發展情境互動式電子書以增進護理生健康識能表現與護病溝通能力之成效研究

Abstract

本研究旨在探討以臨床情境為基礎發展之情境互動式電子書，對護理學生在健康識能表現與護病溝通能力上的學習成效。採準實驗設計，以中部某大學護理系四年級學生為對象，依班級分為實驗組（n=28）與對照組（n=27），分別接受電子書教學與傳統課程。教學介入前後實施「健康識能導向之護病溝通數位學習問卷」進行評量；研究結束後，亦安排對照組補課，以保障受教權益。電子書內容設計結合 Calgary-Cambridge 模型、多媒體學習認知理論、概念構圖法及動機設計原則，強調臨床真實情境的模擬學習與互動式學習體驗。本研究評量問卷，包括「健康識能表現」（共 26 題）與「護病溝通能力」（共 18 題），經專家審查與預試驗證，具良好內容效度（CVI 分別為 0.97 與 0.93）與內部一致性（Cronbach's α 分別為 0.96 與 0.94）。 結果顯示，廣義估計方程式（GEE）分析中雖「時間」與「時間 × 組別」交互作用未達顯著，但控制年齡後，「組別主效應」於健康識能與護病溝通能力表現皆具統計顯著性（p = .015；p = .008）。補充性檢定亦發現，實驗組後測表現在健康識能（p = .035）與護病溝通能力（p = .018）皆顯著優於對照組，並在藥物說明、資訊判讀與臨床溝通技巧等面向有明顯提升。 整體而言，本研究所建構之情境互動式電子書具有良好教學成效與實務應用價值，建議可進一步應用於不同學習階段與多元背景之學生，以拓展其在健康識能導向之溝通訓練上之應用潛力與教育價值。

This study aimed to assess the learning effectiveness of a scenario-based interactive e-book, developed within real clinical settings, on nursing students’ health literacy performance and nurse–patient communication skills. A quasi-experimental design was used to focus on fourth-year nursing students at a university in central Taiwan. Participants were divided by class into an experimental group (n = 28), which received instruction including the e-book, and a control group (n = 27), which followed the traditional curriculum. Pre- and post-intervention assessments were conducted using the “Health Literacy-Oriented Nurse–Patient Communication Digital Learning Questionnaire.” To promote educational equity, the control group was also provided with the e-book intervention after the study ended.The e-book was designed based on the Calgary-Cambridge model, the cognitive theory of multimedia learning, concept mapping, and motivational instructional principles, emphasizing simulation of real-world clinical scenarios and interactive learning experiences. The assessment tool included two subscales: Health Literacy Performance (26 items) and Nurse–Patient Communication Competence (18 items). Both scales were reviewed by experts and pilot-tested, demonstrating strong psychometric properties with content validity indices (CVI) of 0.97 and 0.93, and internal consistency (Cronbach’s α) of 0.96 and 0.94, respectively.Results from the Generalized Estimating Equation (GEE) analysis showed that neither the main effect of time nor the interaction between time and group was statistically significant. However, after controlling for age, significant group effects were found for both health literacy and communication competence (p = .015; p = .008). Additional analyses further indicated that the experimental group performed better than the control group on the posttest in both areas (health literacy: p = .035; communication: p = .018), with notable improvements in medication explanation, information appraisal, and clinical communication strategies.In conclusion, the scenario-based interactive e-book developed in this study showed promising instructional effectiveness and practical usefulness. It is recommended for wider adoption across various stages of nursing education and diverse learner groups to improve communication training based on health literacy principles.