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研究生：	陳萩憶 Chen, Chiu-I
論文名稱：	發展與評價教育課程介入對兒科護理師文化照護能力之成效 Development and Evaluation of Education Intervention for Pediatric Nurses’ Cultural Competence
指導教授：	黃美智 Huang, Mei-Chih
學位類別：	博士 Doctor
系所名稱：	醫學院 - 護理學系 Department of Nursing
論文出版年：	2021
畢業學年度：	109
語文別：	英文
論文頁數：	120
中文關鍵詞：	文化照護能力、繼續教育、ADDIE模式、Kirkpatrick Model 、兒科護理師、兒科護理師文化照護能力量表
外文關鍵詞：	cultural competence, continuing education, ADDIE model, Kirkpatrick Model, pediatric nurses, Pediatric Nurses Cultural Competence Scale
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本研究目的在於發展與評價教育介入對兒科護理師文化照護能力之成效，以ADDIE模式發展介入課程，並以Kirkpatrick模式進行課程成效評價。研究對象及場所為台南市所屬醫院之兒科單位(含兒科特殊單位)護理師，採準實驗之前後測設計，依有無接受文化照護能力教育課程分組，計實驗組34位，對照組31位，兩組皆於課前進行前測，以及6個月後進行後測，實驗組同時輔以焦點團體的經驗分享，以瞭解教育課程介入措施成效。

研究結果：
一、Kirkpatrick的反應層次評價：兒科護理師對文化照護課程整體平均滿意度為4.81分，達96.24% 滿意；在開放性的問題回應中提出建議與回饋，對於文化照護議題具有學習動機。
二、Kirkpatrick的學習層次評價：兒科護理師接受文化照護能力教育課程後，課後文化照護能力各面向分數皆明顯提升。
三、Kirkpatrick的行為層次評價：相較於課程介入後的即刻後測成績，實驗組兒科護理師課後6個月的文化照護能力量表分數有下降，但仍高於初次(前測)的評量分數；在文化知識、文化敏銳度，仍有統計上的差異，顯示課程介入是能改變其知識、態度與行為。實驗組與對照組文化照護能力在前測無統計上的差異，於6個月後文化知識，仍有統計上的差異。
四、Kirkpatrick的結果層次評價：經過文化照護課程介入，兒科護理師的文化照護能力是有提升，並期望能持續學習文化照護相關的技能。

結論：研究結果發現實驗組在接受文化照護教育課程介入措施後，其文化照護能力有提升，呈現統計顯著差異，並能應用於臨床上。建議臨床的在職教育，可規劃文化照護能力相關主題，列為職級晉升之學習內容，以提升護理師文化照護能力學習意願，進而能對不同族群提供合適的照護。同時亦建議各護理學校可以開設有關文化照護之課程，讓學生在校時可以開始培養文化照護能力。

The purpose of this study is to develop and evaluate the effectiveness of education intervention on pediatric nurses' cultural competence. The ADDIE Model was used to develop the educational intervention course, and Kirkpatrick Model was used to evaluate the effectiveness of the course. The research subjects were the nurses of the pediatric unit (including special pediatric units) in Tainan City. The quasi-experimental design with pre-test and post-test was adopted, and the subjects were assigned into groups according to whether they had received cultural competence education courses. There were 34 subjects in the experimental group and 31 in the control group. The pre-test was performed before class and the post-test was performed after 6 months for both groups. Simultaneously, the experience sharing of the focus group discussion in the experimental group was supplemented to understand the effectiveness of the education intervention.

Research Results:
1. Evaluation of Kirkpatrick's reaction level: The overall average satisfaction of pediatric nurses with the course was 4.81 among five Likert scale, with a satisfaction rate of 96.24%. There were suggestions and feedbacks in response to open questions, and they were motivated to learn about cultural care issues.
2. Evaluation of Kirkpatrick's learning level: After pediatric nurses received the cultural competence education course, the scores of cultural competences immediately after class were s significantly improved in all aspects.
3. Evaluation Kirkpatrick’s behavior level: While the scores of the cultural competency scale of the pediatric nurses in the experimental group gradually declined 6 months later, their scores were still higher than the scores in the initial evaluation. There were still statistical differences in cultural knowledge and cultural sensitivity, which shows that education intervention can change their knowledge, attitudes and behaviors; there was no statistical difference in cultural competence between the experimental group and the control group in the pre-test, and there were still statistical differences in cultural knowledge after 6 months.
4. Evaluation Kirkpatrick's result level: Pediatric nurses' cultural competence has been improved, and they hope to continue to learn cultural care.

Conclusions:
Nurses’ cultural competence of the experimental group improved after receiving the cultural care education courses, showing statistically significant differences, and they can apply this knowledge to clinical practice. It is recommended that cultural competence related topics can be planned for on-the-job education and be listed as the necessary learning for promotion, in order to enhance the willingness of nurses to learn about cultural competence and provide suitable care for different ethnic or background groups. It is also suggested that nursing schools could offer the relevant courses on cultural care, in order that students can begin to gain their cultural competence for taking care the patients with diverse cultural background.

