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。     

Developing best practice in critical care nursing: knowledge,evidence and practice

Because the current drive towards evidence-based critical care nursing practice is based firmly within the positivist paradigm, experimentally derived research tends to be regarded as 'high level' evidence, whereas other forms of evidence, for example qualitative research or personal knowing, carry less weight. This poses something of a problem for nursing, as the type of knowledge nurses use most in their practice is often at the so-called 'soft' end of science. Thus, the 'Catch 22' situation is that the evidence base for nursing practice is considered to be weak. Furthermore, it is argued in this paper that there are several forms of nursing knowledge, which critical care nurses employ, that are difficult to articulate. The way forward requires a pragmatic approach to evidence, in which all forms of knowledge are considered equal in abstract but are assigned value according to the context of a particular situation. It is proposed that this can be achieved by adopting an approach to nursing in which practice development is the driving force for change.     

Using Nursing Perspectives to Inform Public Health Nursing Workforce Development

ABSTRACT Recent national and regional public health workforce development efforts have been conducted through a framework of public health services research. Public health nurses (PHNs) are the single largest professional group in the formal public health system, and thus have the greatest potential for positively impacting our community health systems. Effective public health workforce development is contingent on examination of how PHNs themselves make meaning of their practice. This paper suggests that a nursing perspective should be used from which to conduct research surrounding PHN practice. Literature describing PHN practice and recent workforce assessment efforts are reviewed. Assumptions are identified regarding the nature of nursing knowledge, and a theoretical perspective for inquiry about PHN praxis is developed. Finally, a model is offered to illustrate the reciprocal influence of nursing science and public health nursing practice.     

Reflection,the way to professional development?

Background. Many studies have focused on reflection and the advantages that can be gained from the practice of reflection among Registered Nurses (RNs) but, what are the implications of the nurses’ reflections, what do they reflect about, and how do they deal with their reflections? Aims and objectives. The aim of this study was to describe the RNs’ experiences of reflection in relation to nursing care situations, and to understand how RNs use reflection in their daily work. What are the implications of the nursing care situations that the RNs’ reflect upon? What consequences did the practice of reflection have in nursing care situations in relation to the RNs professional development? Design and method. The study was carried out with interviews and the phenomenographic method. Interviews were carried out with four RNs. The choice of informants was made with purposive sampling with the aim of finding informants who could bring the kind of knowledge that was necessary for the study. Results. The qualitative differences regarding the RNs’ experiences of reflection were categorized as follows: to reflect (to think back – consider, mirroring, to reflect before and reflect after, to use experiences), nursing care situations (ethical considerations, to have courage, to use one's imagination, empathy) and consequences (to meet the unique, empathy, development). Finally, the findings were implicated in the model of professional development. Conclusion. By using reflection as a tool, many advantages can be gained in the development of nursing care. Encouraging RNs to reflect upon nursing situations, in order to promote the nurse's professional development, will imply better nursing care for the patients. The model for professional development implies a simplified representation of the thoughts pertaining to professional nursing development. Relevance to clinical practice. The relevance for clinical practice will be to understand the contents of the RNs reflections, to recognize the advantages of reflective practice and how and when to use such measures. Furthermore, to show how the model for professional development can be used in order to create a framework for evaluating these observations and consequently, for expressing tacit knowledge.     

Reflections on the role of the nursing development facilitator in clinical supervision and reflective practice

The notions of clinical supervision and reflective practice are attracting considerable interest across the spectrum of nursing. This paper focuses upon how the two were linked together and, with the support of an independent survey, were used to evaluate the nursing development facilitator role. It is argued that reflective practice, as a model of clinical supervision, may provide a forum for nurses to explore the value of their actions. Linked to this, the personal knowledge that is revealed may mirror reality and as a result it is argued that there is benefit in evaluating practice through reflection.     

The evolution of an intervention — the use of Peplau's process of practice-based theory development

In 1969, at the first Nursing Theory Conference, Hildegard Peplau proposed a research methodology that would guide the development of nursing knowledge. To direct nurses in the development of practice-based theory, Peplau proposed a three-step process that would assist in this pursuit. The purpose of this paper is to describe the use of Peplau's process of practice-based theory development as it has directed a program of research in the area of depression. Peplau's ideas related to practice-based theory development came at a time in nursing when grand theories were being developed and theoretical nursing was highly valued. Peplau, ahead of her time, proposed an approach that valued the development of nursing knowledge in practice, while also combining both qualitative and quantitative methods. This research methodology deserves recognition today, as one that can guide knowledge development in psychiatric nursing.     

