Effect of simulation on knowledge,self‐confidence,and skill performance in the USA: A quasi‐experimental study

In health care, high‐fidelity simulation has been shown to result in increased student learning outcomes when compared to low‐fidelity simulation. With educational facilities investing significant amounts of money into purchasing high‐fidelity simulators, it is imperative to identify if the midlevel simulator, which is less costly, will result in the same learning outcomes. In this study, we examined the effect of midlevel‐fidelity simulation versus low‐fidelity simulation on Bachelor of Science in Nursing nursing students' knowledge, self‐confidence, and skill performance. A quasi‐experimental design examined the effects of midlevel‐fidelity simulation (n = 37) versus low‐fidelity simulation (case study) (n = 37) in junior‐level nursing students. There was a significant difference for both groups in knowledge and skill performance (measured with a mini Objective Structured Clinical Examination), but not between the groups. Unexpectedly, the case‐study group had a higher level of self‐confidence (self‐reported). The results of this study indicate that further research is needed to support faculties' selection of learning strategies with the lowest cost and highest effectiveness in achieving the desired learning outcomes.     

Development of a nasogastric tube insertion simulator: a collaborative interdisciplinary effort

The nursing faculty shortage has created the need for more innovative and effective ways to better stimulate nursing students. Simulation technology is one way to increase the effectiveness of teaching faculty. In this article, a collaborative project between the College of Nursing and College of Engineering at the University of South Florida to develop and evaluate a PC-based software simulator based on videogame technologies for nursing skill acquisition is discussed. A software simulator for teaching and assessing mastery of the procedure for nasogastric tube insertion is described. The purpose of the simulator is to complement the standard training of nasogastric tube insertion that uses static mannequins and instruction/assessment by nursing instructors. The simulator was used in a fundamentals of nursing class at the University of South Florida, with 75 students enrolled. Evaluation showed that the simulator significantly increased the confidence of the students in their ability to perform nasogastric tube insertion.     

糖尿病足发病风险预测模型的系统评价

目的 系统地分析、评价糖尿病足发病风险预测模型,以期为护理实践提供参考依据。 方法 检索PubMed、Embase、Web of Science、Cochrane图书馆、中国生物医学文献数据库、中国知网和万方数据库中有关糖尿病足发病风险预测模型的研究,检索时限为建库至2020年3月1日。由2名研究者独立筛选文献和提取数据,并应用预测模型研究的偏倚风险评估工具分析纳入文献的偏倚风险和适用性。 结果 共纳入7项糖尿病足发病风险预测模型研究,包括6项开发研究和1项验证研究。7个模型的受试者工作特征曲线下面积为0.65~0.88。所有纳入模型中包含最多的预测因子是单丝试验不敏感。7项研究的适用性较好,但存在一定的偏倚,主要是因为未采取或未报告盲法、应变量事件数不足、忽略缺失数据、缺乏模型性能评估以及模型过度拟合。 结论 糖尿病足发病风险预测模型的研究还处于发展阶段,未来应开发性能优良、偏倚风险低的预测模型,并进行内部验证或外部验证。     

临床护理路径在慢性阻塞性肺疾病患者应用效果的Meta分析

目的 采用Meta分析,系统评价临床护理路径在慢性阻塞性肺疾病患者中的应用效果.方法计算机检索PubMed、Embase、The Cochrane Library(2015年第12期)、CNKI、VIP和wanfangdata数据库,全面查找临床护理路径在慢性阻塞性肺疾病患者应用效果的随机对照实验(RCT),检索时间均为从建库至2015年12月.由2名评价员按照纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.3软件进行Meta分析.结果最终纳入49个RCT,包括12311例患者.Meta分析结果显示,与常规护理相比,临床护理路径干预可提高疾病相关知识的掌握〔OR=5.56,95％CI(3.14,9.86),P<0.00001〕、健康教育满意度〔OR=6.62,95％CI(4.11,10.64),P<0.00001〕、治疗的总有效率〔OR=4.75,95％CI(3.07,7.43),P=0.96〕,并可提高患者对护理的满意度、遵医行为,减少住院时间及降低住院费用,差异均有统计学意义(均P<0.05).结论临床护理路径对慢性阻塞性肺疾病患者的实施效果均优于传统护理模式.然而,由于文献存在偏倚的风险较高,分析结果仍需要更多的临床护理实践及大量质量较高的文献来支持.     