Table of Contents
Abstract in Chinese  i
Abstract  iii
Acknowledge v
Table of Contents  vii
List of Tables  ix
List of Figures  xi
Appendix  xii

Table of Contents
Chapter I Introduction 1
1.1 Background  1
1.2 Research Motivation and Significance  3
1.3 Research Purpose  6
1.4 Definitions  7
Chapter II Literature Review
2.1 Cultural Care Theory 10
2.2 Cultural Competence 16
2.3 Related Research on Educational Intervention Measures for Cultural Competence 21
2.4 Continuing Education 24
2.5 ADDIE Model 28
2.6 Kirkpatrick Model of Effectiveness Evaluation  30
Chapter III Pilot Study 33
Chapter IV Research Method
4.1 Research Framework  38
4.2 Research Design 40
4.3 Research Questions and Hypotheses  42
4.4 Intervention  44
4.5 The Preparation Process of Pediatric Nurses Cultural Competence Scale 50
4.6 Research Site and Research Subjects  54
4.7 Research Instruments  55
4.8 Data Collection Process 57
4.9 Data Analysis 59
4.10 Research Ethics  60
Chapter V Research Results
5.1 Demographic Data of Pediatric Nurses 61
5.2 Evaluation of Effectiveness of on-the-job Education in Cultural Care 71
Chapter VI Discussion
6.1 Demographic Data of Pediatric Nurses 97
6.2 Effectiveness of On-the-job Education Intervention in Cultural Care 99
6.3 Objectives of Educational Courses of Culturally Competent Care 104
Chapter VII Conclusion and Suggestions
    7.1 Conclusion 105
    7.2 Suggestions 106
References 108

List of Tables
Table 3-1 Characteristic Data of the Pediatric Nurses of the pilot study 34
Table 3-2 Themes and sub-themes of the cultural competence 35
Table 4-1 Research Design41
Table 4-2 Course Contents of Culturally Competence Care 47
Table 4-3 Expert Content Validity Scoring Results  52
Table 5-1 Characteristic of the Pediatric Nurses of Experimental Group and Control Group  63
Table 5-2 Comparison of Age and Length of Service in Pediatric Department in Experimental Group and Control Group 65
Table 5-3 Data of Pediatric Nurses in Experimental Group and Control Group in Follow-up (6 months later) 68
Table 5-4 Comparison of Age and Length of Service in Pediatric Department in Follow-up for Experimental Group and Control Group 70
Table 5-5 Comparison of PNCCS Pre-test of Experimental Group and Control Group  72
Table 5-6 Survey on Satisfaction of Cultural Care Course 73
Table 5-7 Comparison of PNCCS Pre-test and post-test of Experimental Group 75 
Table 5-8 Comparison of T1, T2, T3 of Experimental Group  76
Table 5-9 Comparison of PNCCS Pre-test (T1) and follow up (T3) Scores of Control Group 77
Table 5-10 Comparison of PNCCS of Experimental Group and Control Group in T1 and T3 79
Table 5-11 Homogeneity of PNCCS of Experimental Group and Control Group 81
Table 5-12 ANCOVA of PNCCS of Experimental Group and Control Group  81
Table 5-13 Data of Pediatric Nurses of Focus-group Interviews  83
Table 5-14 Themes and Definitions of Focus-group Interviews Content  85
Table 5-15 Self-evaluation of Cultural Care 96

List of Figures
Figure2-1 Sunrise Model  11
Figure2-2 Campinha-Bacote’s process of cultural competence model 13
Figure 4-1 Research Framework  39
Figure 4-2 Flow Chart of Intervention Measures and Effectiveness Evaluation 44
Figure 4-3 Data Collection Process  58
Figure 5-1 PNCCS Pre-test Comparison between Experimental Group and Control Group 72 
Figure 5-2 Comparison of PNCCS Pre-test (T1) and post-test (T2) Scores of Experimental  75
Figure 5-3 Comparison of Three Evaluations of PNCCS for Experimental Group  77
Figure 5-4 Comparison of PNCCS Pre-test (T1) and follow-up (T3) Scores of Control Group  78
Figure 5-5 Comparison of Various PNCCS Dimensions of Experimental Group and Control Group in T1 and T3 80
Figure 5-6 Pediatric nurses see the process of cultural care 95

Appendix
Appendix 1 Nurses’ Cultural Competence Scale Consent 115
Appendix 2 Demographic  116
Appendix 3 Pediatric Nurses Cultural Competence Scale 117
Appendix 4 Course Content Satisfaction Feedback Questionnaire 118
Appendix 5 Focus-group Feedback Questionnaire  119
Appendix 6 IRB 120
                                    

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