213
附錄5. 國內外文化照護能力的10個評估工具 214
附錄6. 10個評量工具之文化照護能力所涵蓋的面向 217
附錄7. 10個評量工具的品質綜合 219
附錄8. 3版與4版「文化照護能力評量表(CCA)」之比較 220
附錄9. 「文化照護能力評量表(CCA)」之信效度 223
附錄10. 「文化照護能力評量表(CCA)」之臨床應用 224
附錄11. 美國護理大學學會(AACN)的五項文化照護能力 228
附錄12. 美國護理大學學會(AACN)的六項文化照護核心能力 236
附錄13. 美國醫學大學學會(AAMC)文化照護能力課程的五個領域 239
附錄14. 文化照護能力課程相關研究 246
附錄15. 文化照護能力課程 253
附錄16. 基本資料調查表 265
附錄17. 文化照護能力評估量表-中文版(CCA-CV) 270
附錄18. 文化照護能力課程評量表(QACCC) 274
附錄19. 課程回饋單 277
附錄20. 同意轉譯之批准信件 278
附錄21. 前測「文化照護能力評估量表-中文版(CCA-CV)」在各題得分比率(N=230) 279
附錄22. 「文化照護能力評估量表-中文版(CCA-CV)」未轉軸的成份矩陣 281
附錄23. 前測「文化照護能力課程自評表(QACCC)」各次量表之題目的得分 比率 282
附錄24. IRB證明及研究問卷同意書 285
附錄25. 冰山與文化照護能力 286
附錄26. 文化(cultural)字詞的說明 287
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