實習壓力勝於課室學習，其中又以內外科實習護生的壓力感受度最高，影響實習成效。本教案旨在以Bandura自我效能四項激發過程幫助護生增進實習成效，共54位二技二年級實習外科的護生參與本教案，結果發現在熟練技能部分：護生在FB平台觀看教師自製的教學影片，增進了專業知識與技能且獲得學習掌控；在提供模範部分：經由教師及護理師臨床實務教學後，幫助護生學會整合專業知識技能與臨床實務運用，且提升了他們團隊溝通合作的能力；在身體與情緒狀態部分：透過團隊合作學習，強化了護生書寫護理計畫的能力，進而降低因不會寫作業所帶來的實習壓力；在社會說服部分：護生實習表現良好獲得教師、護理師及病患的肯定、支持與鼓勵增進了他們的自信，進而認同護理價值。此外，採用Lasater臨床判斷評量準則作為護生批判反思引導的工具，結果11個項目皆獲得顯著成長(p<.001)，同時以核心能力評量表讓護生進行自評，結果(基礎生物醫學、專業知識與技能、批判思考及溝通合作)皆獲得顯著成長(p<.001)。期望本教案能成為臨床教師教學策略之參考，以增進護生實習成效。

The stress of a clinical practicum is more than classroom learning. Nursing students involved in a medical-surgical clinical practicum receive the highest stress among all types of clinical practicums, and this may affect students and result in less learning outcomes. The purpose of this clinic plan was to help nursing students improve their clinical practicum effectiveness based on the four motivational processes of Albert Bandura’s self-efficacy theory. A total of 54 second-year undergraduate nursing students participated in the clinic plan. The results of the study included four parts. In the skill mastery part, the nursing students enhanced their professional knowledge and skills and gained control over their learning by watching the teacher self-made video. In the model learning part, the students learned how to integrate professional knowledge and skills with clinical practice, which improved their team communication and cooperation ability. In the somatic and emotional part, the ability to write care plans for nursing students was strengthened and the stress was reduced resulting from their inability to write their assessment after team-based learning, TBL teaching. In the social persuasion part, the performance of nursing students has been well recognized by teachers, nursing staff, and patient support, and has been encouraged to increase their confidence and help them recognize the value of nursing. In addition, the Lasater Clinical Judgment Rubric was used as a tool for critical reflection and the guidance of nursing students in the clinic plan. The results demonstrated significant growth of 11 items (p< .001). The nursing students filled out a self-evaluated questionnaire measuring their core competence based on the following aspects “ basic biomedical and professional knowledge and skills, critical thinking, and communication and cooperation” all participants achieved significant growth (p< .001). The results of this clinic plan may provide teaching strategies for clinical teaching in order to improve the effectiveness of nursing students’ practice.