The incidence of crush is one of the important indicators of the quality of health care in various medical institutions in the world. The Taiwan Hospital Evaluation and Medical Quality Council (referred to as the Medical Policy Council) listed crush as a quality indicator of clinical care in 2011 (Taiwan Clinical Effectiveness indicator system, 2011), the incidence of crush is also a sensitive indicator of nursing care.

The purpose of this study: based on the nursing of crushed wounds, intervene in education and training courses, and add elements of flipped learning, to evaluate the effectiveness of KAP (knowledge, attitude, practice) and self efficacy of nursing staff for learning crushed nursing.

The incidence of crush is one of the important indicators of the quality of health care in various medical institutions in the world. The Taiwan Hospital Evaluation and Medical Quality Council (referred to as the Medical Policy Council) listed crush as a quality indicator of clinical care in 2011 (Taiwan Clinical Effectiveness indicator system, 2011), the incidence of crush is also a sensitive indicator of nursing care, reflecting the effectiveness of the structure, process and results of nursing care (Cai, Zheng, Liu, 2011). Reducing the incidence of crush has been the goal of the joint efforts of health care institutions. In 2008, the US CMS announced that it would stop paying for the treatment of crushed patients in hospitals, allowing medical institutions to pay more attention to the prevention of crushing, so many promote the quality of medical care The organizations have put forward relevant strategies, including the announcement of evidence-based tools for predicting and evaluating crush injuries, guidelines on the classification and prevention of crush injuries, and training materials for crush education (Agency for Healthcare Research and Quality, 2014; Edsberg et al ., 2016; Institute for Healthcare Improvement, 2017). The occurrence of pressure injury can be prevented. Many studies have explored the reasons why nursing staff cannot implement the behaviors of pressure injury prevention. The results show that the common obstacles are the lack of time and manpower of nursing staff, lack of relevant education and training, and failure to provide standard operations. Routine, physicians did not participate, etc. (Jankowski & Nadzam, 2011; Moore & Price, 2004; Worsley, Clarkson, Bader, & Schoonhoven, 2016).

At the same time, many researchers have explored the impact of various education and training methods on nursing staff's cognition, behavior and attitude related to the prevention and treatment of crush. They can all prove that education and training measures can significantly improve nursing staff's cognition. These important changes must be carefully considered as to what learning or training methods should be used to provide first-line nursing staff to familiarize them with and correctly perform practical operations. Clinical nurses are faced with ever-changing patient situations. The goal of learning is not only to transfer knowledge to enhance cognition, but more importantly, how to transform knowledge into clinical practice skills and provide clinical decision-making with appropriate care measures in response to different situations. Ability, teaching must use multiple strategies to achieve this goal, providing a real and interactive learning environment, allowing nurses to participate in operational activities in a simulated real environment, repeatedly learning related knowledge and techniques, and strengthen the proficiency of clinical applications And to build consensus on care can improve the quality of work (Norman, 2012).

The purpose of this study: based on the nursing of crushed wounds, intervene in education and training courses, and add elements of flipped learning, to evaluate the effectiveness of KAP (knowledge, attitude, practice) and self efficacy of nursing staff for learning crushed nursing.

Inclusion Criteria:

• Have a nurse practitioner license in Nantou Hospital
• work as a clinician

Exclusion Criteria:

• Nursing student

The head nurse is blinded, and the unit nurses are randomly arranged according to the unit to participate in any education training