澳门城市大学新生心理健康状况调查

目的:了解澳门城市大学本科一年级新生心理健康状况.方法:使用症状自测量表(SCL-90)对澳门城市大学一年级本科生108人进行心理测查.结果:澳门城市大学一年级本科生SCL-90的高分因子前三位是强迫(1.79±0.53),人际关系(1.55±0.46),抑郁(1.43±0.44)焦虑(1.43±0.41)偏执(1.43±0.45).澳门城市大学生与全国大学生常模各因子均分比较具有显著差异,与全国正常人常模无显著差异.结论:澳门城市大学本科生心理健康状况好于全国大学生,与全国正常人常模相近.     

护理本科生科研参与和可雇佣性的相关性研究

目的探讨护理本科生科研参与和可雇佣性现状,并分析两者的相关性。方法采用本科生参与科研问卷和大学生可雇佣性问卷对山东省5所高校377名护理本科生进行横断面调查。结果 377名护理本科生科研参与得分为(40.16±14.38)分,可雇佣性得分(116.57±21.66)分;不同年级、年龄、院校层次、学业成绩排名、个人规划、参研情况的护理本科生科研参与和可雇佣性得分比较,差异有统计学意义(P0.05,P0.01);护生科研参与和可雇佣性总分及各维度得分呈正相关(均P0.01)。结论护理本科生的科研参与度与可雇佣性得分尚不理想,其受多种因素影响,且二者呈正相关。高校护理教育者应着重为护生提供覆盖全体学生、可持续参与的科研教育体系,以提高护理本科生的可雇佣性技能。     

运用Tanner临床判断模式设计仿真模拟情景学习

目的探讨以Tanner临床判断模式设计仿真模拟学习方法及效果。方法以Tanner临床判断模式为框架,对87名澳门护理本科生进行18学时仿真模拟临床技能训练,学习过程包括关注、诠释、应对、讨论与反思,按"澄清情景-首次表演-启发思考-小组讨论-小组演练-再次表演-小组反思"流程进行仿真模拟训练。训练结束以结构式开放性问题调查学生对仿真模拟学习的看法。结果学生认为仿真模拟学习加强了理论知识的运用、增强了处理突发情况的信心与能力;明确了解决临床问题的思路,增强了团队合作。为增加情景的逼真度,标准化病人需考虑运用于仿真模拟情景的设计。结论 Tanner临床判断模式可用于指导仿真模拟情景学习。学生通过对情景问题的观察、分析与处理,训练临床思维和临床判断力。仿真情景设计还需要进一步改进。     

基于计算机控制模拟人的仿真情景设计及在澳门护理本科生的实践（英文）

目的探讨运用计算机控制模拟人训练护生临床技能的情景设计,并了解护生对仿真模拟设计的看法。方法运用计算机控制模拟人设计5个高度仿真模拟的情景,包括阑尾炎、慢性阻塞性肺疾病、胃肠道出血、心肌梗死及严重创伤。113名护理本科生(二年级77名,三年级36名)完成36个学时的模拟情景训练。结果护生对学习场所、学习目标、学习安排、知识迁移以及决策技能等感到满意;认为仿真模拟学习是最好的学习体验,希望有机会再次参加。但他们也指出模拟人对真实情况的模仿还不够逼真:没有面部和情绪反应,对问询的应答迟缓,呕吐物或痰的气味、颜色性质和量没有演示。结论护生对仿真模拟学习满意,但情景的逼真度需改进。建议将标准化病人运用于仿真模拟情景设计,以模仿面部表情以及情感、心理社会的互动反应。     

护理本科生创造力倾向与心理特质关系的研究

目的探讨护理本科生创造力倾向与心理特质的关系。方法以方便抽样方法抽取山东中医药大学二年级至四年级五年制护理本科生402人,采用威廉斯创造力倾向问卷、心理弹性问卷中文简化版、轻躁狂人格问卷、创造性体验问卷进行调查。结果护理本科生创造力倾向总分为106.39±11.45;不同年级护理本科生创造力倾向得分存在统计学差异(P<0.05);不同创造力水平的护理本科生的心理特质存在统计学差异(均P<0.01);护理本科生创造力倾向总分及各维度得分与心理弹性、轻躁狂人格及幻想倾向得分呈显著正相关(均P<0.01)。结论高创造力水平的护理本科生,其心理弹性相对较高,且具有轻躁狂人格和幻想倾向。需重视增强护理本科生的心理弹性,正确对待具有轻躁狂和幻想倾向的学生,实时地引导其发挥自己的创造力水平。     

