护理学向科学迈进的沿革--介绍美国护理科学探索过程

专业的关键特征之一是拥有一个完整的理论知识体系。护理要从一个职业发展成为一门专业,必须建立和发展能够指导护理实践的科学知识体系。然而,什么是护理学所特有的、能够作为护理实践基础的知识体系呢?其实质又是什么呢?护理界,尤其是美国的护理界,为了寻找这两个问题的答案,进行了孜孜不倦的探索,为护理学科的发展做出了很大的贡献,但在发展过程中同时也出现了一些误区。美国的护理学科发展主要经历了5个不同的时期,从建立护理专业知识体系的思想形成,到改革护理教育的课程设置和课程内容、大力开展护理科研、进行护理研究生教育以及建立和发展护理理论,虽然每个发展时期的努力重点各不相同,但其努力的目标和方向始终是一致的,那就是要建立和发展护理学科特有的理论知识体系,使护理学成为一门专业。     

Nursing science: the transformation of practice

World-wide transformations in nursing practice are evolving as more nurses are embracing extant nursing theories and frameworks in order to fortify their unique contributions to the healthcare system. This article specifies the importance of and the ethical considerations arising when using nursing knowledge from within the school of thought of the discipline to guide practice. The ideas set forth are in stark contrast to the general nursing process with its medical model-driven diagnostic systems now proliferating in nursing practice in the global healthcare community. Both challenges and opportunities are present in the transformation of practice to a nursing knowledge base.     

The Nature of Knowledge and Theory in Nursing

The formulation of nursing as a discipline is under way. Work on theory development, concept clarification and the development of a knowledge base is spurred by the creation of new doctoral programs and the emphasis on nursing research. As nursing establishes itself as an inventor of theory, the contrasts and similarities between its existence as both a practice profession and academic discipline come into sharp focus. As nursing strives to understand itself both as a user-applier and discoverer-inventor of knowledge and theory, it provides a model for other practice professions and academic disciplines to explore such questions as, What is the nature of theory in practice? What is the role of application in the formulation of theory? This paper examines the characteristics of theoretical constructs as they apply to the practice of nursing, the use of theory in that practice and the limitations of theory in application.     

护理教学查房的组织与实施

护理临床教学是理论联系实际的最佳途径,教学查房是常用的临床教学手段。带教教师对教学查房的合理组织与安排,能提高学生应用理论知识、分析和解决临床实际问题的综合能力,弥补课堂理论教学的局限和不足,增进教学效果。根据护理教学查房的类型与形式,带教老师在查房中发挥其组织、教育、咨询和护理的作用。教学查房的效果评价内容包括:教学目标是否达到;学生对相关知识和技能是否掌握;学生是否积极参与讨论;教学活动时间安排的合理性与有效性;学生对教学活动的满意程度。     

跨文化护理理论的评价与应用

本文介绍了跨文化护理理论的主要概念和结构,按照理论评价的标准评述该理论,并结合临床实例揭示了护理是一门跨文化照顾专业。因此,在护理照顾中护士应根据服务对象的社会环境和文化背景,以最大限度满足服务对象的要求,提供与文化一致的最佳护理。旨在让更多的护士在实践中进一步理解和应用该理论。     

Transforming Practice Knowledge into Nursing Knowledge—A Revisionist Analysis of Peplau

Nursing practice typically has been viewed as applying knowledge. However, currently, there is increasing awareness that nursing practice is also a process of knowledge development. Still, research and practice are not always connected. Analysis of Peplau's works illuminates a scholarship of nursing practice that is relevant today. This paper focuses on a specific strategy and philosophic perspective, as derived from Peplau, for integrating nursing practice more fully into today's knowledge development. Emphasis is on the need for nursing practice-based theory, as well as nursing theory-based practice.     

Nursing Specialty Knowledge as Expressed by Standardized Nursing Languages

PURPOSE. To describe how nursing specialty knowledge is demonstrated in nursing records by use of standardized nursing languages. METHODS. A cross‐sectional review of nursing records (N = 265) in four specialties. FINDINGS. The most common nursing diagnoses represented basic human needs of patients across specialties. The nursing diagnoses and related interventions represented specific knowledge in each specialty. Sixty‐three nursing diagnoses (nine appeared in four specialties) and 168 nursing interventions were used (24 appeared in four specialties). CONCLUSIONS. Findings suggest that standardized nursing languages are capable of distinguishing between specialties. Further studies with large data sets are needed to explore the relationships between nursing diagnoses and nursing interventions in order to make explicit the knowledge that nurses use in their nursing practice. PRACTICE IMPLICATIONS. Nursing data in clinical practice must be stored and retrievable to support clinical decision making, advance nursing knowledge, and the unique perspective of nursing.     

