台湾地区专科护理师的发展

护理学科的发展需要护士承担起自身的责任,发挥更大的作用,因此融合各方面经验以切磋显得尤为重要。2008年11月在澳门召开了＂第二届高级实践护理会议＂,主题是创意、协作、规范,主要探讨高级护理的实践及其发展方向。为此本期特约2篇文章重点介绍我国台湾地区专科护理师的发展及国际上有关专科护士核心能力的架构,以使读者能够共同分享。     

产科专科护士核心能力评价体系构建研究

目的汇总分析各国家及地区专科护士核心能力要求,构建产科专科护士核心能力评价体系。方法采用自行设计的问卷咨询表,选取医科大学产科护理教育者、三级甲等医院产科护理管理专家、赴港培训1年并取得中国香港医管局颁布的产科专科护士证书的广东省助产专科护士、卫生行政部门护理专管专家共40名进行德尔菲(Delphi)专家咨询法调查。结果专家咨询的权威系数为0.805,熟悉系数为0.840,判断系数为0.774;经过两轮咨询后确定的临床产科专科护士核心能力评价体系中,一级指标7条,二级指标24条,三级指标49条;专家咨询内部一致性系数为0.723,信度Cronbanch’sα系数为0.871。结论产科专科护士核心能力评价体系分一、二、三级指标共80个条目,经检验,专家意见集中,结果科学、可靠、信度较高,对产科专科护士的评价、培训、考核、准入等均可提供可量化的依据。     

移植专科护士核心能力构架研究进展

器官移植是当前发展迅速的学科之一。它不仅要求护士有牢固的基础知识,还要熟练掌握器官移植的专科临床技术［1］。《中国护理事业发展规划纲要（2011-2015年）》提出：要建立护理的专科领域及培养专科护士,提高护士队伍专业化水平。核心能力是衡量专科护士专业化水平的评价指标之一,也是培养专科护士、设置专科护士培训课程的重要依据。我国对ICU专科护士的专业核心能力已经有了明确的要求和描述［2］。而对于发展迅猛的器官移植医学而言,虽然卫计委组织专家研究制订了《移植专科护理领域护士培训大纲》,规范了培训内容、考核要点等,但对移植专科护士所应具备的核心能力尚无明确的界定。因此,亟须建立系统的、完整的核心能力架构体系,以适应移植医学发展和护理专业化发展的需要。     

医联体模式下上级医院对基层医院专科护理发展的影响

目的:探讨医联体模式下上级医院对基层医院专科护理发展的影响。方法:医联体上级单位对成员单位实施护理共建、一对一帮扶指导、畅通沟通平台、建立培训机制等措施来实现提高基层医院专科护理发展,比较医联体管理前后基层医院专科护理发展情况、专科护士核心能力年度考核情况、专科护理工作质量。结果:医联体模式下,基层医院护理专科在专科数量、专科护理人才的培养及核心能力、专科护理质量考核方面显著优于管理前(P<0.01)。结论:医联体模式能有效促进基层医院专科护理发展,有利于提升基层医院专科护士的核心工作能力,提升专科护理质量。     

专科护士核心能力培养现况

专科护士是指具备一定条件的护士在某一特定的领域通过培训,具备相应专科护理能力并经考核合格获得专科资格证书的注册护士［1］。近年来,专科护士核心能力的研究已经引起护理领域的广泛关注。护士核心能力为护士的相关知识、技能和态度3个基本属性在实践中的有机结合的综合反映［2］,是从事临床工作必须具备的综合能力,是护理教育应着重培养,护理专业人员必须具备的最主要能力。本文通过对我国专科护士核心能力的培养现况作一综述,为专科护士的培训、考核、使用和绩效管理提供依据。     

基于MDT模式的职工医院糖尿病专科护士的培养

提升糖尿病专科护士核心能力,构建满足企业职工医院糖尿病患者服务需求的专科队伍。 方法 将2019年1-12月作为培训时间,应用MDT模式进行培训,比较培训前后糖尿病专科护士的核心能力。 结果 培训前后糖尿病专科护士核心能力比较均有提升,8个维度中,除指导与咨询能力比较P＞0.05,差异无统计学意义;健康教育能力、人际关系能力、科研能力、 批判性思维能力、护理管理能力、指导与咨询能力、个人专业发展能力、直接提供临床护理能力P＜0.05,差异有统计学意义。 结论 将MDT模式用于企业职工医院糖尿病专科护士的培养,可有效提升糖尿病专科护士的核心能力,满足糖尿病患者服务需求。     

