人文关怀教育在胸部肿瘤专科临床护理带教中的探讨和分析

目的探讨人文关怀教育在胸部肿瘤临床护理带教中的应用和效果。方法选取2016年6月—2017年4月在我胸部肿瘤科实习的全日制本科护生22人,将其随机分为对照组和观察组,每组各11人。对照组采取传统教学方法,观察组采取人文关怀教育教学法。出科时分别对两组护生进行理论知识及操作技能考核,并应用人文关怀能力量表对两组护生进行调查。结果观察组护生的理论知识及操作技能成绩得分均明显高于对照组(P0.01);观察组的人文关怀能力显著高于对照组(P0.01)。结论实施人文关怀教育有利于提高护生的护理关怀能力和人文素养,培养护生对患者关怀需求的敏感性。     

基于“一对一”带教结合PBL教学模式对骨科实习护生评判性思维的影响

目的探讨以"一对一"临床带教结合以问题为基础学习(Problem-based learning, PBL)的教学模式对骨科护生评判性思维的影响。方法选取2018年5月—2020年1月在本院实习的护理学专业护生100名为研究对象,其中选取2018年5月—2019年3月50名护生作为对照组,采取"一对一"带教结合传统的临床实习带教方法教学;2019年5月—2020年1月50名护生作为观察组,采取"一对一"带教结合以问题为基础学习(PBL)教学模式教学,分别在实习护生出入科时,应用评判性思维能力测量表(Chinese version of critical thingking disposition inventory, CTDI-CV)进行评分。比较两组学生的评判性思维能力。结果入科前两组护生评判性思维的7个维度评分及总评分相近,差异无统计学意义(P0.05);出科时观察组评判性思维的7个维度评分及总评分均高于对照组,差异有统计学意义(P0.05)。结论 "一对一"带教结合PBL教学模式的实施,能够提高护生评判性思维能力,值得在临床中推广应用。     

基于“匠人精神”理念的人文培训模块在高职护生实习培训中的应用

目的探讨基于"匠人精神"理念的人文培训模块在高职护生实习培训中的应用方法与效果。方法便利抽样选取2018年6月至2019年2月在南京市某三级医院实习的41名高职院校护生为对照组,2019年6月至2020年2月实习的28名高职院校护生为观察组,观察组在实习期前3个月完成基于"匠人精神"的人文关怀模块培训,对照组进行常规培训。比较两组护生的人文关怀能力(caring ability inventory, CAI)、人文关怀品质及教学效果评价。结果观察组护生的CAI认知维度的得分高于对照组(P0.05);反思日记方面,观察组护生关于人文方面的记录较多。结论基于"匠人精神"理念的人文培训有利于提高实习期高职护生的人文关怀能力。     

情景模拟教学联合问题式学习教学管理模式在神经外科护生实习带教中的应用

目的:探讨情景模拟教学联合问题式学习教学管理模式在神经外科护生实习带教中的应用效果。方法:将2018年9月1日～2019年6月30日在神经外科实习的66名护生按随机数字表法分为对照组32名和观察组34名,对照组采用传统带教方法,观察组采用情景模拟教学联合问题式学习教学管理模式。比较两组护生入科、出科时的考试成绩及其对教学效果的评价。结果:出科时观察组护生理论知识与实践操作考试成绩均高于对照组(P 0. 05);观察组护生对教学效果评价的优良率均高于对照组(P 0. 05);观察组护生对带教老师满意度评分高于对照组(P 0. 05)。结论:在神经外科护理实习带教中应用情景模拟教学及问题式学习教学管理模式,可提高护生理论知识及实践操作能力,提高教学质量,护生满意度高,值得临床应用。     

多元化教学在消化内科护生临床实习中的应用

目的探讨多元化教学方法在消化内科护生临床实习带教中的应用效果。方法选取我院消化内科2017年7月至2019年3月实习护生108名作为研究对象,2017年7月至2018年5月54名护生作为对照组,采取常规带教方法; 2018年6月至2019年3月54名护生作为观察组,采用多元化带教方法,即构建愉快和谐的科室学习氛围、一对一带教、实习手册的应用、多种能力的培养、分期教学法等。比较两组护生出科时的理论成绩、操作成绩、病例分析得分和护生满意度。结果观察组的出科考试理论和操作考试成绩、病例分析得分、综合成绩及护生对带教的满意度均高于对照组,差异具有统计学意义(P 0. 05)。结论多元化教学法在消化内科护生临床实习带教中的应用,可强化护生对理论知识和操作技能的掌握,提高护生的临床思维能力。     