Nursing and administration: a synthesis model

The position taken in this article is that nursing administrative practice is a synthesis of knowledge and skills from the two major fields of study, nursing and administration. This synthesis is unique, needs further explication, and differs from a simple combination of content from two separate fields. Expanded study of nursing is an essential component of graduate programs in nursing administration and embraces both discipline and practice considerations. It proceeds from the perspective of clients as pluralities and organizations and systems as appropriate units of analysis. Nurses in executive positions, operating from an expanded knowledge base, have an opportunity to empower nursing and exert substantial influence on the nature and direction of health care. Concurrently they can empower other members of the executive team through development of creative patterns of interdependence as the organization pursues the goal of high-quality, evenly distributed, cost-effective patient care.     

某院护士长护理管理知识及其应用情况调查

目的 了解护士长对护理管理理论知识的掌握情况及在实践中的应用情况,提高其护理管理工作水平和工作质量.方法 采用自行设计的调查问卷,运用方便取样方法,对哈尔滨市某三级甲等医院50名在职一线护士长进行护理管理知识及其应用情况调查,问卷采用当场发放当场收回的方式.结果 护士长虽具备一定的管理理论知识,但基础不牢,深度与广度均显不足.在应用方面存在管理理论与临床实际工作出入较大、临床护理管理工作中运用管理理论的能力欠佳等问题,因而护士长对继续学习护理管理知识有很高的积极性.结论 护士长的管理知识水平有待提高,应鼓励护士长参加在职学习,提高护士长的管理知识水平,强化管理能力的培养,提高护理管理绩效.     

Postgraduate Medical Imaging Nursing Curriculum: Development and Indications for Nursing Practice

Medical Imaging (MI) nurses require advanced education to increase their ability to positively influence patient care, leading to improved patient outcomes. The MI nursing field has been a neglected specialty with regard to postgraduate tertiary education programs, where the eminent skills, knowledge, and expertise of other specialist nursing fields have been recognized and sought after, such as critical care environments. Postgraduate tertiary education incorporates the application of evidence-based theory to clinical practice and can address the theory-practice gap and improve the critical thinking, confidence, and competence of MI nurses. Postgraduate tertiary education can contribute to improved patient outcomes and reduced mortality. A postgraduate tertiary MI nursing program was developed to support the clinical practice and critical thinking of nurses in radiology departments.     

Nursing theory and administrative practice: agenda for the 1990s

Despite past progress in the development of nursing theory, a theoretical nursing perspective is not yet common to the practice of nursing administration. Such a perspective could serve as a catalyst both to advance knowledge development for administrative nursing practice and to align clinical and administrative practice within a common framework. In this article assumptions, concepts, and questions common to both clinical and administrative nursing practice are identified. Select domain concepts are used to exemplify the themes shared by nurse clinicians and nurse administrators. The article concludes with a five-item agenda as a guide for future theory development.     

开展社区护理研究 推动社区护理发展

我国社区护理工作落后,为推动社区护理发展,我们与卫生局合作,建立社区护理实践基地,组织教师参与社区护理实践,积极开展社区护理研究,以研究带动社区护理发展。目前已获得多项省厅级及局级、院级社区护理研究课题,形成了良好的社区护理研究氛围。在社区护理研究中提高了社区护士及护理教师的工作、研究能力,拓展社区护理的范围,促进社区护理的发展及社区护理教育体系的发展。     

Nursing practice draws upon several different ways of knowing

? This paper explores the proposition that nursing practice draws upon several different ways of knowing. ? It highlights difficulties often faced by practising nurses in defining what they do and hence what it is that constitutes nursing practice. ? Following formal definition and analysis of sources of literature regarding nursing knowledge, issues such as the origins of knowledge and the sources of nursing knowledge are addressed. ? The types of knowledge required to enhance nursing practice are discussed, focusing upon future opportunities and innovations in the generation of knowledge for nursing. ? Finally, recommendations are made regarding the way forward for nurses endeavouring to communicate the complexities of nursing practice.     

On Nursing Theories and Evidence

Purpose: To expand the understanding of what constitutes evidence for theory-guided, evidence-based nursing practice from a narrow focus on empirics to a more comprehensive focus on diverse patterns of knowing.
Organizing construct: Carper's four fundamental patterns of knowing in nursing—empirical, ethical, personal, and aesthetic—are required for nursing practice. A different mode of inquiry is required to develop knowledge about and evidence for each pattern.
Conclusions: Theory, inquiry, and evidence are inextricably linked. Each pattern of knowing can be considered a type of theory, and the modes of inquiry appropriate to the generation and testing of each type of theory provide diverse sources of data for evidence-based nursing practice. Different kinds of nursing theories provide different lenses for critiquing and interpreting the different kinds of evidence essential for theory-guided, evidence-based holistic nursing practice.     

