《死亡教育》护士继续教育课程方案的构建与实验研究
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摘要
研究目的
本课题旨在运用课程设计模式，理论构建满足护士继续教育需求的，包括课程目标、课程内容、教学方法、反馈/评价策略、师资条件诸要素的《死亡教育》护士继续教育课程框架，在此基础上，依据相关理论综合运用多种研究方法，完成《死亡教育》护士课程方案的构建并通过教育实验加以验证，本研究的成果可为死亡教育课程在护士队伍中的开展提供基本的课程指导和实施参考。
研究内容与方法
研究分为四个部分，综合应用多种研究方法。
第一部分：《死亡教育》护士继续教育课程的理论研究。研究从死亡教育的研究内容与发展现况入手，分析并运用泰勒目标模式、布卢姆教育目标分类理论和建构主义学习理论，完成对课程基本要素的构建，形成《死亡教育》护士继续教育课程设计模式。
第二部分：《死亡教育》护士继续教育课程方案的初步构建。以前期研究成果“护士死亡教育培训知识体系”为课程目标和课程内容设置的重要信息，开展《死亡教育》护士继续教育课程认知及培训需求的质性研究，对课程目标和课程内容进行补充和修正。之后依据课程设计模式，制定详细课程方案，进而通过两轮专家会议完成《死亡教育》护士继续教育课程方案的初步构建。
第三部分：教育实验测评工具的汉化、修订与研制。对FATCODS量表进行翻译与回译、文化调试、预调查，汉化FATCODS量表；对台湾版DAP-R量表进行文化调试、预调查，修订DAP-R量表；自制《死亡教育》课程反馈调查表。作为课程反馈/评价的工具。
第四部分：《死亡教育》护士继续教育课程方案的实验研究。以某三级甲等医院急诊科护士为实验对象，采用实验对照研究，对构建的《死亡教育》护士继续教育课程方案进行实验论证。在实验期间，采用相同测量工具，对一项“临终关怀”主题且共用部分《死亡教育》课程的国家级继续医学教育培训班进行授课前后测量，进一步地验证了课程的有效性。最后对课程方案及应用提出建议。
结果
1、《死亡教育》护士继续教育课程设计模式
该课程设计模式主要围绕课程内在结构基本要素展开，完成对课程目标、课程内容、教学方法、反馈/评价策略、师资条件等的构建。泰勒目标模式作为课程整体设计的初始框架，对泰勒原理四个问题的回答贯穿于整个过程。研究首先运用泰勒目标模式从学习对象、社会生活、学科专家三方面来源收集课程目标信息，经筛选后依据布卢姆教育目标分类理论分领域进行表述，根据目标选择课程内容，并利用建构主义学习理论加以组织和实施，最后对课程进行评价。
2、实验论证结果
急诊科教育实验的定量结果如下。①干预前后实验组FATCODS得分升高的幅度大于控制组，两组得分差值比较有统计学意义（p<0.001）。且干预后，实验组持正向态度的研究对象比例显著高于控制组（p=0.035）。②干预后，实验组死亡恐惧、死亡逃避维度得分显著低于控制组，自然接受维度得分显著高于控制组，趋近接受、逃离接受维度得分两组间差异没有统计学意义。研究对象职务(p=0.033)、接受过的死亡教育培训方式(p=0.007)与DAP-R量表得分相关。③对《死亡教育》课程反馈调查，肯定了课程的必要性、有效性及接受度。
对实验组的质性访谈表明，护士认为死亡教育课程有效：对改变自身死亡态度和照护临终患者及其家属态度有一定作用；护士建议课程：加强课程内容的实用性与操作性、采取方便灵活的时间安排、采用互动性、趣味性强的教学方法与手段。这为课程方案的修订提供了信息。
国家继续医学教育培训班的测评结果如下。①干预后FATCODS得分显著高于干预前（p<0.001）。持正向态度的研究对象比例显著升高（p=0.009）。②死亡逃避维度得分较干预前明显下降。死亡恐惧、自然接受、趋近接受和逃离接受维度及DAP-R总得分在干预前后无明显变化。③对《死亡教育》课程反馈调查，结果与急诊科实验结果基本一致。
3、《死亡教育》护士继续教育课程方案
方案基于护士继续教育需求，包括课程目标、课程内容、教学方法、反馈/评价策略、师资条件五部分共83项条目。其中课程目标包括“认知领域”、“情感领域”、“动作技能领域”三个层面共17项目标条目；课程内容包括“认知领域”、“情感领域”、“动作技能领域”三方面共44项与课程目标相匹配的课程内容条目；教学方法部分提出13项教学方法；反馈/评价策略包括“认知层面”、“情感层面”、“动作技能层面”3项；师资条件内容包括“认知层面”、“情感层面”、“技能层面”3个层面5项条目。并依据实验研究经验对各子方案提出应用建议。
结论
当代社会，心脑血管疾病、恶性肿瘤等慢性病成为主要的死亡原因，死亡的质量和死亡教育问题越来越引起人们的关注。对护士进行《死亡教育》课程培训是对患者及其家属开展死亡教育的基础。本课题构建了包括课程目标、课程内容、教学方法、反馈/评价策略、师资条件诸要素的《死亡教育》护士继续教育课程方案，并开展教育实验加以论证，提出《死亡教育》护士继续教育课程方案及相关建议，为死亡教育课程在护士队伍中的科学开展提供了具体的课程指导和实施参考，也为今后相关课程的设计提供一定的方法学借鉴。
Aims
The aims of this study is to apply the principles of curriculum to construct death educationcurriculum for nurses’ continuing education, which integrats elemental components such ascurriculum objectives, curriculum content, feedback&assessment procedures, teaching&learning methods and teachers’ qualification. The plan of the curriculum provides theuseful guidance for related nursing educators.
