[Impact of Nurse Practitioners and Nursing Education on COVID-19 Pandemics: Innovative Strategies of Authentic Technology-Integrated Clinical Simulation].

Taiwan Nurses Association and the International 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 organizations recognize NPs with graduate degrees, over 85% of NPs in Taiwan hold a bachelor degree only. Tsay and Wang (2007) emphasized that NP education 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 procedures 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-enhanced clinical simulation to develop and integrate nursing competence to reconceptualize the gap between theory and practice (Weeks et al., 2019). It is increasingly important to teach patient safety, clinical reasoning, and decision-making skills to nursing students using the assistive methods of clinical simulation technology (Aebersold, 2016; Johnsen et al., 2016). Since 2019, the COVID-19 pandemic has had a global impact. In May 2021, clinical practice settings and university campuses in Taiwan were closed following the announcement of a nationwide, level-3 epidemic alert. The Ministry of Education and Taiwan Nurses Association approved the replacement of up to 50% of clinical practicum hours with alternative 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, Fooyin University's School of Nursing has recently established the multi-functional iNursing-Innovative Learning Center. The hardware devices provide interactive virtual patients with character creator 3D, augmented realty (AR) hospital, operating room, intensive care unit, and virtual reality (VR) simulation 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 members supported by the Ministry of Education's Higher Education Sprout Project and university funding was tapped to develop a large number of virtual simulation 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 faculty cooperated with clinical preceptors to develop and design education strategies using authentic technology-integrated clinical simulations to promote advanced and comprehensive care competences in nurse practitioners.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.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。.