微格教学在护生社区健康教育能力培养中的应用

目的探讨微格教学在护生社区健康教育能力培养中的应用效果。方法便利抽样选择湖南医药学院护理学院2013级19名护生,在其社区护理方向班社区护理实训教学中开展微格教学,采用问卷调查和访谈法对教学前后护生的健康教育能力进行比较。结果微格教学前后护生健康教育态度、技能得分及总分间差异均有统计学意义(均P0.01),63.2%(12名)的护生认为微格教学法效果良好。结论微格教学增强了护生的健康教育能力、自我表现意识、语言表达及沟通能力,有利于培养护生的职业素养。     

护理人员对护理技术操作认知状况的调查分析

目的了解临床护理人员对护理技术操作认知状况,并提出对策。方法采用方便抽样的方法,自行设计护理人员对护理技术操作认知状况调查表,随机对本院168名护士进行调查。结果60%以上的护理人员的技术服务理念正确。85%以上护理人员认为护理操作学习和考核地点最好选择在临床;任何护理技术操作及措施实施都必须从评估开始;护理评估不仅要贯穿于病人住院的全过程,而且还要贯穿技术操作全过程。结论护理管理者需进一步更新临床护理人员的护理技术服务理念,强化岗位训练,提高护理人员服务技能。     

微课结合翻转课堂对手术室实习护生学习能力影响的Meta分析

目的 系统评价微课联合翻转课堂教学对手术室实习护生学习能力的影响。方法 检索中国知网、万方、维普、PubMed、Web of Science和Cochrane Library等数据库中与手术室实习护生带教模式相关的文献,检索时限为建库至2022年5月。由2 名研究员根据纳入和排除标准独立进行文献筛选、数据提取并进行质量评价,运用RevMan 5.3软件进行Meta分析。结果 本研究最终纳入9篇文献,共包含研究对象833人。Meta分析结果显示,微课结合翻转课堂教学法可显著提高手术室实习护生的理论成绩[MD=8.48,95%CI(1.61～15.35),P＜0.00001],操作技能成绩[MD=10.24,95%CI(4.26～16.23),P＜0.00001],实习护生对教学方法的满意度[RR=1.16,95%CI(1.10～1.22),P＜0.00001]以及护生的学习能力[RR=1.20,95%CI(1.08～1.33),P＜0.00001]。结论 微课联合翻转课堂教学法可以提高手术室实习护生的理论知识水平、操作技能及护生学习能力,护生认可度高。     

护理平台化管理对护理绩效的影响

目的探讨护理平台化管理模式对护理绩效的影响。方法从心血管内科采取平台化管理模式前随机选取护士59名作为对照组,采取平台化管理模式后选取护士91名作为研究组。比较两组护士的护理绩效指标的达标率。结果两组护理工作质量比较中研究组基础护理合格率（99．3％）、病房环境满意度（100．0％）、出院患者满意度（99．0％）等均高于对照组（83．0％,76．2％,95．2％）,差异具有统计学意义（x2=757．93,1259．27,105．40;P〈0．05）。两组工作态度比较中研究组医护合作满意率（100．0％）、服务态度满意率（100．0％）、诊疗告知满意率（95．0％）等均高于对照组（91．8％,93．0％,90．0％）,差异具有统计学意义（x2=12．24,345．90,72．52;P〈0．05）。两组护理工作能力比较中研究组技术操作成功率（95．0％）、病情变化评估准确率（85．0％）及业务考核合格率（92．3％）均低于对照组（97．0％,92．0％,99．4％）,差异具有统计学意义（x2=617．44,128．75,469．24;P〈0．05）。结论运用护理平台化管理模式,最大限度地发挥了护理人员的积极性和创造性,降低了护理成本,提高了护理质量,保证了护理安全。但提高护理业务水平与实践能力提高仍需要长时间的培养。     