Content and Methods
The research is categorized into four parts.
1. Theoretical construction of death education curriculum for nurses’ continuing educationThrough literature review of research and development of death education domesticallyand abroad, ideas from theories of curriculum design were borrowed, including the TylerRationale, Bloom’s taxonomy theory and Constructivist learning theory to construct thecurriculum design procedure and main components of the curriculum.
2. Constructing a draft of the curriculum plan.
The prior study on training knowledge of death education for nurses provides mainreference for designing curriculum objectives and curriculum content. Qualitative researchand experts’ conferences were conducted based on theoretical construction of deatheducation curriculum to form the preliminary curriculum plan.
3. Development of questionnaires
Based on literature review, a cross-sectional survey was carried out through experts’consultation and pre-test to develop the questionnaires for curriculum evaluation. TheFrommelt Attitude Toward Care of the Dying Scale Chinese version and the Chineseversion of Death Attitude Profile Revised proved good content validity and reliability.Besides, the death education curriculum evaluation questionnaire was designed. They areall used as evaluation tools for the experiment stage.
4. Conducting experimental study
To examine the effectiveness and feasibility of the curriculum plan, a design ofpretest-posttest experiment with control group was performed in an Emergency Depart.,with a good result. During this course, a national Continuing Medical Education program was hold by our research team and part of the courses are just the part of our experiment’s,so we evaluated the nurses of the program before and after taking the courses, with asimilar result. Therefore, the curriculum plan was proposed.
Results
1. Theoretical Construction of Death Education Curriculum for Nurses’ ContinuingEducation
Integrating the Tyler Rationale, Bloom’s taxonomy theory and Constructivist learningtheory to the curriculum design, we constructed the death education curriculum designprocedure and main components of the curriculum.
2. Results of experimental study
Quantity data of experiment showed that post-test scores of attitude toward care of thedying in experimental group were higher than those in the control group (p<0.001). Thenumber of nurses with positive attitudes in the experimental group is more than that in thecontrol group (p=0.035). Post-test scores of the experimental group lowed in fear of death,death avoidance and rised in nautral acceptance. The feedback questionnaire showednecessity, effectiveness and popularity of the curriculum.Qualitative data of experiment showed that the curriculum is effective in changing theirdeath attitudes and attitudes toward care of the dying. Suggestions are given as follows:The content should be feasible and practical; time arrangement should be flexible; teachingmethods should be interactive and interesting.Data of experiment showed that post-test scores of attitude toward care of the dying werehigher than pre-test (p<0.001). The number of nurses with positive attitudes raised(p=0.009). Post-test scores lowed in Death Avoidance. The feedback questionnaire showedaccordance with the experimental results.
3. The plan is designed for nurses’ continuing education, and comprised curriculumobjectives, curriculum content, feedback&assessment procedures, teaching&learningmethods and teachers’ qualification.
Conclusions
Nowadays, chronic diseases such as heart and blood vessels illness or Malignant Tumorillness have become the main reason of death, thus, the quality of death and deatheducation have been paid more and more attention. To educate nurses is the prerequisite foreducating patients and their family. The study constructed death education curriculum for nurses’ continuing education, which integrating elemental components such as curriculumobjectives, curriculum content, feedback&assessment procedures, teaching&learningmethods and teachers’ qualification, which may provide the useful guidance for furtherstudy and education in this field.
