基于循证构建住院患者肠内营养护理质量评价指标体系

目的 构建肠内营养护理质量评价指标体系,为提高临床护士执行力提供理论依据,以提高肠内营养护理质量。方法 基于循证方法学结合本院临床数据分析,应用德尔菲法对20名专家进行2轮函询,确定各指标内容及及重要性,结合层次分析法确定各指标权重。结果 经过2轮专家函询后,得到聚焦于过程质量指标下的一级指标1项即肠内营养规范符合率;4项二级指标即营养风险护理评估落实率、肠内营养护理评估落实率、肠内营养溶液配制落实率和肠内营养输注护理落实率;每项二级指标下级包括依次为3项、2项、3项、13项,共21项三级指标。结论 肠内营养护理质量评价指标体系具有科学性、有效性和可行性,可有效指导护士行为,评价肠内营养护理质量。     

ICU患者护理质量评价指标体系的构建

目的 构建ICU患者护理质量评价指标体系,为客观评价ICU患者护理质量提供参考依据。 方法 在循证护理实践方法的指导下,整合文献检索和半结构式访谈结果构建ICU患者护理质量评价指标池,专家会议确定指标条目池,经过2轮专家咨询确定指标内容。根据指标判定标准、专家意见可靠性程度和研究小组意见对指标进行评价。 结果 汇总专家修订意见,删除9项指标,修改6项指标,补充5项指标,本研究构建的ICU患者护理质量评价指标体系包括物理环境、躯体感知、情感支持、心理感受和护理实践5项一级指标,19项二级指标和60项三级指标,所有指标的重要性赋值均数均>4分,变异系数均<0.25,表明各项指标具有较高的可靠性。 结论 本研究构建的ICU患者护理质量评价指标体系具有较高的科学性和有效性,对ICU患者评价护理质量具有指导意义。     

轻度认知障碍老年人阶梯式营养管理方案的构建

目的 构建轻度认知障碍老年人阶梯式营养管理方案,为轻度认知障碍老年人提供系统、规范的护理干预措施。方法 检索轻度认知障碍老年人阶梯式营养管理方案及护理的所有证据形成最佳证据。拟订营养干预方案初稿。选取21名专家,进行2轮德尔菲专家咨询,按照专家咨询意见,结合临床管理实践,形成轻度认知障碍患者阶梯式营养管理方案。结果 16名专家经过2轮咨询后意见趋于一致,专家权威系数为0.86,2轮咨询指标的重要性肯德尔和谐系数分别为0.14和0.13,差异具有统计学意义（P<0.05）。构建的干预方案有一级条目5个,二级条目10个,三级条目34个。结论 本研究构建的轻度认知障碍老年人阶梯式营养管理方案具有可靠性、科学性、实用性。     

基于奥马哈问题分类系统老年综合评估指标体系的构建

目的 为住院老年病人构建可行的、全面的筛查综合性评估指标体系。方法 基于奥马哈问题分类系统,结合文献回顾、临床调研、小组头脑风暴的方法,初步形成老年综合评估表。通过采用Delphi法对15名老年护理专家进行2轮函询。结果 2轮专家函询问卷回收率分别是100%、93%,专家权威系数0.845。2轮专家函询一级指标、二级指标、三级指标专家意见Kendall’s W系数分别为0.272,0.204,0.207（P<0.01）。最终形成老年综合评估体系一级指标4个、二级指标22个,三级指标125个。结论 专家积极性和权威程度高,意见协调程度好,因此老年综合评估指标体系可以综合评估住院老年病人。     

