4 編者的話

護理雜誌　68卷 5期‧2021年 10月

PhD, RN, Distinguished Professor, School of Nursing, Fooyin UniversityAddress correspondence to: Chih-Ling HUANG, No. 151, Jinxue Rd., Daliao District, Kaohsiung City 831, Taiwan, ROC.Tel: +886 (7) 781-1151 ext. 6100E-mail: huangesther0913@gmail.com

Impact of Nurse Practitioners and Nursing Education on COVID-19

Pandemics: Innovative Strategies of Authentic Technology-Integrated

Clinical Simulation

Chih-Ling HUANG

Taiwan Nurses Association and the Internation-al Council of Nurses recognize nurse practitioners (NPs) as advanced-practice nurses. A total of 11,266 registered nurses held NP certificates in April 2021 in Taiwan (Tsay, 2021). While international organi-zations recognize NPs with graduate degrees, over 85% of NPs in Taiwan hold a bachelor degree only. Tsay and Wang (2007) emphasized that NP educa-tion in Taiwan should be in step with international trends. Therefore, nursing schools must recruit PhD faculty who hold NP certificates. In addition, complicated and simulation-based learning proce-dures and teaching plans must be incorporated into the graduate curriculum and clinical practicum to promote the clinical reasoning competences and advanced nursing capabilities of NPs in light of professional training, qualifying examinations, and occupational practice.

With the evolution of virtual technology, the strategies for teaching core competences in nursing education have shifted from traditional classroom lectures to online format simulation. Recently, scholars have begun using authentic technology-en-hanced clinical simulation to develop and integrate nursing competence to reconceptualize the gap be-tween theory and practice (Weeks et al., 2019). It is increasingly important to teach patient safety, clini-

新冠肺炎疫情衝擊

專科護理師及護理教育—

虛實科技整合的教學創新

黃芷苓

台灣護理學會及國際護理協會皆已明定專科

護理師（簡稱專師）為進階護理師的其一角色。

2021年4月止已有11,266位護理師取得台灣專科護理師證書（蔡，2021），國際認定專師應具備碩士以上學歷，然而台灣85%以上的專師尚未具碩士層級，蔡和王（2007）強調台灣專科護理師培育須符合國際趨勢。因此，護理研究所應該

聘具備專師資格的博士層級教師，另外課程內容

須與臨床接軌，設計複雜的情境模擬學習討論過

程和教案，以提升專師臨床思辨能力，最終才

能獲得教考用合一的進階照護能力。

隨著虛擬科技之演變，護理核心能力教育發

展與整合的策略，已從傳統課室講述演進至線

上模擬教學，近期虛擬科技和實境演練融合的

臨床擬真教學方法成為趨勢，以多元虛實整合

方式補強理論和實務間的學用落差（Weeks et al., 2019）。虛擬科技擬真臨床情境的輔助教學對於病人安全、臨床思辨和決策技能等面向日益重要

（Aebersold, 2016; Johnsen et al., 2016）。另外，2019年全球面臨COVID-19大流行，台灣從2021年5月疫情爆發後的三級警戒，實習場所及校園皆關閉，教育部與護理專業團體協商，臨床實

習時數的替代教學方案上限為50%。面對技術示範教學及臨床實習改為線上學習，護理教師必

須發展創新教學策略，將採用線上標準病人的

擬真教學及虛擬實境教學方法（Shea & Rovera, 2021）。目前台灣對於虛擬擬真取代傳統面對面臨床實習的成效，尚未有研究文獻支持，美國

初步調查顯示學士班及碩士班的虛擬臨床學習

輔英科技大學護理學院護理學系特聘教授

通訊作者地址：黃芷苓　831高雄市大寮區進學路 151號電話：（07）7811151－6100；E-mail: huangesther0913@gmail.comhttps://doi.org/10.6224/JN.202110_68(5).01

5Editor’s Remarks

The Journal of Nursing ■ Vol. 68, No. 5, October 2021

cal reasoning, and decision-making skills to nursing students using the assistive methods of clinical sim-ulation technology (Aebersold, 2016; Johnsen et al., 2016). Since 2019, the COVID-19 pandemic has had a global impact. In May 2021, clinical practice set-tings and university campuses in Taiwan were closed following the announcement of a nationwide, level-3 epidemic alert. The Ministry of Education and Tai-wan Nurses Association approved the replacement of up to 50% of clinical practicum hours with alter-native learning activities. Therefore, faculties require innovative strategies to teach requisite skills and deliver clinical practica online. The faculty members of California State University use virtual clinical education and standardized patient-based telehealth simulations (Shea & Rovera, 2021). In Taiwan, there is a lack of studies in the literature examining the effect of replacing 50% of traditional face-to-face clinical activities with educational alternatives. Prior survey results have demonstrated the efficacy of transitioning to virtual clinical experiences in an online environment for undergraduate and graduate students (Fogg et al., 2020). Moreover, a systematic review provided evidence that virtual simulations support learning outcomes (Foronda et al., 2020).