CDIO模式下输液室实习护生带教方法的探讨

目的探讨构思-设计-实现-运作(CDIO)模式下输液室实习护生带教方法的改进。方法选取2020年12月—2021年9月在医院门急诊输液室实习的120名护生,按照组间基本特征具有可比性的原则分为对照组和观察组,每组60名。对照组采用传统带教,观察组采用CDIO带教,比较两组实习护生临床工作能力、自主学习能力、教学满意率等方面的差异。结果观察组病情观察能力/发现问题能力、专业知识点掌握、规范操作能力、表达沟通能力、应变处理能力、人文关怀及素养评分均高于对照组,差异具有统计学意义(P<0.05)。观察组学习动机、自我管理能力、学习合作能力、信息素质评分均高于对照组,差异具有统计学意义(P<0.05)。观察组护生满意率、科室教学满意率及院级教学满意率均高于对照组,差异具有统计学意义(P<0.05)。结论采用CDIO带教提高了实习护生临床工作能力及自主学习能力,提升了实习护生教学满意率。     

以人文关怀为导向的优质护理带教模式在临床教学中的应用

[目的]探讨以人文关怀为导向的优质护理带教模式在临床护理教学中的应用效果。[方法]将在神经外科实习的护生124人随机分为观察组与对照组,每组62人。对照组以传统跟班制带教模式进行临床带教,观察组在优质护理服务理念下结合护理人文关怀,创新临床教学方法,以优质护理带教模式进行临床带教,对两组教学效果进行比较。[结果]观察组护生出科理论和操作考核、病人体验与满意度、护生临床实习满意度评分均高于对照组(P0.05)。[结论]针对目前的临床教学环境,优质护理带教模式的开展可提高护生临床实习满意度,提升临床护理带教的质量。     

临床路径式教学法在内分泌肾内科护生实践教学中的应用

目的 总结临床路径式教学法的实施过程,探讨其在内分泌肾内科护生实践教学中的运用效果.方法 选取2017年6月—2018年6月在某院内分泌肾内科实习的护生80名为研究对象,按入科时间将80名护生随机分成两组,对照组采用传统的教学方法进行教学,观察组采用临床路径式教学法进行教学.比较两组教学效果.结果 观察组的出科考试理论、操作成绩及授课能力明显优于对照组;观察组对带教老师的满意度、带教老师对护生的学习能力及护生在实习过程中解决问题的能力较对照组高,差异均有统计学意义(P<0.05).结论 临床路径式教学法的应用,提高了整体带教能力,使护理教学质量管理得以持续改进.     

人文关怀对消毒供应中心护生实习的效果

目的：探讨人文关怀对消毒供应中心护生实习的效果。方法选取在我院消毒供应中心实习的护生58名,实习时间为4 w。将本组护生随机分为人文关怀组与对照组,每组29名。对照组采用传统的一对一的带教方式,人文关怀组在对照组的基础上加入人文关怀带教模式。对两组护生的理论与实践能力进行评价,并通过调查问卷对护生的就业态度及护生对带教的满意度进行评价。结果人文关怀组护生的理论与操作能力均优于对照组（均P＜0.05）,愿意从事与喜欢消毒供应中心护理工作的护生均多于对照组（均P＜0.05）,护生对带教老师与带教质量的满意度优于对照组（均P＜0.05）。结论消毒供应中心护生带教中实施人文关怀的方式更加注重以人为本,护生实习效果能够得到很好的提升。     

临床路径式教学法在肝胆外科护理带教中的应用

目的 探讨临床路径式教学法在肝胆外科护理带教中的应用效果.方法 选择2008年9月至2011年7月在肝胆外科进行临床实习的护生48名为研究对象,其中2008年9月至2009年7月实习护生16人为对照组,2009年8月至2011年7月实习护生32人为观察组.实习期间,对照组按照常规的传统教学方式进行带教.观察组按照临床路径教学要求进行实习带教.实习结束后,由带教小组进行效果评价,比较分析运用不同带教方法后护生的理论、操作成绩及对带教方法的满意度.结果 观察组护生实习出科理论与操作技能成绩均高于对照组;观察组护生满意度明显高于对照组.结论 将临床路径式教学法引入到肝胆外科护理带教中,结合肝胆外科的特点,使教学目标、教学方法管理具体化,可有效提高肝胆外科护理教学质量.     