住院患者肠外营养护理质量评价指标体系的构建

目的 构建住院患者肠外营养护理质量评价指标体系,指导护士行为,确保肠外营养被安全执行,促进患者康复。方法 系统检索中国指南网、Up To Date、美国肠外肠内营养学会、欧洲肠外肠内营养学会、Joanna Briggs Institute（JBI）等数据库,严格筛选、评价文献,综合证据,结合医院近2年临床数据分析结果,形成初始问卷。应用德尔菲法对30名专家进行2轮函询,确定各指标内容及重要性,使用层次分析法确定各指标权重。结果 共纳入9篇文献,其中临床决策2篇、证据总结1篇、指南2篇、专家共识4篇。经过2轮专家函询后,得到住院患者肠外营养护理质量评价指标体系,为聚焦于过程的肠外营养规范落实率,包括4项一级指标,即营养风险护理评估落实率、肠外营养护理评估落实率、肠外营养溶液配制规范落实率和肠外营养输注护理规范落实率,以及17项二级指标。结论 住院患者肠外营养护理质量评价指标体系具有科学性、实用性和可操作性,能有效规范护士的行为、评价肠外营养护理质量。     

重症患者早期肠内营养耐受性评估及管理方案的构建

目的 构建重症患者早期肠内营养耐受性评估及管理方案。方法 检索国内外数据库,获取和评价肠内营养相关文献,经课题组讨论,制订肠内营养方案初稿,采用德尔菲法对肠内营养专家进行2轮咨询。结果 形成重症患者早期肠内营养耐受性评估及管理方案,包括2个一级指标、8个二级指标、20个三级指标;2轮专家咨询的权威系数分别为0.937和0.934,专家协调系数为0.119和0.112。结论 专家意见协调程度好,权威性高,可为重症患者早期肠内营养耐受性评估及管理提供依据。     

基于Servqual模型构建急性酒精中毒护理质量评价体系

目的 基于Servqual模型构建急诊科急性酒精中毒护理质量评价体系。方法 从Servqual模型5个角度及文献研究的基础上,初步构建急性酒精中毒护理质量评价体系,应用德尔菲法专家咨询后最终确定各级指标,并最后采用优序图法确定各指标权重。结果 经过2轮专家函询后,共形成5项一级指标,13项二级指标和57项三级指标的评价体系;专家积极性较好,分别为93%和89%;专家权威程度较高分别为0.89和0.87;2轮专家协调程度良好（P<0.05）,且第2轮W值高于第1轮。结论 本研究基于Servqual模型所构建的急诊科急性酒精中毒护理质量评价体系具有较强的科学性和可靠性,可为提升急性酒精中毒护理质量及改善其预后提供参考依据。     

腹部创伤患者肠内营养喂养不耐受预警评估指标体系的构建

目的 构建腹部创伤患者喂养不耐受预警评估指标体系,为早期识别腹部创伤患者喂养不耐受风险提供参考。方法 基于循证,结合临床护理实践,采用德尔菲专家咨询法对16名专家进行2轮专家咨询,并对调查数据进行统计分析,最终确定方案。结果 专家的积极性分别为94%、100%;专家权威系数为0.906;2轮重要性及准确性的变异系数分别为0~0.265、0~0.255及0.084~0.250、0.068~0.178,肯德尔协调系数差异有统计学意义。最终形成患者基本状况、实验室指标、临床治疗措施、临床用药以及肠内营养相关因素5个维度,32个条目。结论 构建的腹部创伤患者喂养不耐受评估预警指标内容较为全面,具有科学性,临床实用性强,可为临床早期识别腹部创伤患者喂养不耐受风险提供参考。     

麻醉后监护室护理质量敏感指标的构建

目的 构建适用于麻醉后监护室（post anesthesia care unit,PACU）的护理质量敏感指标,为PACU治疗监测及管理提供标准、量化的依据。方法 以“结构-过程-结果”理论模式为依据,借鉴美国国家护理质量指标数据库及其他国内外麻醉护理专家的研究成果形成指标初稿,运用德尔菲技术进行3轮专家咨询,结合帕累托定律确定指标的内容和科学的测量方法。结果 构建了包含复苏时间中位数、收治各类麻醉患者比例、低体温干预有效率、术后疼痛干预有效率等11项指标的PACU护理质量敏感指标体系。3轮专家咨询的问卷有效回收率均为100%,专家权威系数分别为0.86、0.84、0.90,专家意见的肯德尔和谐系数分别为0.245、0.256和0.356（P<0.01）。 结论 PACU护理质量敏感指标涵盖麻醉后监护的关键内容,可操作性强,专科特色鲜明,具有科学性和实用性,可为基于数据的持续质量改进和提高PACU护理质量提供参考。     

