遊戲化教學提升護理師評估腫瘤藥物相關皮膚不良反應之成效

Abstract

護理師在照護接受癌症藥物或臨床試驗藥物治療之病人時，常需面對由腫瘤治療藥物引起的皮膚不良反應(Cutaneous Adverse Drug Reactions, CADRs）。過去護理教育對於藥物不良反應的教學較常使用文字教材，缺乏能促進臨床判斷與實務應用之互動式學習設計。隨著數位與互動式教學的興起，遊戲化教學漸被視為提升學習動機與實務表現的有效策略，近年國內已有學者開發圖像式遊戲教學介入臨床研究護理師照護CADRs，並發現具正向成效。然臨床照護CADRs病人之護理師角色多元，除研究護理師外，一般臨床護理師也有許多機會照護CADRs的病人，因此本研究旨在運用過去學者之研究為基礎，擴大探討遊戲化教學於一般護理師學習CADRs之成效。 本研究採準實驗設計（quasi-experimental design），以臺灣北部某醫學中心之臨床護理人員為對象，依類隨機方式分為介入組與對照組。介入組接受CADRs圖像式影音教學及遊戲化活動，包含運用CADRs圖像牌卡，搭配小組競賽與互動討論，強調CADRs辨識、分級與處置流程之臨床應用。對照組則為常規對照組，可提供常見毒性標準（Common Terminology Criteria for Adverse Events, CTCAE）第五版常規文字教材。所有受試者於教學介入前後填寫問卷，評估其認知、態度與實務成效，後測問卷也包含課程滿意度與學習感受。 本研究共納入139名受試者，介入組67位與對照組72位，介入組於三大學習層面（認知、態度與技能）之後測得分皆顯著高於前測，且明顯優於對照組（p < .0001）。在CADRs皮膚表徵判別、毒性分級與初步處置情境題中，介入組展現更高答對率與臨床推論能力，以廣義加乘模型（Generalized Additive Model, GAM）及多元逐步迴歸探討學習成效與相關因素之關聯，發現介入組、年齡、學歷、臨床試驗相關年資與照護CADRs經驗等因素具有顯著交互影響。受試者對課程表達高度滿意，認為課程具實用性且能提升臨床應用意願，並肯定圖像式遊戲牌卡與互動活動設計有助於促進參與感與學習動機。 本研究提供實證支持遊戲化教學提升護理人員在 CADRs 評估之知識掌握、態度轉變與技能應用能力。結合圖像、互動與競賽元素之設計，能有效激發學習動機、促進記憶與理解，對臨床教育具實際應用潛力。建議未來可持續優化此類教學模式，作為強化護理教育品質與實務能力的創新策略之一。

Nurses who care for patients receiving cancer therapies or clinical trial medications often encounter cutaneous adverse drug reactions (CADRs) induced by antineoplastic agents. In the past, nursing education on adverse drug reactions has predominantly relied on text-based materials, lacking interactive instructional designs that promote clinical reasoning and practical application. With the rise of digital and interactive learning approaches, gamified teaching has increasingly been recognized as an effective strategy to enhance learning motivation and clinical performance. In recent years, domestic researchers have developed image-based gamified teaching interventions for clinical research nurses caring for patients with CADRs and have demonstrated positive outcomes. However, nurses involved in CADRs care are diverse in their roles. In addition to research nurses, general clinical nurses also frequently provide care for patients experiencing CADRs. Therefore, this study aims to build upon prior research and expand the application of gamified teaching to evaluate its effectiveness in enhancing general nurses’ learning outcomes related to CADRs assessment and care. This study adopted a quasi-experimental design and recruited clinical nurses from a medical center in northern Taiwan. Participants were allocated into either the intervention or control group. The intervention group received an educational program incorporating image-based audiovisual content and gamified activities related to CADRs. The intervention included the use of CADRs image cards, integrated with team-based competitions and interactive discussions, emphasizing the clinical application of CADRs recognition, grading, and management procedures. In contrast, the control group was provided with conventional text-based materials derived from the Common Terminology Criteria for Adverse Events (CTCAE), Version 5, covering the same content areas. All participants completed pre- and post-intervention questionnaires to assess their knowledge, attitudes, and practical competencies. The post-test questionnaire also included course satisfaction and learning experience. A total of 139 participants were included in the study, with 67 in the intervention group and 72 in the control group. The intervention group demonstrated significantly higher post-test scores across all three learning domains, knowledge, attitude, and skills, compared to their pre-test scores, and their performance was markedly superior to that of the control group (p < .0001). In assessing CADRs, toxicity grading, and management, the intervention group exhibited higher accuracy and stronger clinical reasoning abilities. To examine the relationship between learning outcomes and associated factors, a Generalized Additive Model (GAM) and multiple stepwise regression analysis were conducted. Results revealed significant interaction effects involving group assignment, age, educational level, clinical trial-related experience, and prior experience in caring for patients with CADRs. Participants reported high levels of satisfaction with the course, noting its practical value and its effectiveness in enhancing their willingness to apply knowledge in clinical practice. They also affirmed that the image-based game cards and interactive activities helped foster engagement and motivation to learn. This study offers empirical evidence for the effectiveness of gamified teaching in enhancing nurses’ knowledge acquisition, attitudinal shifts, and skill application in the assessment of CADRs. The integration of visual elements, interactive engagement, and competitive activities was shown to effectively enhance learning motivation, reinforce memory, and improve conceptual understanding. These findings highlight the practical applicability of gamification in clinical education. It is recommended that future efforts continue to refine such instructional approaches as an innovative strategy to strengthen the quality of nursing education and professional competence.