急危重症方向护理硕士专业学位研究生专科能力的调查研究

目的了解急危重症方向护理硕士专业学位研究生在急危重症专科的能力现状,为培养高层次急危重症专科护士提供依据。方法于2016年10月-2017年3月采用便利抽样法,应用急诊专科护士自评问卷、重症监护护士核心能力综合评价量表(CICCN),对150名全日制急危重症方向护理硕士专业学位研究生进行调查;应用急诊专科护士自评问卷对140名急诊专科护士进行调查;应用重症监护护士核心能力综合评价量表(CICCN)对160名ICU专科护士进行调查。结果急危重症方向护理硕士专业学位研究生急诊专科能力总体处于中下水平,除专业发展能力水平高于急诊专科护士外其余能力水平均较低,各维度分别与急诊专科护士比较差异有统计学意义(P<0.01);急危重症方向护理硕士专业学位研究生ICU能力处于中上水平,其中科研及学术能力、个人及专业发展水平高于ICU专科护士,除职业道德维度差异无统计学意义(P>0.01)外,其余维度差异均有统计学意义(P<0.01)。结论急危重症方向护理硕士专业学位研究生发展成急危重症专科护士还有很大差距,护理教育者应根据研究生的具体欠缺,制定有效的干预措施,积极促进两者并轨培养。     

母婴护理专科护士核心能力培养方法探讨

核心能力于21世纪初被引用到我国护理专业领域[1],逐渐引起了护理研究者和管理者的重视.专科护士(clinical nurse specialist,CNS)是指在某一特殊或者专门的护理领域具有较高水平和专长的专家型临床护士[2-4].专科护士的核心能力是指直接临床实践能力、指导和教育能力、提供咨询的能力、进行护理科研的能力、领导和革新的能力以及协调、合作能力[5-6].目前江苏省母婴护理专科护士(苏州)培训基地共培养了44名学员,采用师生共同参与型小讲座、自主式护理教学查房、举办读书报告会、分组教学实践等,提升了母婴护理专科护士核心能力.现报告如下.     

综合病例站点式培训对临床护士老年专科护理能力培养的效果观察

目的 探讨综合病例站点式培训在临床护士老年专科护理能力培养中的应用效果。方法 选取在我院月均老年住院病人≥40%病区中的工作年限<5年的护士为研究对象。按随机数字表法分成观察组（n=30）和对照组（n=30）,对照组采用传统培训方式,观察组采用综合病例站点式培训方式。观察比较2组临床护士培训前和培训8个月末老年专科护理的理论与技能考核及护士核心能力评分。结果 培训前2组临床护士老年专科护理的理论与技能考核及护士核心能力评分比较,差异无统计学意义（P>0.05）;培训8个月末观察组临床护士老年专科护理的理论与技能考核评分高于对照组（P<0.05）,观察组科研和评判性思维能力、临床护理能力、人际关系、伦理和法律实践能力、教育指导能力及总分高于对照组（P<0.05）。结论 综合病例站点式培训能提高临床护士老年专科护理理论与技能水平,提升护士核心能力,值得临床借鉴使用。     

骨科专科护理培训对骨科护理质量影响的研究

目的分析骨科专科护士培训前后专业护理能力考核和临床护理能力评价情况,为骨科专科护士的建设发展提供依据。方法建立骨科专科小组,采用德尔菲法确定核心能力评价体系,组织专科护士培训学习,进行护理培训效果考核。结果实施骨科专科护理培训后,专科护士理论知识和技能操作考核的优秀率增加,但差异无统计学意义(P0.05);专科护理组较非专科护理组在骨折患者的满意度、康复知识知晓率和骨科功能恢复上得到明显提高,并发症发生率显著降低,差异均有统计学意义(P0.05)。结论骨科专科护理培训有助于提高骨科护士自身的专业护理能力和临床护理质量,值得临床推广。     

手术室专科护士临床实践能力指标体系的构建

目的：构建科学、全面的手术室专科护士临床实践能力指标体系。方法：采用德尔菲法从全国范围内选取专家40名进行两轮函询。结果：专家函询的群体权威系数为0.87,两轮函询问卷回收率分别为95.00%、92.10%,一级指标和二级指标的协调系数分别为0.38、0.31。最终形成的手术室专科护士临床实践能力指标体系包含6个一级指标及25个二级指标。结论：初步确定手术室专科护士临床实践能力指标体系,为手术室专科护士的培训、评价提供科学依据。     

The development of clinical nurse specialist roles in Ireland

While the term specialist in nursing can be traced to the turn of the 20th Century, it is only since 2001 that a framework was developed for a clinical career pathway in Ireland. This framework has promoted the development and expansion of the clinical nurse/midwife specialist (CNS/CMS) throughout Ireland over the past 10 years guided by the National Council for the Professional Development of Nursing and Midwifery (NCNM). To build upon the achievements of the NCNM and advance nursing practice, it is imperative that CNS/CMSs adopt and fulfil the components of their role. Since CNS/CMS practice is relatively new to Ireland, there is the opportunity to learn from experiences of other countries. This article outlines the development and challenges of the CNS role in Ireland.     

