[[alternative]]The learning outcomes of a self-learning DVD regarding central venous catheter infection control for nurses

[[abstract]]研究目的：旨探討某醫學中心介入自學光碟教學策略後，護理人員對中央靜脈導管感染管制之學習成效。研究設計：採實驗性之雙組前後測研究設計，於2014年11月至2015年4月期間，以北部某醫學中心的心臟外科加護病房與一般病房護理人員為研究對象，經抽籤分實驗組介入「中央靜脈導管感染管制自學光碟」學習2週，控制組則不提供任何結構式教育訓練。2組分別在介入前、介入2週後立即，和介入結束後3個月施測，包括中央靜脈導管感染管制知識測驗及態度與行為意向量表自評，以及接受中央靜脈導管感染管制照護相關查檢。所有資料回收建檔後以SPSS19.0進行檢定，描述性統計將類別變項以次數和百分率呈現，連續變項則以平均值和標準差說明；推論性統計則以卡方檢定或Fisher exact test檢定類別資料；t檢定(含pair-t)或Mann-Whitney U test檢定連續性資料，最後以廣義估計方程式(Generalized Estimating Equations, GEE)推定介入成效。研究結果：共81位護理人員參與研究(實驗組39人、控制組42人)，兩組在基本屬性與前測結果之檢定符合同質與可比較性。研究結果顯示實驗組在自學光碟介入後之成效為(一)中央靜脈導管感染管制知識立即後測與結束後3個月後測得分顯著高於前測，(二)中央靜脈導管感染管制態度立即後測得分顯著高於前測，但結束後3個月後測得分與前測沒有差異，(三)中央靜脈導管感染管制行為意向立即後測與結束後3個月後測得分顯著高於前測，但是2次行為查檢結果與前測均無顯著差異。最後以多變項分析結果，(四)控制前測效應與控制組時間成長效應後，實驗組在中央靜脈導管感染管制知識得分顯著優於控制組；但在中央靜脈導管感染管制態度與行為，實驗組與控制組間沒有差異。結 論：導入多媒體光碟自學的教學策略，對提升護理人員知識層面有顯著成效，但態度與行為之改變可能需經長期且反覆學習，且單一教學策略改善成效不大。[[abstract]]OBJECTIVE: To assess the learning outcomes of a self-learning DVD educational intervention regarding central venous catheter infection prevention among nurses in a tertiary hospital in Taiwan. DESIGN: This was an experimental two-group pre and posttest design. We studied in two cardiac surgical intensive care units and general wards of a medical center in November 2014 to April 2015 period. The experimental group completed a "central venous catheter infection control self- learning DVD" for two weeks, and the control group did not provide any formal structure education. All of them had finished tests and check before intervention, after two weeks of intervention immediate and three months later, including knowledge test, attitude and behavior intention self-evaluation, and checklist. All data were analyzed by SPSS19.0 software. Continuous variables were expressed as mean with standard deviation, and categorical variables were expressed as percentages. Univariate analysis performed by using Student’s t-test or Mann-Whitney U test for continuous variables and the Pearson's chi-squared test or Fisher’s exact test for categorical variables. Multivariate analysis was used generalized estimating equation (GEE) to identify the effect of the learning strategy. RESULTS: The results of the experimental group who finished self-learning DVD showed (1) There were significant increase in knowledge of central venous catheter infection control immediately and following the third months ; (2) There were significant increases in attitude immediately ,but not following the third months; and (3) significant increase in behavior intention self-evaluation immediately and following the third months, but not significant increases by checklist after intervention immediately as well as following the third months. (4) After adjustment for confounding factors of the effects for time and time by control group, the experimental group showed a significant increase in central venous catheter infection control knowledge than the control group; however, no differences between the central venous catheter infection control attitudes and behavior. CONCLUSIONS: The learning strategy of self-learning DVD can enhance the nurses’ knowledge of central venous catheter infection prevention recommendations, but not changing attitudes and behavior. May be learning effect on attitudes and behavior can achieve by longitudinal observe, and we need multifaceted strategies to improve performance in central venous catheter infection prevention practice not only single educational program