基于战术战伤救治的野战救护实践教学模式在护理本科生《野战护理学》课程中的应用

目的探讨基于战术战伤救治的野战救护实践教学模式在护理本科生《野战护理学》课程中的应用效果。方法便利抽样法选取第二军医大学2012级41名护理本科生为研究对象,在前3次理论课中融入战术战伤救治(tactical combat casualty care,TCCC)理论精华,在后2次实践课中利用动物组织、仿真模拟人、标准化伤员模拟战伤和大规模伤亡,分别开展TCCC关键救护技术实战化训练和野战救护综合模拟演练。演练后对学生进行问卷调查,了解其自我感知变化和对教学质量的评价。结果护生对战创伤救护知识、能力和态度的自我感知均实现了积极的显著性提升,一致认为此次教学改革是一种创新的实践教学模式。结论基于TCCC的野战救护实践教学改革取得了较好效果,今后还需不断贴近战场实际,更新救治理念,完善训练模式,进一步提高训练效果。     

医学模式转变对护理人员知识结构的要求

对泸州市五县一区县级以上医院１４所１３２２名护理人员接受新理论、新知识学习情况的调查。结果表明：１３２２名护理人员中仅３５％的人员接受过医学伦理学学习，接受护理心理学学习的仅占１２．７％，护理管理学学习的占６．４％，其它学科学习的人数则更少，说明护理人员中存在着明显的知识结构缺陷。作者对此提出了针对性的对策。     

Nursing based evidence: moving beyond evidence-based practice in mental health nursing

Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplines favour knowledge developed using quantitative methodologies so they and evidence-based practice (EBP) and evidence-based nursing (EBN), increasingly called for in mental health nursing, fit seamlessly together. Nevertheless, as these movements dismiss qualitative approaches to knowledge (evidence) development, I argue against the move toward EBP/EBN in mental health nursing. This is because the specialty's primary interests - human experiences of illness/health care and human relationships, often do not lend themselves to being quantitatively researched. Using nursing examples, I demonstrate how qualitative research, wholly unacceptable in relation to EBP/EBN quality of evidence scales, is indispensable to mental health nursing. The need for evidence arising from qualitative research in no way precludes the need for quantitatively derived evidence. Indeed, the specialty's twofold interest - the work of nurses with clients and the explication of phenomena which inform practice, require diverse knowledge and thus, diverse research approaches. This twofold interest defines the area of mental health nursing practice, and knowledge informing it is referred to as nursing based evidence (NBE). Because it values multiple approaches to knowledge development, NBE provides a way to articulate the specialty's distinct contribution to the health care of people experiencing mental illness and advances mental health nursing.     

护理硕士专业学位研究生循证护理课程的效果评价

目的评估护理硕士专业学位研究生循证护理(evidence-based nursing,EBN)课程的教学效果。方法便利抽样法选取本校护理学院2013、2014级护理硕士专业学位研究生62名为研究对象。采用中文版循证实践知识、态度、行为问卷(evidence-based practice questionnaire,EBPQ)和EBN课程反馈问卷在EBN课程教学前、后对学生进行教学评价。结果在接受EBN课程后,护理硕士专业学位研究生的循证实践行为、态度、知识技能3个维度的得分及总分较课程前均有很大提升(均P0.01)。学生对EBN课程的反馈评价良好,对教学内容、教学方法、考核方式、总体评价的满意度分别为91.9%、85.5%、85.5%、90.3%。结论在护理硕士专业学位研究生教育中开展循证护理课程,能提升学生的循证实践知信行水平,其对课程满意度较高。     

护理本科生临床实习带教方法的探讨与分析

护理是一门科学性极强的应用性学科,在临床实习期运用好的带教方法为护理本科生实施带教,以帮助其更快、更好地完成从单纯接受知识到运用知识解决实际问题的转变。文章总结了近年来在护理本科生临床实习过程中所采用的创新带教方法,并对其科学依据和特点进行分析,为本科护理实习临床带教提供理论参考。     

中医护理技术难度分级及准入管理

目的对中医护理技术进行难度分级,确立准入管理机制,以提高护理人员中医护理技术水平,实现分层次培训。方法采用德尔菲专家咨询法对36名专家进行3轮问卷调查,形成中医护理技术的难度分级并给出准入管理建议。结果中医护理技术操作难度分级结果:中医护理技术项目的平均难度水平在5.57,68%属于中、低难度水平的项目。其中耳针法等7项针刺法为高难度操作;穴位按摩等8项技术操作为中难度操作;中药煎煮等7项技术操作为低难度操作。中医护理技术准入机制:(1)高难度技术操作准入建议本科及以上学历、主管护师、10年以上中医临床护理工作经验,且必须接受过1年以上中医护理技术操作理论和实践专项培训;(2)中难度技术操作准入建议大专及以上学历、护师以上职称、从事中医护理工作5年以上、经过6个月以上中医理论和技能系统培训;(3)低难度技术操作准入建议中专及以上学历、护士以上职称、从事中医护理工作2年以上、经过3个月以上中医理论和技能系统培训。结论中医护理技术难度分级及准入机制的确立,为护理人员资质培训内容的界定、中医临床护理技术操作的规范化管理提供了有益的借鉴。