JCI标准下基于同质护理服务理念的儿科护理知识培训效果

目的探讨儿科护理知识培训对收治14岁以下患者的临床科室护士的培训效果。方法本院组建了儿科知识培训小组,根据需求内容有针对性的对护理人员进行理论知识和实践技能的培训,比较培训前后护理人员的理论考核、技能考核、临床综合能力得分和患者满意度。结果经过培训,理论考试成绩、技能考核成绩、临床综合能力及患者对护士的满意度均较培训前有明显的提高,差异有统计学意义(P0.01)。结论 JCI标准下基于同质护理服务理念培训提高了临床护士的儿科理论知识、操作技能和综合能力水平及患者满意度,值得临床推广。     

ICU护士对谵妄评估的认知与实践调查

目的调查ICU护士对谵妄评估的认知与实践情况。方法选取北京市10所三级甲等医院148名重症监护室护士进行谵妄及评估工具认知情况的问卷调查。结果 ICU护士对谵妄的临床表现、评估、机制、处理、危害及危险因素的认知度低,十分了解者占4.05%～10.81%,比较了解者占22.97%～40.54%;ICU护士不能熟练掌握谵妄评估工具,经常用重症监护室意识模糊评估法、护理谵妄筛查量表、检测重症监护谵妄筛查量表的护士非常少,分别占5.41%、3.38%和2.70%;科室目前评估谵妄的工具主要是格拉斯哥昏迷量表,每天评估1次及以上的护士占60.14%。结论 ICU护士对谵妄的认知和对谵妄评估工具的认知需要提高,医院的继续教育培训课程中应考虑增加ICU谵妄及其评估工具相关知识,且国内应采用客观专业的评估工具进行常规谵妄的评估。     

临床护士实际工作能力考核评分表在护生带教中的应用

[目的]探讨临床护士实际工作能力考核评分表在急诊重症监护室护理临床带教中的应用效果。[方法]选择2016年1月—2017年4月来急诊重症监护室实习的50名护生随机分为对照组和观察组各25名,对照组采用传统教学法,观察组采用临床护士实际工作能力考核评分表的带教模式。在实习后期对两组护生进行理论、操作技能和综合能力考核,调查护生对带教的满意度。[结果]观察组护生出科理论、技能考核、综合能力考核成绩优于对照组,差异有统计学意义(P0.05);观察组护生对临床带教方法满意度高于对照组,差异有统计学意义(P0.05)。[结论]在急诊重症监护室护理临床带教中应用临床护士实际工作能力考核评分表有利于调动护生学习的主动性和积极性,提高了教学质量和护生对带教方法的满意度,效果优于传统教学法。     

KWL表格联合案例讨论教学在新生儿科新入职护士培训中的应用

目的 探讨KWL表格联合案例讨论教学在新生儿科新入职护士培训中的应用效果。方法 采用KWL表格联合案例讨论教学法对新生儿科2019年6月至2021年6月入职的49名护士进行培训，比较培训前后他们的理论知识、操作技能、患儿管理考核成绩，并进行培训效果满意度调查。结果 培训后，49名新入职护士理论知识、操作技能、患儿管理考核成绩均高于培训前（均P＜0.05）。培训效果满意度调查显示，培训内容选择、培训计划安排满意度较高。结论 KWL表格联合案例讨论教学法能提高新生儿科新入职护士理论知识水平和操作技能水平，提高自主学习能力和对患儿的管理能力。     

多学科合作互动式培训模式对ICU护理人员核心能力的影响

目的 探讨对重症监护室(ICU)护理人员采用多学科合作互动式培训模式,对其核心能力的影响.方法 构建多学科合作互动式培训模式对该院ICU 22名护理人员进行培训,培训内容包括专科理论知识、实践操作技能、多学科模拟配合抢救、疑难病例讨论、重大手术术前讨论等.培训模式实施前后,对22名护理人员进行专科理论知识和实践操作技能考核及采用注册护士核心能力量表进行护士核心能力测评.结果 对重症监护室(ICU)护理人员采用多学科合作互动式培训后,22名护理人员进行专科理论知识和实践操作技能考核成绩明显优于培训前,差异均有统计学意义(均P<0.05);经注册护士核心能力量表测评发现,培训后22名护理人员护士核心能力总分及评判性思维/科研能力、临床能力、人际关系、专业发展能力、教育/咨询能力较培训前有明显的提高,差异均有统计学意义(均P<0.05).结论 多学科合作互动式培训模式是一种主题鲜明、形式灵活、目标明确的培训模式,它是由各个科室临床医生、护士以及ICU医生、护士等相关的专业人员共同构成合作模式,通过互动交流、知识分享等形式来强化ICU专科护士核心能力的提升,从而确保ICU患者的安全.     