认知训练护理门诊构建的专家共识

目的 制订认知训练护理门诊构建的专家共识。方法 查阅国内外文献并与关键知情人进行访谈,设计专家咨询表,通过2轮德尔菲专家咨询和专家会议,结合证据和专家意见,对共识内容进行调整和修改。结果 专家共识包括认知训练护理门诊的设置及人员配置、认知训练护理门诊的工作内容、认知训练护理门诊的管理、认知训练护理门诊的人员培训4个方面。结论 《认知训练护理门诊构建的专家共识》具有较强的可靠性和实用性,可为构建认知护理门诊提供指导,促进认知训练的规范开展。     

Commanding insights in a survey of psychiatrists' and registered nurses' levels of mental health literacy in a Chinese general hospital

ADLER‐COLLINS J.K. (2011) Commentary: commanding insights in a survey of psychiatrists' and registered nurses' levels of mental health literacy in a Chinese general hospital. International Nursing Review 58 , 370–371     

The effects of applying an assessment form based on the health functional patterns on nursing student's attitude and skills in developing the nursing process

ObjectivesComprehensive nursing assessment, as the first step in the nursing process, involves the systematic and constant data gathering to facilitate the development of the patient-specific nursing process. The aim of this study is to determine the effects of applying an assessment form based on the health functional patterns on nursing student's attitude and skills in developing nursing process.MethodsA randomized controlling design was conducted. Of 84 undergraduate nursing students, 42 students were allocated to the intervention or control group. In clinical education, a patient assessment form based on Gordon's functional health patterns was applied to help students in the intervention group to develop nursing process, while the control group received traditional methods. The data were gathered using a demographic information questionnaire, skills in nursing process development checklist, and attitudes towards nursing process questionnaire.ResultsThe average scores for students’ attitude and skills in developing nursing process in the intervention group were greater than those of the control group.ConclusionApplying nursing assessment using the patient assessment form based on Gordon's functional health patterns can improve the students' learning in developing nursing process.     

The impacts of faculty caring on nursing students’ intent to graduate: A systematic literature review

ObjectivesTo examine the current studies about the impacts of faculty caring on nursing students’ intent to graduate and provide recommendations. The nursing profession continues to face nursing shortages. One of the solutions recognized to alleviate the shortage is increasing the number of students graduating from nursing schools. It lacks a literature review synthesizing the current research about the impacts of faculty caring on nursing students’ intent to graduate and indicate areas for future research.MethodsThis is a systematic literature review. The search of the literature was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Databases searched included MEDLINE via PubMed, CINAHL, PsycINFO, and ProQuest Search. Search terms included ‘attrition,’ ‘dropouts,’ ‘graduation rate,’ ‘faculty,’ ‘instructor,’ ‘professor,’ ‘nursing,’ and ‘caring.’ResultsTen articles met the inclusion criteria. The articles were conducted in the Associate Degree of Nursing and the Bachelor of Science in Nursing programs. Nursing faculties played a significant role in students’ intent to graduate by building students’ confidence, creating a compassionate learning environment, and promoting students’ competence. Faculties’ caring behaviors, including respecting students, showing empathy, and using caring communication skills, were essential characteristics to affect students’ learning environments.ConclusionsThe findings indicate that students’ perceptions of faculty caring can affect their perceptions of the learning environment and sense of belonging, and therefore, impact their intent to graduate. Students’ perceptions of their instructors’ caring behaviors are instrumental in motivating them to continue learning. The capacity of faculty caring plays a significant role in students’ success.     

