探究不同的教學語言及訓練教學方案對外籍照顧服務員口腔照護學習成效之影響

Evaluation of Language and Instructional Method for On-the-Job Training of Foreign Nursing Assistants: An Example of an Oral Hygiene Training Program

臺灣高齡者的長期照護工作多仰賴外籍照顧服務員，然因其工作繁重，受限於時間及母語講師人力的缺乏，職前訓練與在職訓練均有所不足。本研究目的即在設計出一套適合外籍照顧服務員的在職訓練方案，解決資源限制的問題，且能因應其語言不熟悉的障礙提升教學成效。本研究採類實驗設計，以臺北市、新北市及基隆市住宿式長期照顧機構325位外籍照顧服務員為研究對象，參與者被分為四組，接受不同的在職訓練方案，並於在職訓練前、後進行口腔照護能力相關認知、情意及技能的評估。四種不同的在職訓練方案由教學語言（母語／華語）與訓練教學方案（互動式多媒體教學法／傳統式課堂教學法）兩個變項所構成，分別為：母語互動式多媒體教學組、華語互動式多媒體教學組、母語傳統式課堂教學組、華語傳統式課堂教學組。結果發現使用外籍照顧服務員的母語教學有相對的教學成效優勢，其全面性的學習成效較佳。其次，不同教學方式在認知、情意及技能向度上會展現不同的優勢：互動式多媒體教學法在認知及技能向度上較傳統式課堂教學法佳；若欲使用華語教學提升情意向度的學習成效，則傳統式課堂教學法較互動式多媒體教學法具有優勢。根據本研究的發現，建議實務上應隨著在職訓練的目標彈性地調整教學法，選用合適的教學法能使有限的資源於照護在職訓練工作上發揮最大的效用。

Background and Purpose

The long-term care of the elderly population in Taiwan relies on foreign nursing assistants. However, their on-the-job training is inadequate because of the high workload, unfamiliar language, and limitations of traditional teaching methods. This study designed a set of training programs suitable for foreign nursing assistants to address the problem of resource constraints and improve their oral care skills.

Method

Volunteers were recruited from long-term care institutions in Taipei, New Taipei, and Keelung. The volunteers committed to a 2-week oral hygiene training program with a pretest and posttest. The participants were assigned to four groups, each of which received training with a different combination of language of teaching method: (1) interactive multimedia teaching in a familiar language (Indonesian or Vietnamese), (2) interactive multimedia teaching method in an unfamiliar language (Chinese), (3) traditional teaching in a familiar language (Indonesian or Vietnamese), or (4) traditional teaching in an unfamiliar language (Chinese).

All participants had normal or corrected-to-normal vision, and no significant differences were detected among the four groups in terms of age (p = .59), sex (p = .99), countries of citizenship (p = .57), level of education (p = .07), or work experience (p = .89). The pretest and posttest both took approximately 40 minutes and consisted of questions relating to the cognitive domain, affective domain, and skill domains of oral care. In addition, the participants’ satisfaction with the training program was evaluated after the posttest.

Results

The normalized scores on the three domains were compared in a 2 (language: Chinese or Indonesian/Vietnamese) × 2 (teaching method: interactive multimedia teaching or traditional teaching) between-subjects design with analysis of variance. The learning outcomes of the four training programs were as follows:

1. Cognitive domain. Both language (F(1, 321) = 69.83, p = .001, np2= .18) and learning method (F(1, 321) = 4.40, p = .037, np2 = .014) were significant. In addition, a significant interaction between language and learning method was identified (F(1, 321) = 21.73, p = .001,  np2 = .063). The results demonstrated that interactive multimedia teaching methods used with a familiar language improved cognitive performance more than the other combinations of teaching method and language. The results corroborate the findings of Hemmati, Omrani, and Hemmati (2013).

2. Affective domain. Both language (F(1, 321) = 408.89, p = .001,np2 = .56) and learning method (F(1, 321) = 4.42, p = .036, np2 = .014) were significant. In addition, a significant interaction between language and learning method was detected (F(1, 321) = 126.19, p = .001, np2 = .282). Interactive multimedia teaching methods used with a familiar language improved performance in the affective domain. The self-perceived importance of the care work was enhanced after the training program. These results are not consistent with those of the study by Jeffries, Woolf, and Linde (2003), who did not observe improvements in the affective domain when interactive multimedia methods were used. The different findings of the two studies may be caused by the influence of language. The benefit of interactive multimedia teaching methods in the affective domain was greater when a familiar, rather than unfamiliar, language was used.

3. Skill domain (self-reported). Language (F(1, 321) = 140.38, p = .001, np2 = .30) and teaching method (F(1, 321) = 30.99, p = .001, np2 = .088) were significant. No significant interaction between language and teaching method was identified (F(1, 321) = 0.22, p = .633,np2 = .001). Our findings echo those of other studies demonstrating that multimedia teaching methods enhance the development of care skills (Cardoso et al., 2011; Jiang et al., 2013). Multimedia teaching methods enabled the demonstration of care skills through various formats, and the learners could replay videos and practice the skills until they had become proficient. Thus, multimedia teaching methods were most suggested to enhance the care skills.

4. Skill domain (expert-evaluated). Language (F(1, 321) = 25.33, p = .001, np2 = .073) and learning method (F(1, 321) = 4.44, p = .036, np2 = .014) were significant. No significant interaction between language and learning method was detected (F(1, 321) = 0.02, p = .888, np2 = .001). The results were similar to the self-reported results.

5. Satisfaction. The participants’ satisfaction after the training program was evaluated. The differences between four groups were significant (F(3, 321) = 200.91, p = .001,np2 = .653), demonstrating that the participants preferred learning in a familiar language. when learning in an unfamiliar language, the satisfaction was higher when used the traditional teaching method than the interactive multimedia teaching method. The major reason for the findings is the fact that when learning in an unfamiliar language, the traditional teaching method enables learners to directly interact with the lecturer, and the lecturer can paraphrase when the learners were confused during the learning phase.

Conclusions and Discussion

In conclusion, this study reveals that oral hygiene training programs for foreign nursing assistants should be designed to be taught in a language familiar to the participants. The use of a familiar language can improve learning outcomes in several domains. In addition, the use of appropriate media can remove practical restrictions to on-the-job training. Interactive multimedia learning combines diversity with sensory stimulation, and, in this study, its efficacy with respect to all the domains evaluated was higher than that of traditional classroom learning. The first limitation concerns the convenience sampling method used in the current study, convenience sample doesn’t provide a representative result. The second limitation is rooted in the course only focused on the care work of oral hygiene. Thus, the generalization of the results to other populations with different regions and courses for different care works may be limited. Although the results of the present study are not conclusive and future research is obviously required, but this is an exciting first step.