三阶段模式在手术室新护士带教中的应用

目的为了规范、科学、系统地培养手术室新护士,提高新护士的理论知识和操作技能,提升手术室新护士的综合能力。方法采用三阶段(总-分-总)带教模式对手术室24名新护士进行系统、全面的培训和培养。培训效果与由手术室护士长统一管理,科室总指导老师、新护士总带教老师进行集中授课,带教老师随排班而定的对照组进行比较。结果采用三阶段带教模式的手术室新护士理论知识、专科操作技能成绩高于对照组,综合能力优于对照组,手术医生满意度高于对照组,均差异有统计学意义(P0.05)。结论采用三阶段的带教模式,培训效果显著,新护士的理论知识和操作技能明显提高。     

太原市三级甲等医院ICU护士术后谵妄管理知信行现状及知识需求的调查研究

目的:探索太原市三级甲等医院重症监护室(ICU)护士的术后谵妄管理知信行现状及知识需求,为制订ICU术后谵妄管理培训方案提供依据。方法:采用非概率抽样法及自行设计的问卷,通过问卷星的方式对太原市5所三级甲等医院的332名ICU护士进行调查。结果:332名ICU护士术后谵妄管理知信行问卷总得分为(135.72±11.99)分,得分率为84.83%,知识得分为(51.98±5.31)分,态度得分为(43.00±4.39)分,行为得分为(40.73±4.86)分;多元线性回归结果显示,有术后谵妄管理培训方案、术后谵妄评估时间是ICU护士术后谵妄知信行得分的影响因素;88.6%的ICU护士认为学习术后谵妄的知识主要通过科室集中培训;89.5%的ICU护士认为临床实践中缺乏术后的镇痛、镇静管理来预防术后谵妄的相关知识;亟待学习术后谵妄的诊断标准、谵妄评估量表的准确使用及术后谵妄的预防及处理。结论:ICU护士术后谵妄知识水平较高,态度积极,但实践行为能力较弱。管理者应建立术后谵妄知识培训体系、制订规范化的术后谵妄管理培训方案与流程以促进临床实践。     

基于核心能力的麻醉科护士培训实践

目的探讨麻醉科护士培训方法和效果。方法对我省48所医联体单位的101名学员进行基于护士核心能力的麻醉科护士培训,培训内容包括理论和临床实践,并通过调查麻醉科护士核心能力、理论知识和操作技能考核成绩、满意度评估培训效果。结果培训前101名麻醉科学员麻醉核心能力得分为(125.57±4.80)分,培训后得分为(156.45±4.39)分,差异有统计学意义(P0.05);培训后学员理论知识与操作技能均分分别为(88.76±2.34)分、(86.68±3.46)分;学员对培训体系的满意度均分为(4.89±0.34)分。结论通过对麻醉科护士培训,提高了麻醉科护士的核心能力,巩固了麻醉科护士理论知识与临床实践技能。     

案例学习结合情景模拟在护理实习生岗前技能培训中的应用

目的:探讨案例学习结合情景模拟在护理实习生岗前技能培训中的应用效果。方法:本次研究选取的对象为在我院实习的护理专业学生100名,按照培训方式的不同等分为观察组和对照组,对照组学生采用培训和考核各项护理技能操作的方法,观察组学生采用案例学习结合情景模拟的方式进行培训。对比两组护理实习生的各临床科室实习理论考核成绩和操作技能考核成绩以及带教老师对学生的综合评价。结果:观察组学生各临床科室实习理论考核成绩和操作技能考核成绩均高于对照组(P0.05),带教老师对观察组护理实习生的满意度高于对照组(P0.05)。结论:在护理实习生岗前技能培训中应用案例学习结合情景模拟教学法的效果较为理想,学生的综合能力得到了提高。     