The clinical nurse specialist as a case manager in acute care

The role of the clinical nurse specialist continues to evolve. The clinical nurse specialist is viewed as an educator, change agent, researcher, consultant, caregiver, and, currently, case manager. At a nonprofit 250-bed acute-care facility in the Northeast, the role of the CNS is ill defined, and the CNS is considered part of the staff education department. Through a review of the literature and a personal interview with a clinical nurse specialist from the facility, a new role, the critical-care case manager will be defined as a proposed solution toward increasing the visibility and economic worth of the clinical nurse specialist.     

Competencias y perfil profesional de la enfermera de práctica avanzada

IntroductionThe advanced practice nurse can foster the development of innovative approaches in the design of patient, families and community care. This study has aimed to explain the importance of the advanced practice nurse, especially that of the clinical nurse specialist (CNS), within the care setting and to go deeper into the knowledge of this nursing profile.DesignA review of the literature.MethodThe following databases were used: CINAHL, PubMed and Medline. Search terms were ‘clinical nurse specialist,’ ‘implementation,’ and ‘advanced practice nursing.’ResultsThe sample included 24 publications. A synthesis of the findings generated a summary of the competencies of CNS and their definitions, with some examples in their daily practice and the outcome on its 3 spheres of influences: patients and families, staff and organization.ConclusionCNS emerges in the health systems in order to improve the outcomes in the patients, staff and the organization per se because of its competence as an agent of change and transformational leaderRelevance to clinical practiceNational policies and national strategies are needed to implement CNS on the Master's level in the Spanish National Health System given the evidence-based improvement in the care standards.     

A competency-based orientation program for the clinical nurse specialist

A factor affecting role development of the clinical nurse specialist (CNS) is the orientation process. Unless nursing service provides the structure for enhancing role development, frustration, nonacceptance, and even early termination of a qualified clinical nurse specialist may result. An orientation program provides the mechanism to guide the CNS through the introduction phase of the CNS role in the institution. Without such a program, the CNS may not acquire the fundamental understanding of the nursing department's service and educational philosophy.     

The role of the clinical nurse specialist in medical-surgical nursing.

A clinical nurse specialist (CNS) is an expert nurse clinician who focuses on improving nursing care. The CNS role is the subject of a great deal of debate and confusion, but clinical nurse specialists make a valuable contribution to the health care team.     

The clinical nurse specialist as an external consultant: a framework for practice.

In today's changing health-care system and periods of acute shortages for bedside nurses, the role of the clinical nurse specialist (CNS) is often reevaluated. Budgetary constraints, position cuts, limited resources in small rural areas, and acute shortages have forced many hospitals to do without the expertise of a CNS. This paper proposes that a possible method of meeting identified needs in these situations is through the CNS as an external consultant. A framework is discussed to incorporate the consultant position with the CNS roles. CNS expertise can be made available to underserved facilities without placing extenuating demands on the resources and economic structure that exist.     

Senior clinical nurse specialist pilot position in Hong Kong

This article reports findings of a consultancy project commissioned by Hospital Authority, Hong Kong, to explore the scope of service, role competence, and contribution to patient service of senior-position clinical nurse specialists. Three clinical nurse specialists were selected for this project. The consultant guided and monitored effects of initiatives proposed by each clinical nurse specialist. The evaluation strategies were dependent on the nature of the projects proposed by the senior clinical nurse specialist. Data were collected through nonparticipant observation and interviews to address the overall consultancy project aims. This study shows that the role components of clinical nurse specialists were common across different countries. The value of the clinical nurse specialist to initiate strategies to promote cost-effective and quality care were confirmed, but the career development of these specialists remains a concern in a healthcare environment with constraining resources.     

The clinical nurse specialist and nurse practitioner roles: room for both or take your pick?

OBJECTIVE: The aim of this paper is to contribute to pertinent discussions regarding advanced practice nursing roles. In particular discussion will focus on the potential implications for the developing nurse ractitioner (NP) role on the existing clinical nurse specialist (CNS) roles. SETTING: The literature presented originates primarily from the United States of America (USA), United Kingdom and Australia. Specific emphasis is placed on the psychiatric/mental health nursing context. PRIMARY ARGUMENT: Amidst the confusion in terminology to describe and explain advanced, expanded or extended nursing roles, and to distinguish between the clinical nurse specialist and the nurse practitioner, there is a need to establish clarity. The need for both clinical nurse specialist and nurse practitioner roles has been hotly debated in the USA. CONCLUSIONS: The roles of clinical nurse specialist and nurse practitioner may be complementary but fulfil different functions. It is therefore important that both roles be maintained and implemented in response to consumer and health service needs.