基于CIPP评价模式优化护理学高仿真模拟教学的行动研究

目的分析高仿真模拟教学的现存问题,构建适宜的教学方案,指导护理学高仿真模拟教学实践。方法采用行动研究法,综合运用问卷调查法、访谈法、观察法等多种方法收集资料并进行分析。根据收集的资料,行动小组构建包括高仿真模拟教学环境准备要求、学生准备要求、教师准备要求、高仿真模拟案例编制要求和高仿真模拟教学流程的教学优化方案,运用于2013级23名护理本科生(实验组)并与2012级23名护理本科生(对照组)比较评价教学效果。结果实验组学生护理综合能力、学生学习行为和提高模拟教学仿真性评分显著优于对照组(P0.05,P0.01)。结论行动研究是一种有效地持续改善护理教学实践的研究方法,通过行动研究构建的高仿真模拟教学优化方案可有效提升教学效果。     

以TBL为核心的护理伦理学教学改革探索

目的探索以团队为基础的教学(TBL)模式在护理伦理学课程应用的效果。方法对80名大二年级护理本科生,设计并实施以TBL为核心的护理伦理学教学,并对学生学习效果进行多元化考核,了解学生对课程教学模式的评价、参与等情况。结果课程结束后,学生综合考核得分(84.00±3.15)分;学生对课程设计、课程参与、伦理知识掌握及伦理决策能力得分分别为(4.32±0.54)、(4.60±0.51)、(4.20±0.63)、(4.43±0.65)分。结论以TBL为核心的教学模式用于护理伦理学教学,能有效提高学生学习的积极性、主动性和学习效果。     

护理本科生科研能力培养方法的改进

目的对护理本科生科研能力培养方法进行改进,以提高其科研能力。方法用整群抽样法抽取2008级和2009级护理本科生114人作为对照组,采用传统临床实习方法,2010级和2011级护理本科生180人作为观察组,在进行传统临床实习的同时安排其定期参与临床科研指导老师的科研项目,并使用护理本科生科研能力自评量表将护理本科生在参与临床科研实践前后的科研能力进行对比分析。结果护理本科生自评科研能力得分64.05±23.38;两组比较,观察组除问题发现维度外,总分及各维度评分显著优于对照组(P0.05,P0.01)。结论护理本科生的科研能力整体偏低,让其参与临床科研工作有利于提高科研能力。     

Relationship between creativity and psychological traits in undergraduate nursing students

目的 探讨护理本科生创造力倾向与心理特质的关系.方法 以方便抽样方法抽取山东中医药大学二年级至四年级五年制护理本科生402人,采用威廉斯创造力倾向问卷、心理弹性问卷中文简化版、轻躁狂人格问卷、创造性体验问卷进行调查°结果 护理本科生创造力倾向总分为106.39±11.45;不同年级护理本科生创造力倾向得分存在统计学差异(P＜0.05);不同创造力水平的护理本科生的心理特质存在统计学差异(均P＜0.01);护理本科生创造力倾向总分及各维度得分与心理弹性、轻躁狂人格及幻想倾向得分呈显著正相关(均P＜0.01).结论 高创造力水平的护理本科生,其心理弹性相对较高,且具有轻躁狂人格和幻想倾向.需重视增强护理本科生的心理弹性,正确对待具有轻躁狂和幻想倾向的学生,实时地引导其发挥自己的创造力水平.     

肿瘤晚期患者参与临床决策期望的现况研究

目的探讨肿瘤晚期患者参与临床决策的期望,以期更好地为患者提供医疗护理服务。方法采用患者参与医疗决策期望问卷对200例肿瘤晚期患者进行调查。结果该组人群参与临床决策期望总分为(34.74±3.03)分,信息需求、交流需求和决策需求3个维度的条目均分分别为(2.87±0.32)、(2.88±0.24)和(2.21±0.53)分。相比女性患者,男性患者在信息需求方面期望更高(P0.05);相比66岁及以上的患者,年龄18~50岁和51~65岁患者参与临床决策期望总得分和信息需求维度得分更高(均P0.01)。结论肿瘤晚期患者参与临床决策的信息需求和交流需求较高,而决策需求偏低。不同性别、年龄的患者参与临床决策的期望不同。在实际临床工作中,医务人员有必要关注患者参与临床决策的期望,并根据不同患者参与决策的期望开展医疗护理服务,以满足患者对疾病及治疗等相关知识的需求,促进患者参与决策的积极性,进而提高患者治疗依从性和满意度。     

Surgical decision making

Decision making is an integral part of surgical practice and is a skill that is as important as the ability to operate. Sound decision making is the result of acquiring ‘surgical wisdom’, which is achieved through learning, experience and reflection. This paper reviews the processes of surgical decision making with respect to choosing the correct procedure and deciding when to operate, and how operative decisions are made, together with the factors that influence our surgical decisions.     