To promote clinical-reasoning competence in graduate students with NP certificates and prepare alternative, virtual-based teaching plans to meet the remaining clinical hours required of students, Foo-yin University s School of Nursing has recently established the multi-functional iNursing-Innovative Learning Center. The hardware devices provide in-teractive virtual patients with character creator 3D, augmented realty (AR) hospital, operating room, intensive care unit, and virtual reality (VR) simu-lation plans for different nursing divisions as well as editors of electronic book and AR/VR teaching plans. The simulation plans include commercial products and self-design produced by well-trained faculty members. A group of seeding faculty mem-

是有效的（Fogg et al., 2020），另一篇系統性文獻回顧已經支持虛擬擬真護理教育的學習成果

（Foronda et al., 2020）。筆者所服務的輔英科技大學，為了提升具備

專師資格研究生的臨床思辨能力及整備臨床實

習的遠距替代教學方案，近期建置「智慧護理—

創新學習中心」，硬體設備包括高效率3D建模的互動式虛擬病人、擴增實境（augmented reality, AR）醫院、手術室、加護病房和各科虛擬實境（virtual reality, VR）的護理情境教案，以及電子書和AR/VR教案學習編輯模組。除了廠商開發的現有護理情境教案，教師經過訓練後，開發

各種臨床實境結合科技的擬真教案，因此成立

「數位科技種子教師」的社群團隊，由教育部高

教深耕計畫及學校自籌經費補助，希望有大量的

課程教案可以被教師開發出來。教案設計過程需

遵行四個步驟，教師先進行同儕討論及設定學

習目標、行動期、教學者及學生皆進行反思討

論、收集和分析資料以了解學習者及教學者的過

程和成果評價（Verkuyl et al., 2021）。目前國內外疫情仍反覆衝擊護理臨床教學活動，期望未來研

究，護理教育者與醫院臨床教師合作，發展及

設計各科的虛實科技整合臨床擬真情境的教學策

略，以促進專師的進階級整合性照護能力。

參考文獻

蔡淑鳳（2021，5月18日）．台灣專科護理師制度回顧與前瞻．國家衛生研究院論壇。https://forum.nhri.edu.tw/r40/ [Tsay, S.-F. (2021, May 18). The transformation of

nurse practitioners in Taiwan. National Health Research Institutes Forum. https://forum.nhri.edu.tw/r40/]

蔡淑鳳、王秀紅（2007）．台灣專科護理師的政策制定與發展．護理雜誌，54（6），5–10。[Tsay, S.-F., & Wang, H.-H. (2007). The making and development of policy concerning nurse practitioners in Taiwan. The Journal of

Nursing, 54(6), 5–10.] https://doi.org/10.6224/JN.54.6.5Aebersold, M. (2016). The history of simulation and its impact

on the future. AACN Advanced Critical Care, 27(1), 56–61. https://doi.org/10.4037/aacnacc2016436

Fogg, N., Wilson, C., Trinka, M., Campbell, R., Thomson, A.,

bers supported by the Ministry of Education’s High-er Education Sprout Project and university funding was tapped to develop a large number of virtual sim-ulation plans. In addition, when developing virtual simulation, it is necessary to follow teaching team discussion and learning objective setting procedures, pre-brief teachers and students, enact plans, conduct debriefing, and collect and evaluate data to explore the learning and teaching process and outcomes (Verkuyl et al., 2021). The nursing clinical practicum continues to be impacted by the ongoing COVID-19 pandemic. In a further study, nursing academic fac-ulty cooperated with clinical preceptors to develop and design education strategies using authentic tech-nology-integrated clinical simulations to promote advanced and comprehensive care competences in nurse practitioners.

Merritt, L., Tietze, M., & Prior, M. (2020). Transitioning from direct care to virtual clinical experiences during the COVID-19 pandemic. Journal of Professional Nursing, 36(6), 685–691. https://doi.org/10.1016/j.profnurs.2020. 09.012

Foronda, C. L., Fernandez-Burgos, M., Nadeau, C., Kelley, C. N., & Henry, M. N. (2020). Virtual simulation in nursing education: A systematic review spanning 1996 to 2018. Simulation in Healthcare, 15(1), 46–54. https://doi.org/ 10.1097/sih.0000000000000411

Johnsen, H. M., Fossum, M., Vivekananda-Schmidt, P., Fruhling, A., & Slettebø, Å. (2016). Teaching clinical reasoning and decision-making skills to nursing students: Design, development, and usability evaluation of a serious game. International Journal of Medical Informatics, 94, 39–48. https://doi.org/10.1016/j.ijmedinf.2016.06.014

Shea, K. L., & Rovera, E. J. (2021). Preparing for the COVID-19 pandemic and its impact on a nursing simulation curriculum. Journal of Nursing Education, 60(1), 52–55. https://doi.org/10.3928/01484834-20201217-12

Verkuyl, M., Lapum, J. L., St-Amant, O., Hughes, M., & Romaniuk, D. (2021). Curricular uptake of virtual gaming simulation in nursing education. Nurse Education in

Practice, 50, Article 102967. https://doi.org/10.1016/j.nepr.2021.102967

Weeks, K. W., Coben, D., O’Neill, D., Jones, A., Weeks, A., Brown, M., & Pontin, D. (2019). Developing and integrating nursing competence through authentic technology-enhanced clinical simulation education: Pedagogies for reconceptualising the theory-practice gap. Nurse Education in Practice, 37, 29–38. https://doi.org/10.1016/j.nepr.2019.04.010

6 編者的話

引用格式 黃芷苓（2021）．新冠肺炎疫情衝擊專科護理師及護理教育—虛實科技整合的教學創新．護理雜誌，68（5），4–6。[Huang, C.-L. (2021). Impact of nurse practitioners and nursing education on COVID-19 pandemics: Innovative strategies of authentic technology-integrated clinical simulation. The Journal of Nursing, 68(5), 4–6.] https://doi.org/10.6224/JN.202110_68(5).01