重症监护室护士培训模式的改进与效果分析

目的：改进重症监护室（ICU）护士能级进阶培训模式并对培训效果进行评价。方法：构建重症监护室护士能级进阶培训模式,并采取该模式对20名护士实施培训,对改进培训模式前后护士的理论及操作考核成绩、ICU护理质量检查评分及护士满意度进行比较。结果：改进后护士的理论考核成绩由（85.65±3.79）分提高到（95.20±2.14）分,操作考核成绩由（89.60±2.80）分提高到（96.80±1.85）分,与改进前相比差异均有统计学意义（P〈0.05）;护士满意度由培训前的70%上升到培训后的100%。结论：实施能级进阶培训模式,能有效提高护士的护理水平和为患者服务的能力,提高护理工作质量。     

Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients

OBJECTIVE: Although medical intensive care unit nurses at our institution routinely use the Intensive Care Delirium Screening Checklist (ICDSC) to identify delirium, physicians rely on traditional diagnostic methods. We sought to measure the effect of physicians' use of the ICDSC on their ability to detect delirium. DESIGN: Before-after study. SETTING: Medical intensive care unit of an academic medical center. PATIENTS AND PARTICIPANTS: A total of 25 physicians with >or=1 month of clinical experience in the medical intensive care unit conducted 300 delirium assessments in 100 medical intensive care unit patients. MEASUREMENTS AND MAIN RESULTS: Physicians sequentially evaluated two patients for delirium using whatever diagnostic method preferred. Following standardized education regarding ICDSC use, each physician evaluated two different patients for delirium using the ICDSC. Each physician assessment was preceded by consecutive, but independent, evaluations for delirium by the patient's nurse and then a validated judge using the ICDSC. Before (PRE) physician ICDSC use, the validated judge identified delirium in five patients; the physicians and nurses identified delirium in zero and four of these patients, respectively. The physicians incorrectly identified delirium in four additional patients. After (POST) physician ICDSC use, the validated judge identified delirium in 11 patients; the physicians and nurses identified delirium in eight and ten of these patients, respectively. The physicians incorrectly identified delirium in one patient. After physician ICDSC use, agreement improved between both the physicians and validated judge (PRE kappa = -0.14 [95% confidence interval {CI} = -0.27 to -0.02] to POST kappa = 0.67 [95% CI = 0.38 to 0.96]) and physicians and nurses (PRE kappa = -0.15 [95% CI = -0.29 to -0.02] to POST kappa = 0.58 [95% CI = 0.25 to 0.91]). Nurses vs. validated judge agreement was strong in both periods (PRE kappa = 0.65 [95% CI = 0.29 to 1.00] and POST kappa = 0.92 [95% CI = 0.76 to 1.00]). CONCLUSIONS: Use of the ICDSC, along with education supporting its use, improves the ability of physicians to detect delirium in the medical intensive care unit.     

INDICATION for critical care nurses: Protocol for a quasi-experimental study testing the effects of a multi-modal education intervention for delirium care

BackgroundDelirium is associated with serious adverse health outcomes, particularly increased intensive care unit (ICU) stay and mortality rate. Critical care nurses lack sufficient knowledge about delirium and it remains undetected and poorly managed.AimIn this protocol, the development, implementation and evaluation of the INDICATION (INnovative DelIrium CAre educaTION) program on delirium care knowledge, confidence, competence and clinical practice among critical care nurses in Taiwan is reported.MethodsA quasi-experimental trial will be performed to examine the effects of the INDICATION program. This study will be conducted at a teaching hospital in Taiwan. Two ICUs will provide the sites to recruit critical care nurses to participate. The INDICATION program for the intervention group will be delivered as a multi-modal delirium care education intervention consisting of: (1) one face-to-face education session; (2) five online delirium care learning modules; and (3) simulation education using scenario-based objective structured clinical examination. Participants in the comparison group will only receive: (1) One face-to-face education session; and 2) five online delirium care learning modules. Outcomes including knowledge, confidence and competence of delirium care will be collected at baseline (T0), immediately after the intervention (T1), and 6 weeks postintervention (T2) to evaluate changes over time.FindingsStudy protocol.DiscussionIt is anticipated that the INDICATION program will improve the detection and management of delirium by critical care nurses.ConclusionThe INDICATION program highlights the importance of achieving outcomes to improve the knowledge, confidence, competence, and clinical performance of delirium care among critical care nurses.     