The approaches to learning of student nurses in the Republic of Ireland and Northern Ireland

The approaches to learning of student nurses in the Republic of Ireland and Northern Ireland In recent years during a period of change in nurse education, there has been an increased interest in educational theory and nurse educators have examined and questioned the fundamental principles upon which the system of education is constructed. In nurse education it is likely that no single theory of learning can account for all aspects of learning and there are reflections of many learning theories in the nursing curriculum. The literature in the area of student learning is complex and wide ranging and is poorly represented in the nurse education literature. In recognition of a lack of understanding and clarity on learning approaches in nurse education during a period of unprecedented change in Irish and United Kingdom (UK) nurse education, this paper aims to highlight the importance of understanding student nurse learning. A study is described which investigated the approaches to learning of student nurses from the Republic of Ireland, who were receiving a traditional apprenticeship training, and student nurses from Northern Ireland in a Project 2000 programme. On comparative statistical analysis significant differences were identified between the two groups in their approaches to learning. It is concluded that students' constructs of learning in nurse education are primarily dependent on their interpretation of the demands of the task, on assessment, teaching and the learning environment. The study provides nurse educationalists with important evaluative information from the students' perspective. It suggests that the way forward is to identify the significant contextual factors influencing student learning and to incorporate them into the nursing curriculum. Such an approach will serve to focus the system on variability in the quality of learning rather than on stability in human attributes.     

Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students

Abstract

Theory

Self-regulated learning theory suggests that individualized learning plans can benefit medical trainees by providing a structured means of goal setting, self-monitoring, and self-evaluation. External feedback also plays an important role in affecting learner motivations, perceptions, and self-evaluations. Accordingly, having learners share individualized learning plans with preceptors might promote self-regulated learning by helping align the feedback they receive with their learning goals. Hypothesis: We hypothesized having medical students share individualized learning plans with attendings and residents would improve the quality of the feedback they received, increase the likelihood that feedback correlated to their learning goals, and improve their perceptions of feedback received. Method: In this multisite study, third-year medical students on their pediatric clerkship created individualized learning plans and shared them with residents and attendings by writing a learning goal on at least one of their required faculty feedback forms. The quality of feedback on forms with versus without a learning goal written on top was scored using a validated scoring tool and compared using a Wilcoxon signed-ranks test, and the frequency with which feedback directly correlated to a student learning goal on forms with versus without a learning goal written on top was compared using a chi-square test. Students completed a post-clerkship survey rating the quality of feedback and teaching they received, perceptions of the individualized learning plans, progress toward achieving learning goals, and whether or not they received teaching and/or feedback related to learning goals. Results: Thirty-six students completed a total of 108 learning goals and 181 feedback forms, of which 42 forms (23.2%) had a learning goal written on top. The mean (SD) feedback score between forms with [3.9 (0.9)] versus without [3.6 (0.6)] a learning goal written on top was not different (p = .113). Feedback on forms with a learning goal written on top was more likely to correlate to a student learning goal than feedback on forms without a learning goal (92.9% vs 23.0% respectively, p < .001). Student perceptions of the usefulness of learning goals did not differ between students who reported receiving teaching or feedback related to a learning goal and those who did not. Conclusions: Sharing individualized learning plans with preceptors helped align feedback with learning goals but did not affect the quality of feedback. Further research should examine the bidirectional relationship between individualized learning plans and feedback in light of other contextual and interpersonal factors.     

Friendship fosters learning: The importance of friendships in clinical practice

This paper reports on one of the key findings from a recent ethnographic study (Roberts, D., 2007. Friendships and the community of students: peer learning amongst a group of pre-registration student nurses. Unpublished PhD Thesis, University of Salford, UK) and aims to highlight the importance of friendships for student nurses in clinical practice. An interpretive ethnographic approach was taken in order to reveal the student experience during their pre registration programme. Data was collected using ethnographic interviewing (Sorrell, J.M., Redmond, G.M., 1995. Interviews in qualitative nursing research: differing approaches for ethnographic and phenomenological studies. Journal of Advanced Nursing 21, 1117–1122.) and participant observation. Within this paper I argue that student nurses exist on the edge of the community of practice (of the qualified staff) and therefore form their own parallel community where students are all seen as being in the same boat. In particular students use the friendships they develop in clinical practice to enable them to learn; developing an ‘ask anything’ culture where all students are perceived as valuable sources of knowledge. Furthermore, it appears that knowledge is contextually bound and not therefore linked to seniority, or length of time served on the course.     