PSA-based prostate cancer screening: the role of active surveillance and informed and shared decision making

Since the first publication describing the identification of prostate-specific antigen (PSA) in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used as a diagnostic tool. Over time, the test has been heavily debated due to its lack of sensitivity and specificity. However, up to now the PSA test is still the only biomarker for the detection and monitoring of prostate cancer. PSA-based screening for prostate cancer is associated with a high proportion of unnecessary testing and overdiagnosis with subsequent overtreatment. In the early years of screening for prostate cancer, high rates of uptake were very important. However, over time the opinion on PSA-based screening has shifted towards the notion of informed choice. Nowadays, it is thought to be unethical to screen men without them being aware of the pros and cons of PSA testing, as well as the fact that an informed choice is related to better patient outcomes. Now, as the results of three major screening studies have been presented and the downsides of screening are becoming better understood, informed choice is becoming more relevant.     

The impact of anxiety on the accuracy of diagnostic decision‐making

The impact of anxiety on the accuracy of diagnostic decision‐making is a neglected area of research despite its clear implications for the welfare of clients receiving health care. This paper presents the findings of two studies examining the effects of experimentally‐induced performance anxiety (Study 1) and naturally‐occurring state anxiety (Study 2) on the ability of senior radiography students to make simple same–different decisions about simultaneously presented images and to carry out a secondary verbal memory task. In both studies the more anxious group was less accurate in the primary decision‐making task, but there was no decrement in performance on the secondary task. The results are difficult to reconcile with predictions from Eysenck and Calvo's 9 processing efficiency account of the impact of anxiety on performance. Rather, the results are consistent with the notion that a primary adaptive purpose of anxiety is to disengage from tasks or stimuli currently occupying attention in order to allow organisms to attend to potential threats. Copyright © 2001 John Wiley & Sons, Ltd.     

共享决策在膀胱癌患者中的研究进展

阐述膀胱癌患者面临的决策挑战和共享决策的实施途径，分析共享决策在膀胱癌患者实施中的障碍因素(包括患者、医生及社会因素),提出应在我国推广共享决策理念、研制决策辅助工具、加强多学科合作、发挥专科护士的决策辅导作用的建议，以期提高膀胱癌患者决策自我效能和决策质量，减少决策后悔。     

Information for decision making by post-menopausal women with hormone receptor positive early-stage breast cancer considering adjuvant endocrine therapy

PurposeTo identify the information that post-menopausal women with hormone-receptor positive, early-stage breast cancer want, to help them decide among six treatment options for adjuvant-endocrine therapy.MethodsWe surveyed women with early-stage breast cancer who were eligible for adjuvant endocrine-therapy 3–18 months earlier. Participants rated the importance of getting each of 95 questions answered before this decision is made (options: essential/desired/not important/avoid). For questions rated essential or desired, participants identified the purpose(s) for having the question answered: to help them understand, make the decision, plan, or other. Participants indicated the role they played in their actual decision and the role they would prefer if the decision was made today. They also indicated whether they felt they had had a choice of endocrine therapy treatments.Results188 of 343 questionnaires were returned (response rate 55%). Mean age was 67 yr (range 38–88 yr); 76% were married, and 39% had secondary school education or less. On average, respondents rated 18 questions (range 0–94) essential for decision making. Each question was rated essential for decision making by ≥7% of participants but only 1 question by >50%. Regarding roles, 89% of respondents had participated in their actual decision and would want to again; an additional 9% had not participated in their actual decision but would want to at the time of the survey. The percentage of respondents who felt they had no choice of endocrine therapy treatments varied between centres, 25% vs 41% and 49%.ConclusionsMost patients want to participate in the decision but they vary widely in the amount and which specific details they want to help them make the decision.ImplicationThe wide variation in questions considered important means the support should be tailored to the needs of the individual patient.     

Patient and provider factors associated with the noninitiation of tamoxifen for young women at high‐risk for the development of breast cancer

We sought to identify factors associated with disparities in tamoxifen utilization among young patients at high‐risk for developing breast cancer. We identified 67 premenopausal, high‐risk women age 35‐45, without surgical prophylaxis, who did not initiate tamoxifen. Factors associated with noninitiation were examined. About 37% of patients had no documented provider‐based discussion regarding initiation. Type of high‐risk diagnosis was the only factor associated with a provider‐based discussion (P = .03). For patients offered tamoxifen, primary reasons for noninitiation were perceived minimal benefit (66.7%), fertility concerns (16.7%), and concerns about side effects (7.1%). Implementation of comprehensive educational strategies regarding the benefits of tamoxifen should be facilitated to improve initiation among young high‐risk patients.