本课题旨在运用课程设计模式，理论构建满足护士继续教育需求的，包括课程目标、课程内容、教学方法、反馈/评价策略、师资条件诸要素的《死亡教育》护士继续教育课程框架，在此基础上，依据相关理论综合运用多种研究方法，完成《死亡教育》护士课程方案的构建并通过教育实验加以验证，本研究的成果可为死亡教育课程在护士队伍中的开展提供基本的课程指导和实施参考。
研究内容与方法
研究分为四个部分，综合应用多种研究方法。
第一部分：《死亡教育》护士继续教育课程的理论研究。研究从死亡教育的研究内容与发展现况入手，分析并运用泰勒目标模式、布卢姆教育目标分类理论和建构主义学习理论，完成对课程基本要素的构建，形成《死亡教育》护士继续教育课程设计模式。
第二部分：《死亡教育》护士继续教育课程方案的初步构建。以前期研究成果“护士死亡教育培训知识体系”为课程目标和课程内容设置的重要信息，开展《死亡教育》护士继续教育课程认知及培训需求的质性研究，对课程目标和课程内容进行补充和修正。之后依据课程设计模式，制定详细课程方案，进而通过两轮专家会议完成《死亡教育》护士继续教育课程方案的初步构建。
第三部分：教育实验测评工具的汉化、修订与研制。对FATCODS量表进行翻译与回译、文化调试、预调查，汉化FATCODS量表；对台湾版DAP-R量表进行文化调试、预调查，修订DAP-R量表；自制《死亡教育》课程反馈调查表。作为课程反馈/评价的工具。
第四部分：《死亡教育》护士继续教育课程方案的实验研究。以某三级甲等医院急诊科护士为实验对象，采用实验对照研究，对构建的《死亡教育》护士继续教育课程方案进行实验论证。在实验期间，采用相同测量工具，对一项“临终关怀”主题且共用部分《死亡教育》课程的国家级继续医学教育培训班进行授课前后测量，进一步地验证了课程的有效性。最后对课程方案及应用提出建议。
结果
1、《死亡教育》护士继续教育课程设计模式
该课程设计模式主要围绕课程内在结构基本要素展开，完成对课程目标、课程内容、教学方法、反馈/评价策略、师资条件等的构建。泰勒目标模式作为课程整体设计的初始框架，对泰勒原理四个问题的回答贯穿于整个过程。研究首先运用泰勒目标模式从学习对象、社会生活、学科专家三方面来源收集课程目标信息，经筛选后依据布卢姆教育目标分类理论分领域进行表述，根据目标选择课程内容，并利用建构主义学习理论加以组织和实施，最后对课程进行评价。
2、实验论证结果
急诊科教育实验的定量结果如下。①干预前后实验组FATCODS得分升高的幅度大于控制组，两组得分差值比较有统计学意义（p<0.001）。且干预后，实验组持正向态度的研究对象比例显著高于控制组（p=0.035）。②干预后，实验组死亡恐惧、死亡逃避维度得分显著低于控制组，自然接受维度得分显著高于控制组，趋近接受、逃离接受维度得分两组间差异没有统计学意义。研究对象职务(p=0.033)、接受过的死亡教育培训方式(p=0.007)与DAP-R量表得分相关。③对《死亡教育》课程反馈调查，肯定了课程的必要性、有效性及接受度。
对实验组的质性访谈表明，护士认为死亡教育课程有效：对改变自身死亡态度和照护临终患者及其家属态度有一定作用；护士建议课程：加强课程内容的实用性与操作性、采取方便灵活的时间安排、采用互动性、趣味性强的教学方法与手段。这为课程方案的修订提供了信息。
国家继续医学教育培训班的测评结果如下。①干预后FATCODS得分显著高于干预前（p<0.001）。持正向态度的研究对象比例显著升高（p=0.009）。②死亡逃避维度得分较干预前明显下降。死亡恐惧、自然接受、趋近接受和逃离接受维度及DAP-R总得分在干预前后无明显变化。③对《死亡教育》课程反馈调查，结果与急诊科实验结果基本一致。
3、《死亡教育》护士继续教育课程方案
方案基于护士继续教育需求，包括课程目标、课程内容、教学方法、反馈/评价策略、师资条件五部分共83项条目。其中课程目标包括“认知领域”、“情感领域”、“动作技能领域”三个层面共17项目标条目；课程内容包括“认知领域”、“情感领域”、“动作技能领域”三方面共44项与课程目标相匹配的课程内容条目；教学方法部分提出13项教学方法；反馈/评价策略包括“认知层面”、“情感层面”、“动作技能层面”3项；师资条件内容包括“认知层面”、“情感层面”、“技能层面”3个层面5项条目。并依据实验研究经验对各子方案提出应用建议。
结论
当代社会，心脑血管疾病、恶性肿瘤等慢性病成为主要的死亡原因，死亡的质量和死亡教育问题越来越引起人们的关注。对护士进行《死亡教育》课程培训是对患者及其家属开展死亡教育的基础。本课题构建了包括课程目标、课程内容、教学方法、反馈/评价策略、师资条件诸要素的《死亡教育》护士继续教育课程方案，并开展教育实验加以论证，提出《死亡教育》护士继续教育课程方案及相关建议，为死亡教育课程在护士队伍中的科学开展提供了具体的课程指导和实施参考，也为今后相关课程的设计提供一定的方法学借鉴。
Aims
The aims of this study is to apply the principles of curriculum to construct death educationcurriculum for nurses’ continuing education, which integrats elemental components such ascurriculum objectives, curriculum content, feedback&assessment procedures, teaching&learning methods and teachers’ qualification. The plan of the curriculum provides theuseful guidance for related nursing educators.