Stakeholder acceptance of digital team-based learning

Team-Based Learning (TBL) can be associated with administrative processes that are labour intensive. A commercially-available online system offered an opportunity to reduce this burden. The aims of this study were to test the feasibility of integrating digital TBL into health curricula, and to explore the experiences and perspectives of students and educators participating in digital TBL. A prospective mixed methods design was used to survey postgraduate nursing and optometry students (n = 162), and educators (n = 8) at an Australian university. Student and educator perceptions of digital TBL collected were: usability (System Usability Scale); level of student engagement (Student Self-Report of Engagement); and user satisfaction post-participation in digital TBL (Post-Study System Usability Questionnaire). Mean Student Self-Report of Engagement Scores reflected high student engagement with significantly higher levels of engagement reported for digital ($\bar{x}$=4.16, SD = 0.199) over paper-based ($\bar{x}$=3.97, SD = 0.267) TBL (p = 0.001). System Usability Scores revealed students (during: $\bar{x}$ = 72.35, SD = 15.70; post: $\bar{x}$ = 74.02, SD = 14.00) and educators ($\bar{x}$=75.0, SD = 15.12) perceived usability of digital TBL to be above average for systems on this scale. Students ($\bar{x}$=2.40, SD = 0.19) and educators ($\bar{x}$=2.36, SD = 0.80) were highly satisfied with digital TBL (Post-Study System Usability Questionnaire). High satisfaction and engagement outcomes suggest digital TBL is feasible, efficient, engaging and well accepted by stakeholders.     

Understanding the essential elements of work-based learning and its relevance to everyday clinical practice

williams c. (2010) Journal of Nursing Management  18, 624–632
Understanding the essential elements of work-based learning and its relevance to everyday clinical practice Aim To critically review the work-based learning literature and explore the implications of the findings for the development of work-based learning programmes. Background With NHS budgets under increasing pressure, and challenges to the impact of classroom-based learning on patient outcomes, work-based learning is likely to come under increased scrutiny as a potential solution. Evidence from higher education institutions suggests that work-based learning can improve practice, but in many cases it is perceived as little more than on-the-job training to perform tasks. Evaluation The CINAHL database was searched using the keywords work-based learning, work-place learning and practice-based learning. Those articles that had a focus on post-registration nursing were selected and critically reviewed. Key issues Using the review of the literature, three key issues were explored. Work-based learning has the potential to change practice. Learning how to learn and critical reflection are key features. For effective work-based learning nurses need to take control of their own learning, receive support to critically reflect on their practice and be empowered to make changes to that practice. Conclusions A critical review of the literature has identified essential considerations for the implementation of work-based learning. A change in culture from classroom to work-based learning requires careful planning and consideration of learning cultures. Implications for nursing management To enable effective work-based learning, nurse managers need to develop a learning culture in their workplace. They should ensure that skilled facilitation is provided to support staff with critical reflection and effecting changes in practice. Contribution to New Knowledge This paper has identified three key issues that need to be considered in the development of work-based learning programmes.     

Informal interprofessional learning: an untapped opportunity for learning and change within the workplace

Abstract

In this paper, we explore the educational and workplace learning literature to identify the potential and significance for informal interprofessional learning within the workplace. We also examine theoretical perspectives informing informal workplace interprofessional learning. Despite numerous studies focusing on formal interprofessional education programs, we suggest that informal interprofessional learning opportunities are currently unrealized. We highlight reasons for a focus on learning within the workplace and the potential benefits within an interprofessional context.     

