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標題: | 應用情境判斷測驗了解臨床研究護理師對工作情境之能力內涵 Applying Situational Judgement Test to Understand the Competency toward Job-related Situations among Clinical Research Nurses |
作者: | Mei-Hui Wang 王美惠 |
指導教授: | 張榮珍(Jung-Chen Chang) |
關鍵字: | 臨床研究護理師,情境判斷測驗,臨床試驗,能力內涵,護理能力內涵, clinical research nurse,situational judgment test,clinical trial,competency,nursing competency, |
出版年 : | 2020 |
學位: | 碩士 |
摘要: | 背景: 臨床試驗是人類醫學進步和發展的重要過程,受試者保護與試驗品質是試驗成功的重要因素。臨床試驗研究團隊中的臨床研究護理師(Clinical Research Nurse, CRN)已成為護理專業的進階新角色並具有關鍵重要性。了解CRN在面對臨床試驗工作時的情境判斷反應,可做為評估個人工作能力內涵之參考,以維護受試者安全並提升臨床試驗品質。情境判斷測驗(Situational Judgement Test, SJT)是近年醫學、牙醫與教育領域,用以評量個人在工作相關情境下的判斷,藉以理解受評量者之能力內涵,預估未來工作表現與專業期待之相符程度。本研究運用SJT理念,設計我國CRN於臨床試驗執行時可能遭遇的情境判斷,並評估CRN情境判斷高低分與個人背景與臨床試驗護理執行背景經驗之相關性。
方法: 經過焦點團體、專家會議與前驅測試,擬定具信度與效度之SJT問卷,適用於我國CRN於臨床試驗計畫執行之情境判斷,問卷共20題幹及40子題。運用滾雪球方式邀請具有臨床試驗執行經驗的CRN以不記名方式填寫問卷,並邀請其中30位完成再測評估,以建立再測信度,利用迴歸分析模型了解與SJT得分高低之相關因素。 結果: 本研究發展CRN適用的SJT問卷之專家內容效度為0.96,問卷內部一致性信度指標Cronbach’s Alpha為0.68,本研究共收集116位CRN之完整問卷,再測信度相關係數有30子題具顯著正相關(p<0.05)。將SJT得分高低分組後,運用羅吉斯逐步迴歸了解CRN於SJT評量可獲高分之可能相關因素,結果發現CRN的工作職稱為「臨床研究護理師」、最常執行收案科別為血液腫瘤科、曾執行多國多中心試驗計畫等三項因素具顯著相關性(p<0.05)。工作職稱若自述為「臨床研究護理師」則相較於自述為「研究助理」者,成為SJT高分者的勝算比為3.539(adjusted odds ratio, aOR= 3.539,95% CI: 1.264- 9.907);若CRN最常執行試驗收案的科別為「血液腫瘤科者」,相較於非血液腫瘤科之CRN,其aOR為 6.057 (95% CI: 1.340- 27.383);曾參與多國多中心試驗計畫的CRN,相較無此經驗者亦高出五倍以上機會成為SJT高分組(aOR= 6.812,95% CI:1.236- 37.534)。 結論: CRN的職稱與聘用均建議使用「臨床研究護理師」而非「研究助理」,正確的職稱與專業情境判斷高分具關連性;參與多國多中心臨床試驗計畫案之經驗有助於提升CRN之臨床情境判斷能力內涵,建議未來透過正式名稱聘任CRN,專業認同將有助於品質的提升;除了臨床研究護理以外,其他護理專業領域亦可發展具信效度之情境判斷測驗,用以了解護理師於特定情境下之判斷與行為抉擇意向,藉此可以發展合適的教育訓練計畫,提高專業的執業能力內涵共識,在傳統的知識傳遞外,能透過專家共識之情境判斷反應,逐步型塑新手往專家行為態度意向趨於專業認同的能力內涵。 Background: Clinical trials are an important process in the advancement and development of medicine. Subject protection and trial quality are two critical elements for success of clinical trials. The Clinical Research Nurse (CRN) is a vital role in the research team and has been a newly recognized advanced practice in nursing profession. CRN’s personal characteristics and nursing competency are crucial for safety of subjects and quality of clinical trials. Situational Judgement Test (SJT) has applied recently in medicine, dentisty, and education. Through SJT, we can predict the respondants’ future job performance and the similarity to professional expectation. This study aims to design SJT for CRN in the implementation of clinical trials in Taiwan. The personal background caracteristics and trial experiences are evaluated for the association with the SJT performance. Methods: Through focus groups and expert meetings, a reliable and valid SJT questionnaire is developed which is applicable to the situational judgment in the implementation of clinical trial by CRNs in Taiwan. The questionnaire contains 20 clinical situations and 40 questions. A snowball method is used to invite CRNs to respond to the SJT anonymously. Among all participants, 30 CRNs are invited for test-retest reliability. The statistical methods contain univariate analyses (t-test) and logistic regression. Results: The content validity index (CVI) of the SJT is 0.96 and the internal consistency reliability is 0.68. The SJT has also acceptable retest reliability (p<0.05). A total of 130 questionnaires sent out, 116 CRNs respond to the questionnaire. After grouping CRN into high- and low-SJT scores, we used stepwise logistic regression to understand the possible factors related to SJT performance. Using CRN as job title, working in Hematology, and implementing global multi-center clinical trial are essential factors related to high scored in SJT (p <0.05). If the job title is 'Clinical Research Nurse', the odds ratio for high-scored SJT is 3.539 (adjusted odds ratio, aOR = 3.539, 95% CI: 1.264-9.907) compared with the job title being 'Research Assistant.' Working in the field of hematology, CRNs can scored high in SJT (aOR: 6.057, 95% CI: 1.340-27.383). If the CRNs have experiences in global trials with multi-centers, their scores were five times higher than those who did not have this experience (aOR = 6.812, 95% CI: 1.236- 37.534). Conclusion: It is recommended to use 'Clinical Research Nurse' instead of 'Research Assistant' as the job-title for CRN. The professional title and experiences in clinical trials are associated with the scores of SJT. Professional recognition will help improve the competency for CRNs. Reliable and effective clinical situation judgment tests can be developed in the nursing profession. In the process of professionalism, SJT can be used to improve the competency of CRN in the process of novice to expert. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/65238 |
DOI: | 10.6342/NTU202000334 |
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顯示於系所單位: | 護理學系所 |
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