Content and Methods
The research is categorized into four parts.
1. Theoretical construction of death education curriculum for nurses’ continuing educationThrough literature review of research and development of death education domesticallyand abroad, ideas from theories of curriculum design were borrowed, including the TylerRationale, Bloom’s taxonomy theory and Constructivist learning theory to construct thecurriculum design procedure and main components of the curriculum.
2. Constructing a draft of the curriculum plan.
The prior study on training knowledge of death education for nurses provides mainreference for designing curriculum objectives and curriculum content. Qualitative researchand experts’ conferences were conducted based on theoretical construction of deatheducation curriculum to form the preliminary curriculum plan.
3. Development of questionnaires
Based on literature review, a cross-sectional survey was carried out through experts’consultation and pre-test to develop the questionnaires for curriculum evaluation. TheFrommelt Attitude Toward Care of the Dying Scale Chinese version and the Chineseversion of Death Attitude Profile Revised proved good content validity and reliability.Besides, the death education curriculum evaluation questionnaire was designed. They areall used as evaluation tools for the experiment stage.
4. Conducting experimental study
To examine the effectiveness and feasibility of the curriculum plan, a design ofpretest-posttest experiment with control group was performed in an Emergency Depart.,with a good result. During this course, a national Continuing Medical Education program was hold by our research team and part of the courses are just the part of our experiment’s,so we evaluated the nurses of the program before and after taking the courses, with asimilar result. Therefore, the curriculum plan was proposed.
Results
1. Theoretical Construction of Death Education Curriculum for Nurses’ ContinuingEducation
Integrating the Tyler Rationale, Bloom’s taxonomy theory and Constructivist learningtheory to the curriculum design, we constructed the death education curriculum designprocedure and main components of the curriculum.
2. Results of experimental study
Quantity data of experiment showed that post-test scores of attitude toward care of thedying in experimental group were higher than those in the control group (p<0.001). Thenumber of nurses with positive attitudes in the experimental group is more than that in thecontrol group (p=0.035). Post-test scores of the experimental group lowed in fear of death,death avoidance and rised in nautral acceptance. The feedback questionnaire showednecessity, effectiveness and popularity of the curriculum.Qualitative data of experiment showed that the curriculum is effective in changing theirdeath attitudes and attitudes toward care of the dying. Suggestions are given as follows:The content should be feasible and practical; time arrangement should be flexible; teachingmethods should be interactive and interesting.Data of experiment showed that post-test scores of attitude toward care of the dying werehigher than pre-test (p<0.001). The number of nurses with positive attitudes raised(p=0.009). Post-test scores lowed in Death Avoidance. The feedback questionnaire showedaccordance with the experimental results.
3. The plan is designed for nurses’ continuing education, and comprised curriculumobjectives, curriculum content, feedback&assessment procedures, teaching&learningmethods and teachers’ qualification.
Conclusions
Nowadays, chronic diseases such as heart and blood vessels illness or Malignant Tumorillness have become the main reason of death, thus, the quality of death and deatheducation have been paid more and more attention. To educate nurses is the prerequisite foreducating patients and their family. The study constructed death education curriculum for nurses’ continuing education, which integrating elemental components such as curriculumobjectives, curriculum content, feedback&assessment procedures, teaching&learningmethods and teachers’ qualification, which may provide the useful guidance for furtherstudy and education in this field.
引文
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