線上微課程對提升護理師理解務實性臨床試驗之成效

Abstract

【背景與目的】隨著真實世界數據（Real World Data, RWD）與真實世界證據（Real World Evidence, RWE）在醫療決策中日益普及，務實性臨床試驗（Pragmatic Clinical Trials, PCT）因其設計貼近常規臨床實務，已成為連接研究與臨床應用的關鍵工具。然而，台灣臨床研究護理師對PCT的認知普遍不足，且缺乏系統性教育資源。鑑於數位科技日新月異，線上教學已成為當前教育發展的重要趨勢。為此，本研究旨在探究數位化學習工具如何與護理專業知識結合，以提升護理人員的學習成效，評估線上微課程對具臨床試驗照護經驗之護理師PCT知識理解之提升成效，並探討心理狀態及學習者特質對學習成效的影響。此研究結果將為未來護理教育訓練提供重要的實證參考。 【方法】本研究採用單組前後測之類實驗設計，透過便利與滾雪球取樣法進行招募。受試者於REDCap平台完成前測問卷後，觀看約8分鐘的PCT線上微課程（透過平台或外接至YouTube播放），隨即進行後測。研究工具包括18題PCT知識測驗、7題學習者主導量表與6題學習動機量表、PHQ-2憂鬱2題及職業倦怠評估1題。所有數據使用SPSS 26.0進行描述及推論性統計，包含獨立樣本T檢定、配對樣本T檢定、皮爾森積差相關係數、階層迴歸分析及逐步迴歸分析。 【結果】本研究最終納入 150 位具臨床試驗照護經驗之護理人員，以女性為主（89.3%），平均年齡 37.8 歲；七成最高學歷為大學。八分鐘線上微課程介入後，務實性臨床試驗知識後測（15.44 ± 3.05）顯著高於前測（10.84 ± 4.25）（t = 13.57，p < .001）。後測成績與學習者主導（r = .21）及自我效能（r = .20）呈正相關，與憂鬱（r = –.23）及職業倦怠（r = –.21）呈負相關（皆 p < .05）。階層迴歸顯示控制人口與臨床背景後，憂鬱為影響學習成效的顯著負向因子（β = –.24, p < .05），總解釋力達56.5%；逐步迴歸模型則納入六項顯著預測變項，解釋力33.9%，其中臨床背景、近期培訓時數與憂鬱程度具重要影響；敏感度分析以心理變項二分法重新建模，模型解釋力提升至 56.7%（F = 33.324，p < .001），顯示「無職業倦怠」與「心情良好」者學習成效最佳。整體而言，線上微課程有效提升護理人員之 PCT 知識，學習成效受心理狀態顯著影響，未來教育設計應考量學員的心理健康，以達更佳學習效果。 【結論】本研究證實，線上微課程是提升護理人員務實性臨床試驗（PCT）知識的有效途徑，並發現學習成效與護理人員的心理特質及臨床背景密切相關。結果顯示，較高自我效能與學習者主導特質者為正向驅動力，反之，情緒憂鬱、職業倦怠或特定的臨床單位科別經驗則與學習成效不佳相關。綜合以上，本研究支持微課程為臨床教育中具效能且可複製之教學模式，未來可進一步依據學習者差異設計分層教材，以優化學習成果並強化實務應用力。

Background and Objective: As real-world data (RWD) and real-world evidence (RWE) gain prominence in healthcare decision-making, pragmatic clinical trials (PCTs) have become essential for bridging research and routine practice. In Taiwan, clinical research nurses often lack sufficient knowledge of PCTs and access to structured educational resources. With the rise of digital learning, this study aims to evaluate the effectiveness of an online microlearning course in enhancing PCT knowledge among nurses involved in clinical trials. It also explores how psychological factors and learner characteristics influence learning outcomes. The findings will provide valuable insights for advancing nursing education and training. Methods: This study employed a single-group pretest-posttest quasi-experimental design. Participants were recruited using convenience and snowball sampling. After completing a pretest questionnaire via the REDCap platform, participants viewed an 8-minute online microlearning video on PCTs (hosted on the platform or linked to YouTube), followed immediately by a posttest. Instruments included an 18-item PCT knowledge test, a self-efficacy scale (comprising 7 items on learner autonomy and 6 on learning motivation), the 2-item Patient Health Questionnaire (PHQ-2) depression scale, and a single-item burnout measure. Data were analyzed using SPSS 26.0 for both descriptive and inferential statistics, including independent and paired-sample t-tests, Pearson’s correlation, hierarchical regression, and stepwise regression analyses. Results: A total of 150 nurses with clinical trial experience were enrolled, predominantly female (89.3%) with a mean age of 37.8 years; 70% held a bachelor's degree. Following the 8-minute online microlearning intervention, posttest scores on PCT knowledge (15.44 ± 3.05） were significantly higher than pretest scores (10.84 ± 4.25) (t = 13.57, p < .001). Posttest scores were positively correlated with learner autonomy (r = .21) and self-efficacy (r = .20), and negatively correlated with depression (r = –.23) and burnout (r = –.21) (all p < .05). Hierarchical regression showed that, after controlling for demographic and clinical variables, depressive score was a significant negative predictor of learning outcomes (β = –.24, p < .05), with the model explaining 56.5% of the variance. Stepwise regression identified six significant associated factors, accounting for 33.9% of variance, with clinical background, recent training hours, and depression level being key factors. Sensitivity analysis using dichotomized psychological variables improved explanatory power to 56.7% (F = 33.324, p < .001), indicating that participants with no burnout and positive mood had the best learning outcomes. Overall, the microlearning course effectively enhanced PCT knowledge among nurses, with psychological well-being significantly influencing learning performance. Future educational interventions should consider learners’ mental health to optimize outcomes. Conclusions: This study demonstrates that online microlearning is an effective approach for enhancing nurses’ knowledge of pragmatic clinical trials (PCTs). Learning outcomes were closely associated with psychological condition and clinical background. Higher self-efficacy and learner autonomy positively influenced performance, whereas depressive symptoms, burnout, and certain clinical working roles were linked to poorer outcomes. These findings support microlearning as an efficient and scalable model for clinical education. Future curriculum design should incorporate learner-specific adaptations to optimize outcomes and strengthen practical application.