开设护士门诊促进我国护理专业发展

通过综述国内、外护士门诊的发展状况,进一步分析在我国设立护士门诊的必要性,以及对我国护理专业发展的意义,旨在弥补我国护士门诊专家的不足。建议护士门诊专家在具有护理专业知识的同时,还应掌握全面的预防保健和临床理论知识、丰富的临床实践经验、有效沟通以及紧急应急能力,必要时进行高效的团队合作,以促进我国护理专业的发展。     

A pluralistic evaluation of nursing/practice development units

Nursing/practice development units (N/PDU) are perceived as centres for pioneering, evaluating and disseminating innovative practice development and facilitating the professional development of practitioners. This paper reports on a pluralistic evaluation research study of the nursing/ practice development unit accreditation programme provided by the University of Leeds, UK. Individual and focus group interviews were undertaken with key stakeholders involved in six nursing/practice development units. These included: clinical leaders, team members, executive nurses, trust board members, general medical practitioners, nursing/practice development unit steering group members, and accreditation panel members. Stakeholder perceptions of what constituted a successful nursing/practice development unit were elicited and then used to judge the success of the programme. Seven criteria for judging the success of nursing/practice development units were identified. These were: achieving optimum practice; providing a patient-orientated service; disseminating innovative practice; team working; enabling practitioners to develop their full potential; adopting a strategic approach to change and autonomous functioning. The findings highlighted differences between the rhetoric of a successful nursing/practice development unit and the reality in which they function. Whereas all the units were actively involved in innovative practice development, evaluation, dissemination and networking activities, several factors influenced the success of the units, in particular, the role of the clinical leader, the motivation and commitment of nursing/practice development unit members, financial resources, and the nature of support from managers, medical staff and education institutions. Although the nursing/practice development units had made significant progress in developing both healthcare practice and practitioners, there is still a need to consider how the claim that nursing/practice development units benefit patients can be substantiated.     

Focus on community: directions for nursing knowledge development

Nurses are challenged to advance the theoretical foundations of community practice. This paper offers ideas on what has been done and what needs to be done to meet this challenge. Within a community health nursing perspective, the paper defines community, proposes an integrated knowledge development framework that focuses on community, analyses contemporary theoretical and philosophical foundations of community in nursing, considers three world-views in which nursing can be framed, and examines parameters for knowledge development for the future.     

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.     

A personal nursing philosophy in practice

The use of a nursing philosophy as the basis for nursing practice promotes the proper application of nursing knowledge as well as the development of further nursing theory and knowledge. My personal philosophy of nursing seeks to encompass the art of conveying nursing science holistically with compassion and dignity. To illustrate this nursing philosophy, the four nursing metaparadigm concepts are described in relation to nursing as both a science and an art. Nursing science and art are also discussed in relation to nursing as a profession. The concepts of family-centered care and developmental care highlight the practice of nursing as an art. The use of nursing knowledge in practice is discussed through the use of nursing's five ways of knowing, nursing theories, borrowed theories, and nursing's paradigms. The concept of the nurse scholar and the further development of nursing knowledge is identified as a priority. Supportive examples from my nursing experience working in a Neonatal Intensive Care Unit (NICU) are utilized to highlight the importance of nursing knowledge development and the provision of optimal patient care.     

Evolution and revision of the Perioperative Nursing Data Set

The Perioperative Nursing Data Set (PNDS) is a nursing language that provides standardized terminology to support perioperative nursing practice. The PNDS represents perioperative nursing knowledge and comprises data elements and definitions that demonstrate the nurse's influence on patient outcomes. Emerging issues and changes in practice associated with the PNDS standardized terminology require ongoing maintenance and periodic in-depth review of its content. Like each new edition of the Perioperative Nursing Data Set, the third edition, published in 2010, underwent content validation by numerous experts in clinical practice, vocabulary development, and informatics. The goal of this most recent edition is to enable the perioperative nurse to use the PNDS in a meaningful manner, as well as to promote standardization of PNDS implementation in practice, both in written documentation and the electronic health record.     

Research directions for specialist practice

Emergency nursing is a specialist area of practice that demands particular knowledge and skills. This paper reports on a study to identify the research directions necessary to advance emergency nursing as a specialist area of practice. Nurses working in nine Australian hospital emergency departments responded to questions about current research practices, and the research priorities necessary to inform the development of knowledge and practice in the evolving specialty of emergency nursing. Forty-four core topics considered relevant to the knowledge base of emergency nursing were identified by nurses who were directly involved in providing patient care. The highest ranked topics were clustered into four priority areas for further research. The key areas for further research are education needs and opportunities, specialist roles of triage, trauma and practitioner, and nurses' coping mechanisms. Discussion of these topics is framed by the increasing specialisation of nursing practice, thus this paper aims to encourage consideration and debate about the research based development of the specialty of emergency nursing.     

中美护理本科《母婴护理学》教材比较研究

目的 比较中美两国本科《母婴护理学》教材在逻辑框架、内容、形式结构和配套资源方面的异同点,探索我国该门学科教材进一步发展和革新的方向。方法 采用教育学中的比较研究法对中美《母婴护理学》教材进行比对分析,以进一步认识本国教育状况和特点,找寻发展和进步的方向和空间。结果 中美《母婴护理学》教材在逻辑理念、内容、架构和辅助材料等方面具有相似性,都体现了护理的特色,重视母婴的专业性,注重知识与技能的培养。相比于中方,美方教材更注重健康孕产妇人群的照护,且对少数弱势孕产妇群体给予关注;运用案例、提问、图表等形式引导、帮助和促进学生学习,且注重思维、循证等能力的培养。结论 在突出护理特色、凸显整体护理理念、重视知识和技能的基础上,学习美方教材融入行业标准的理念;参考美方教材紧密结合案例与知识点的方式;借鉴美方教材培养学生思维及循证能力的方法,实现我国《母婴护理学》教材的进一步发展。