The training needs of Korean intensive care unit nurses regarding delirium

ObjectivesThe aim of this study was to investigate high-priority training needs by analysing the perceived importance and self-reported performance of nurses’ delirium care competency.DesignA cross-sectional survey with a convenience sample of 255 Korean intensive care units nurses.SettingIntensive care units in the Republic of Korea.Main outcome measuresIntensive care unit nurses’ delirium care competency.ResultsExploratory factor analysis of the Nurse Delirium Care Competency Scale showed a six-factor structure, which accounted for 67.51% of the variance in nurses’ delirium care competency: management algorithm, prevention, communication, nursing management, assessment, and collaboration. The self-reported performance scores of all six factors were significantly lower than their perceived importance scores. The delirium assessment factor was identified as a high training priority on the importance-performance matrix for new graduate nurses.ConclusionTraining programmes should be developed considering the six delirium care competency factors identified in this study. Further, nurse educators must adopt active educational modalities such as case-based small group learning and simulation-based learning to improve nurse competency in recognising and managing delirium.     

Nurses' knowledge and attitudes on comfort nursing care for hospitalized patients

To investigate the knowledge and attitudes of practicing nurses on comfort care for hospitalized patients, a survey was conducted in 311 registered nurses from a major teaching hospital. A total of 212 (68.1%) of the participants showed an adequate knowledge of comfort care. Participants who had 6 years or more working experience returned a higher mean scores on physiological and psychological aspects of comfort care (P < 0.05). The total scores were the highest among participants from intensive care unit and the lowest among participants from the oncology department. Although 282 (90.7%) participants were involved in comfort care, only 210 (67.5%) received formal hospital‐based training in this practice. We conclude that there was a large difference in the knowledge between nurses from different departments on comfort care. Continuing education programmes are required to improve the knowledge and skills in comfort care.     

Self-efficacy of caring for patients in the intensive care unit with delirium: Development and validation of a scale for intensive care unit nurses

BackgroundImproving the self-efficacy of intensive care unit nurses for delirium care could help them adapt to the changing situation of delirium patients. Validated measures of nurses' self-efficacy of delirium care are lackingObjectivesThe objective of this study was to develop a Delirium Care Self-Efficacy Scale for assessing nurses' confidence about caring for patients in the intensive care unit and to examine the scale's psychometric properties.MethodsDraft scale items were generated from a review of relevant literature and face-to-face interviews with intensive care unit nurses; content validity was conducted with a panel of five experts in delirium. A group of nurses were recruited by convenience sampling from intensive care units (N = 299) for item analysis of the questionnaire, assessment of validity, and reliability of the scale. Nurse participants were recruited from nine adult critical care units affiliated with a hospital in Taiwan. Data were collected from August 2020 to July 2021.ResultsContent validity index was 0.98 for the initial 26 items, indicating good validity. The critical ratio for item discrimination was 14.47–19.29, and item-to-total correlations ranged from 0.67 to 0.81. Principal component analysis reduced items to 13 and extracted two factors, confidence in delirium assessment and confidence in delirium management, which explained 66.82% of the total variance. Cronbach's alpha for internal consistency was 0.94 with good test–retest reliability (r = 0.92). High scale scores among participants were significantly associated with age (≥40 years), work experience in an intensive care unit (≥10 years), delirium education, and willingness to use delirium assessment tools.ConclusionsThe newly developed Delirium Care Self-Efficacy Scale demonstrated acceptable reliability and validity as a measure of confidence for intensive care nurses caring for and managing patients with delirium in the intensive care unit.     

翻转课堂在肿瘤科护理人员姑息护理培训中的应用

目的探讨翻转课堂在肿瘤科护理人员姑息护理培训中的应用效果,拓展临床护理培训方法。方法选取南京市第二医院肿瘤科临床护士60名。按照随机数字表法分为对照组和试验组,各30名。分别对两组护士进行姑息护理专项培训,对照组采取传统理论授课的培训方法,试验组采取翻转课堂的教学培训方法。采用姑息护理知识问卷及教学培训满意度测评表对两组护士的培训效果进行测评。结果试验组护理人员姑息知识平均得分(17.19±2.85)分,对照组平均(14.25±3.92)分,试验组理论知识测试在疼痛及其他症状的控制、心理精神社会支持和总分得分明显高于对照组;试验组授课模式激发主动学习兴趣、学习内容有助于知识的理解和掌握、课堂互动交流提高分析解决问题的能力及教学培训方法总体评价的满意度明显高于对照组,差异均有统计学意义(均P<0.05)。结论翻转课堂的教学培训方法有助于提升护理人员学习的主动性及评判性思维能力,加深对姑息护理培训知识的理解与固化,提高了教学满意度。     