Introducing the Learning Practice--I. The characteristics of Learning Organizations in Primary Care

RATIONALE, AIMS AND OBJECTIVES: This paper is the first of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. Here we introduce the notion of the Learning Practice (LP) and outline the characteristics and nature of an LP, exploring cultural and structural factors in detail. METHODS: Drawing upon both theoretical concepts and empirical research into LOs in health care settings, the format, focus and feasibility of an LP is explored. RESULTS AND CONCLUSIONS: Characteristics of LPs include flatter team-based structures that prioritize learning and empowered change, involve staff and are open to suggestions and innovation. Potential benefits include: timely changes in service provision that are realistic, acceptable, sustainable, and owned at practitioner level; smoother interprofessional working; and fast flowing informal communication backed up by records of key decisions to facilitate permanent learning. Critical comment on potential pitfalls and practical difficulties highlights features of the present system that hinder development: tightly defined roles; political behaviours and individual-oriented support systems; plus the ongoing difficulties involved in tolerating errors (whilst people learn). This paper contributes to the wider quality improvement debate in the area in three main ways. First, by locating Government's desires to create health systems capable of learning within the theoretical and empirical evidence on LOs. Second, it suggests what an LP could be like and how its culture and structures might benefit both staff and patients in addition to meeting externally driven reforms and health priorities. Third, it extends the application of LO concepts to the health care sector locating the principles in bottom-up change.     

Development and initial validation of the interprofessional team learning profiling questionnaire

Informal workplace interprofessional learning occurs as health professionals interact with each other as part of everyday work practice. Participation in interprofessional team meetings is a practical way to foster learning. However, a gap exists in the availability of a reliable and valid instrument that adequately captures the nuances of informal workplace interprofessional learning in this setting. The purpose of this study was to develop a questionnaire to measure the different components of interprofessional learning that contribute to the quality of interprofessional learning within the interprofessional team meeting. Questionnaire items were developed from a review of the literature and interviews with health professionals. Exploratory factor analysis was used to determine the underlying factor structure. Two hundred and eighty-five health professionals completed a 98-item questionnaire. After elimination of unreliable items, the remaining items (n = 41) loaded onto four factors named personal and professional capacity; turning words into action—“walk the talk”; the rhetoric of interprofessional learning—“talk the talk”; and inclusiveness. Internal consistency was high for all sub-scales (Cronbach’s alpha 0.91, 0.87, 0.83, and 0.83, respectively). Content, construct, and concurrent validity were assessed. The instrument developed in this study indicated consistency and robust psychometric properties. Future studies that further test the psychometric properties of the questionnaire will help to establish the usefulness of this measure in establishing evidence for the perceived effectiveness of interprofessional learning in a healthcare setting.     

Local contrastive loss with pseudo-label based self-training for semi-supervised medical image segmentation

Supervised deep learning-based methods yield accurate results for medical image segmentation. However, they require large labeled datasets for this, and obtaining them is a laborious task that requires clinical expertise. Semi/self-supervised learning-based approaches address this limitation by exploiting unlabeled data along with limited annotated data. Recent self-supervised learning methods use contrastive loss to learn good global level representations from unlabeled images and achieve high performance in classification tasks on popular natural image datasets like ImageNet. In pixel-level prediction tasks such as segmentation, it is crucial to also learn good local level representations along with global representations to achieve better accuracy. However, the impact of the existing local contrastive loss-based methods remains limited for learning good local representations because similar and dissimilar local regions are defined based on random augmentations and spatial proximity; not based on the semantic label of local regions due to lack of large-scale expert annotations in the semi/self-supervised setting. In this paper, we propose a local contrastive loss to learn good pixel level features useful for segmentation by exploiting semantic label information obtained from pseudo-labels of unlabeled images alongside limited annotated images with ground truth (GT) labels. In particular, we define the proposed contrastive loss to encourage similar representations for the pixels that have the same pseudo-label/GT label while being dissimilar to the representation of pixels with different pseudo-label/GT label in the dataset. We perform pseudo-label based self-training and train the network by jointly optimizing the proposed contrastive loss on both labeled and unlabeled sets and segmentation loss on only the limited labeled set. We evaluated the proposed approach on three public medical datasets of cardiac and prostate anatomies, and obtain high segmentation performance with a limited labeled set of one or two 3D volumes. Extensive comparisons with the state-of-the-art semi-supervised and data augmentation methods and concurrent contrastive learning methods demonstrate the substantial improvement achieved by the proposed method. The code is made publicly available at https://github.com/krishnabits001/pseudo_label_contrastive_training.