What is the process of a comprehensive mental health nursing assessment? Results from a qualitative study

COOMBS T., CURTIS J. & CROOKES P. (2013) What is the process of a comprehensive mental health nursing assessment? Results from a qualitative study. International Nursing Review 60 , 96–102 Background: It is a truism that nursing care must be informed by assessment, otherwise how can one know what care is required or that it has been successfully delivered? Yet, little is known about the process of comprehensive mental health nursing assessment in practice. If the education of mental health nurses is to be effective, it is essential that the key content of, and the processes involved in carrying out a mental health nursing assessment in practice are able to be articulated to learners. Aim: To identify the processes of assessment that occur in mental health nursing practice based on interviews with mental health nurses working in clinical and management roles in clinical areas. Method: Interviews were undertaken with 18 nurses who worked in inpatient and community mental health settings either as clinicians or managers. The nurses ranged from new graduates to those with more than 20 years of experience. Findings and discussion: Clear processes were reported to be involved in undertaking a comprehensive mental health nursing assessment in practice, with three main themes emerging during analysis. First is the importance of engaging the patient; second is tell me what the problem is? with one subtheme reconcile inconsistencies; and finally, the ongoing nature of the assessment process. Conclusion: Common processes emerged when the nurses described their individual approaches to undertaking comprehensive mental health assessment. The results have important policy implications for the educational preparation of mental health nurses, their ongoing supervision and further research into contemporary mental health nursing practice.     

专科护理小组在护理质量控制中的作用

目的探讨专科护理小组实施持续质量督导对提高护理质量的效果。方法自2008年开始,在运行院二级护理质量控制模式的基础上,成立6个专科护理小组,对各病区护理工作实施持续质量督导,比较实施前后的护理质量。结果与实施前比较,病区管理、基础护理、危重症护理、健康教育、消毒隔离、急救质量、护士操作技能、患者健康知晓率及满意度均有提高,差异均有统计学意义（t分别为2．025,2．498,2．320,2．159,2．639,2．765;x^2分别为14．38,10．57;P〈0．05或P〈0．01）。结论成立专科护理小组实施持续质量督导,保证护理质量与安全,控制护理质量影响因素,提高护理质量。     

Nursing students in clinical practice--developing a model for clinical supervision

The aim of this study was to develop a model for clinical supervision to promote the clinical practice of nursing students. The study was implemented in Finland and it was carried out in three phases. Firstly, data were collected by means of a literature review and focus group interviews. Secondly, the data were analysed and described in expert groups, and finally the model itself was evaluated by 23 nursing experts. The data of literature review and focus group interviews consisted of 27 studies and four groups from three organisations: nurses (n = 7), managers (n = 6), teachers (n = 8) and students (n = 6). The data were analysed by qualitative content analysis. The model devolved from the study includes the concepts describing prerequisites, content and influence of clinical supervision. The prerequisites are nursing skills, a holistic view of the nursing curriculum, pedagogical, organisational, development, cooperation and interaction competence and decision-making skills. The content of clinical supervision includes support of professional development, pedagogical competence, research and development activities and collaborative working. Clinical supervision has influence on students’ professional and personal development and conception of the future of nursing profession, students’ preparedness for career planning and the teacher’s and preceptor’s professional development. The model could unify the notions of all parties concerned of the prerequisites, content and influence of clinical supervision. Furthermore, the entire supervision process and its control could be clarified. The model may be utilised in selecting and educating preceptors and evaluating the quality of clinical supervision.     

Nursing in disasters: A review of existing models

BackgroundSince nurses play an important role in responding to disasters, evaluating their knowledge on common patterns of disasters is a necessity. This study examined researches conducted using disaster nursing as well as the models adopted. It provides a critical analysis of the models available for disaster nursing.MethodsInternational electronic databases including Scopus, PubMed, ISI Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar were investigated with no limitation on type of articles, between 1st January 1980 and 31st January 2016. The search terms and strategy were as follows: (Disaster¹ OR Emergenc¹) AND (Model OR Theory OR Package OR Pattern) AND (Nursing OR Nurse¹). They were applied for titles, abstracts and key words. This resulted in the generation of disaster nursing models.ResultsOut of the 1983 publications initially identified, the final analysis was conducted on 8 full text articles. These studies presented seven models. These evinced a diverse set of models with regard to the domains and the target population.ConclusionsAlthough, disaster nursing models will inform disaster risk reduction strategies, attempts to systematically do so are in preliminary phases. Further investigation is needed to develop a domestic nursing model in the event of disasters.