基于思维导图的双轨教学对静脉用药调配中心规范护士岗位胜任力与教学满意度的影响

目的探讨基于思维导图的双轨教学对静脉用药调配中心规范护士岗位胜任力及教学满意度的影响。方法选取2016年8月至2019年5月我院静脉用药调配中心护士42名,采用随机抽样法将其等分为对照组和观察组,对照组接受常规教学培训,观察组利用思维导图进行双轨教学培训。比较两组护士专业素养能力、实践创新能力、继续教育学习能力及教学满意度。结果观察组专业素养能力、实践创新能力、继续教育学习能力评分均高于对照组(P <0. 05),观察组教学满意度高于对照组(P <0. 05)。结论将思维导图结合双轨教学模式应用于静脉用药调配中心护士教学培训中,能够全方位提高岗位胜任力及教学满意度,值得推广应用。     

老年精神科护士谵妄知识掌握状况的调查分析

目的 调查精神病专科医院老年科护士对谵妄相关知识的掌握情况,为谵妄相关知识培训提供理论依据.方法 采用自设问卷对某精神病专科医院老年科60名护士进行谵妄相关知识调查.结果 60名老年精神科护士谵妄知识得分及各维度得分均不足80分,评估内容得分最低（57.41±22.61）分;护士谵妄知识得分与护士既往是否曾正确判断出谵妄病情相关（P＜0.01）;所有护士均认为需要谵妄知识的继续教育和培训,但33.33％和41.67％的护士对于谵妄发生的危险因素及评估内容方面的知识关注不够.结论 应加强对老年精神科护士谵妄知识的培训,同时应关注培训内容和培训方式.     

Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study

AimTo evaluate the impact of video education on critical care nurses’ knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses’ experiences with video education.MethodsForty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients’ pain assessment between nurses and the researcher was determined to examine nurses’ skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis.ResultsThe knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction.ConclusionsVideo education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool.     

Barriers to low tidal volume ventilation in acute respiratory distress syndrome: survey development, validation, and results

OBJECTIVE: To evaluate perceived attitudes, knowledge, and behaviors regarding the use of low tidal volume ventilation in acute respiratory distress syndrome among physicians, nurses, and respiratory therapists in intensive care units. DESIGN: Cross-sectional, self-administered survey. SETTING: Large Acute Respiratory Distress Syndrome Network teaching hospital in Baltimore, MD. PARTICIPANTS: Attending, fellow, and resident physicians; staff nurses; and respiratory therapists in three intensive care units. INTERVENTIONS: A survey was designed to assess barriers related to clinicians' perceived attitudes, knowledge, and behaviors related to low tidal volume ventilation in acute respiratory distress syndrome and intensive care unit organization-related barriers. Survey development was guided by a published framework of barriers to clinician adherence to practice guidelines; individual items were derived through literature review and refined through pilot testing. Content validity, face validity, and ease of use were verified by local clinicians. Psychometric properties were assessed and regression analyses were conducted to examine differences in perceptions and knowledge level by provider discipline and training level. MEASUREMENTS AND MAIN RESULTS: There were 291 completed surveys with a response rate of 84%. Validity and acceptable psychometric properties were demonstrated. Barriers related to clinician attitudes, behaviors, and intensive care unit organization were significantly higher among nurses and respiratory therapists vs. physicians. Knowledge-related barriers also were significantly higher among nurses vs. physicians and respiratory therapists. Barriers were lower and knowledge test scores higher among fellows and attending physicians vs. residents. Similarly, barriers were lower and knowledge test scores higher among nurses with >10 yrs of experience vs. <10 yrs of experience. CONCLUSIONS: Important organizational and clinician barriers, including knowledge deficits, regarding low tidal volume ventilation were reported, particularly among nurses and resident physicians. Addressing these barriers may be important for increasing implementation of low tidal volume ventilation.