[[alternative]]Design and Evaluation of an Extracorporeal Membrane Oxygenation Simulation Learning System

[[abstract]]葉克膜常用於病危病患，藉以爭取時間以能進行更多治療。加護病房護理人員照護使用葉克膜的病人，需即時監測和評估病人相關資料，以執行緊急治療處置，因此需接受相關教育訓練以增進照護專業能力。國內目前多以傳統授課方式進行葉克膜教育訓練，缺乏多元化的學習途徑，而數位化的模擬學習方式，能提供更即時且彈性的學習。本研究目的在探討加護病房護理人員對葉克膜模擬學習系統的需求，依其需求設計葉克膜模擬學習系統雛型，並分析加護病房護理人員對此系統雛型評估的意見。 本研究依據ADDIE教學系統設計模式，以北部某醫學中心加護病房護理人員為研究對象，採用訪談及文獻探討等方法分析護理人員對葉克膜模擬學習系統需求，根據其需求設計此模擬學習系統雛型，於系統雛型規劃後採用方便取樣方式，透過系統可用性量表（SUS）及使用者互動滿意度問卷（QUIS）等工具，蒐集35位護理人員對此系統雛型評估意見。資料分析採用SPSS 22.0版統計軟體進行資料建檔，以描述性統計及推論性統計進行分析。 本研究結果包括：（1）加護病房護理人員對葉克膜模擬學習系統的需求內容包含：葉克膜放置前護理、葉克膜放置期間每日護理評估、及準備移除葉克膜護理等三部份，其學習項目包括8項知識層面及11項技能層面。（2）葉克膜模擬學習系統設計有課程學習、自我測驗、模擬情境等三個子系統。規劃系統功能有查詢及瀏覽學習內容、葉克膜照護的模擬情境操作、自我測驗考題、學習歷程記錄與查詢等。（3）加護病房護理人員對葉克膜模擬學習系統雛型的可用性評估，其整體平均分數為80.00分，顯示此系統雛型介於Good與Excellent等級，在使用者互動滿意度五大層面，其平均分數皆大於五分。 由研究結果顯示本研究設計葉克膜模擬學習系統雛型，可提供加護病房護理人員學習葉克膜專業照護知識，並藉由模擬情境案例進行重複且有彈性的操作練習，因此可成為加護病房護理人員學習葉克膜專業照護知識與技術的數位化學習工具。此外，本研究研發葉克膜模擬學習系統的分析、設計及雛型評估的經驗，能提供未來建置葉克膜模擬學習系統或其他維生醫療儀器模擬學習系統之參考。[[abstract]]Extracorporeal Membrane Oxygenation (ECMO) is often used for critically-ill patients to gain time for future treatment of imminently lethal diseases. Intensive care unit (ICU) nurses caring for patients using ECMO need to perform real-time monitoring and evaluation of patient-related data to implement urgent treatment and nursing care. Therefore, relevant education and training is vital to provide nursing function properly and cultivate nursing competence. In Taiwan, current ECMO educational training is mainly through traditional lecture teaching methods without much diversity in learning approaches. Today, digital simulation learning methods offer virtual learning situations, and can provide instant and flexible learning opportunities. Therefore, the aim of this study was to analyze the needs of ICU nurses utilizing an ECMO simulation learning system and design an ECMO simulation learning system prototype according to their needs. Subsequently, user opinions were obtained to evaluate the system prototype. This study was conducted in a medical center in northern Taiwan according to the ADDIE instructional model. Intensive care unit nurses were recruited to participate in the study and system design. Interviews and a literature review analyzed ICU nurse needs for an ECMO simulation learning system. After summarizing the interview data and literature review, we designed a system prototype for this simulation learning system. Upon completion of the system prototype development, “System Usability Scale (SUS)” and “Questionnaire for User Interface Satisfaction (QUIS)” were used to develop the research questionnaire with convenience sampling selecting 35 ICU nurses to evaluate the system usability and provide comments. SPSS 22.0 version statistical software was used to build data files for data analysis, and descriptive statistics and inferential statistics were used for analysis. This study found the following items. (1) The needs of ICU nurses for an ECMO simulation learning system included three parts: pre-ECMO placement care, daily care during ECMO placement, and care in preparation for ECMO removal. The learning content items included eight items knowledge domains and 11 items skill domains. (2) The ECMO simulation learning system was designed with three subsystems: course learning, self-test, and simulation situations. The system functions included search and browsing of learning content, performing of ECMO care in simulated situation cases, self-test questions, record and query of a learning portfolio, and account management. (3) The usability evaluation with ICU nurses resulted in an the overall average score of 80.00 SUS points, showing that the prototype was between Good and Excellent. In the five major domains of user interaction satisfaction, the average scores were all greater than 5 points. This prototype system provided ECMO care knowledge and simulation cases to practice appropriate skills through repeated and flexible learning. As such, it may become a practical ECMO in-service education digital learning tool for ICU nurses. In addition, the experience with analysis, design, and evaluation of the development prototype of the ECMO simulation learning system provides a reference for future construction of an ECMO simulation learning system or other life-saving medical equipment simulation learning systems