CDIO教学模式在高职护生综合护理技能实训中的应用研究

目的探讨CDIO教学模式在高职护生综合护理技能实训中的应用效果。方法选取139名高职护生为对照组,131名高职护生为观察组,对照组采用传统教学模式进行综合护理技能实训教学,观察组采用CDIO教学模式,通过构思-设计-实现-运作4个步骤进行教学,包括组建教学师资、制订教学计划、设置教学内容及实施教学方案。课程结束后,比较两组高职护生的理论、技能考核成绩,评判性思维能力及对教学效果的满意度。结果两组高职护生的理论、技能考核成绩及对教学效果的满意度有显著差异,观察组高于对照组(P0.01或P0.05)。评判性思维能力量表中自信心、分析能力、开放思维、系统化能力、求知欲5个维度得分观察组高于对照组(P0.01)。结论将CDIO教学模式应用于高职护生综合护理技能实训教学中,全面提升其综合能力及职业核心胜任力,护生对教学的满意度较高,值得推广应用。     

The use of high-fidelity manikins for advanced life support training—A systematic review and meta-analysis

ObjectivesThe objective of this study was to evaluate the effectiveness of high versus low fidelity manikins in the context of advanced life support training for improving knowledge, skill performance at course conclusion, skill performance between course conclusion and one year, skill performance at one year, skill performance in actual resuscitations, and patient outcomes.MethodsA systematic search of Pubmed, Embase and Cochrane databases was conducted through January 31, 2014. We included two-group non-randomized and randomized studies in any language comparing high versus low fidelity manikins for advanced life support training. Reviewers worked in duplicate to extract data on learners, study design, and outcomes. The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the overall quality of evidence for each outcome.Results3840 papers were identified from the literature search of which 14 were included (13 randomized controlled trials; 1 non-randomized controlled trial). Meta-analysis of studies reporting skill performance at course conclusion demonstrated a moderate benefit for high fidelity manikins when compared with low fidelity manikins [Standardized Mean Difference 0.59; 95% CI 0.13–1.05]. Studies measuring skill performance at one year, skill performance between course conclusion and one year, and knowledge demonstrated no significant benefit for high fidelity manikins.ConclusionThe use of high fidelity manikins for advanced life support training is associated with moderate benefits for improving skills performance at course conclusion. Future research should define the optimal means of tailoring fidelity to enhance short and long term educational goals and clinical outcomes.     

高级智能综合模拟人ECS在急诊护理学实训教学中的应用

目的：探讨高级智能综合模拟人ECS在急诊护理学实训教学中的应用效果。方法对江西中医药大学大三护理专业学生随机分组,实验组利用ECS模拟人模拟临床急救环境进行急诊护理技能实训授课,对照组配备普通模拟人按传统教学模式授课,分别比较考核教学效果。结果实验组学生考核成绩明显优于对照组,差异有统计学意义（P＜0．05）。结论 ECS模拟人用于急诊护理学实训教学有利于提高学生实际动手能力,培养急救意识、团队合作精神及综合急救素质。     

Lessons from the surgical experience with simulators: incorporation into training and utilization in determining competency

Simulation technology in laparoscopic surgery has developed in response to a need to teach fundamental surgical skills in a safe environment. The skill set needed was defined carefully according to the classic educational model of needs assessment. Once defined, the skills were modeled in a simulator. The recognition that a simulator need not have high fidelity to achieve significant educational value was important in keeping costs reasonably low. Intrinsic to an effective simulation program is a set of metrics or measurements of performance. These metrics provide motivation for the student and allow comparison among students. Once shown to be reliable and valid, the simulator metrics can be used to set reasonable goals and standards for certification. Although simulators permit verification of learning, point simulation testing cannot by itself be used at present to ensure competence. Until the predictive value of these tests has been validated further, competence still needs to be determined by expert assessment of observed performance in real cases and by measurable outcome variables from real procedures. Simulation training is most beneficial when incorporated into a curriculum that teaches the accompanying knowledge and judgment essential for safe practice of the skills taught in the simulator. The FLS program distributed by the Society of American Gastrointestinal and Endoscopic Surgeons and the American College of Surgeons is an example of a carefully planned and validated program that incorporates these principles in laparoscopic surgery education. The lessons learned from development of the FLS program can be useful in designing a similar program for flexible gastrointestinal endoscopy.     

神经外科重症监护病房内感染防控强化护理干预的成效

目的 分析和总结神经外科重症监护病房(neurocranial surgery intensive care unit,NSICU)内的各种感染风险因素,针对不同的感染原因指出了强化护理干预的措施和管理办法,并探讨其实施成效.方法 回顾性分析2015年第3、4季度第二军医大学长征医院神经外科神经外二科(神经肿瘤外科)的NSICU收治的患者的临床资料,将已采取强化护理干预的4季度数据和未采取强化护理干预的3季度数据进行分析,以评价强化护理干预措施的效果.结果 观察组189名患者中,发生感染者11例,总体感染发生率为5.82％.而对照组212例患者中,发生感染者25例,总体感染发生率为11.79％.实施强化护理干预后,NSICU内感染发生率明显下降,与实施强化护理干预前相比,差异有统计学意义(x2=4.0663,P=0.0437).结论 NSICU是院内感染的高风险区,有针对性地强化护理干预措施和管理办法能够有效降低神经外科院内感染的发生率.     

高仿真模拟人在护理教学中应用效果的系统评价

目的系统评价高仿真模拟人在护理教学中的应用效果。方法计算机检索Cochrane图书馆、JBI循证护理中心图书馆、PubMed、EMbase、中国期刊全文数据库、中国生物医学文献数据库,搜集有关模拟人对比传统教学法在护理教学中应用的随机对照试验（randomized controlled trial,RCT）或类随机对照试验（quasi randomized controlled trial,q-RCT）。对纳人研究进行方法学质量评价,而后提取有效数据并采用RevMan5．0软件进行Meta分析。结果最终纳入3个RCT和5个q-RCT,共2732位研究对象。质量评价结果表明,8个研究的总体质量水平不高。由于纳人研究间的同质性较差,本研究仅采用描述性分析。评价结果显示,与传统教学法相比,应用模拟人可提高学生专业知识水平、护理操作技能,培养学生的临床胜任能力、知识的综合运用、团队合作等多项能力。结论应用高仿真模拟人进行护理教学是一种深受学生欢迎的教学模式,但由于有关高仿真模拟人在护理教学中应用的RCT尚少,纳入研究的教学方法和考核标准差异较大,上述结论尚需开展更多高质量的研究予以验证。     

Methodological quality in randomised controlled trials of transcutaneous electric nerve stimulation for pain: low fidelity may explain negative findings

The benefits of transcutaneous electrical nerve stimulation (TENS) for pain relief have not been reliably established, as most systematic reviews find poor methodological quality in many studies. The paradox within the evidence base for TENS is that despite identified sources of bias that may lead to an overestimation of treatment effects, no benefits for TENS can be clearly demonstrated. Conventional assessments of quality assume a single direction of bias, and little work has been undertaken examining other directions of bias. Our hypothesis was that low fidelity in studies (bias leading to an underestimation of treatment effects) may account for inconclusive findings. We included 38 studies from 3 recently published Cochrane systematic reviews that examined TENS for acute, chronic, and cancer pain. We extracted data relating to treatment allocation, application of TENS and to the assessment of outcomes. We quantified these data and judged this against standardised assessment criteria using a “traffic light” approach based on the number of studies reaching the standard. We identified significant sources of potential bias in both directions in relation to study design and implementation fidelity that have not been quantified previously. Suboptimal dosing of TENS and inappropriate outcome assessment were particularly prevalent weaknesses indicating low fidelity. We propose criteria for judging directions of bias in future studies of TENS that may be adapted to assess other trials in which implementation fidelity is important, such as other nonpharmacological interventions for pain.     

Effects of Smartphone-Based Mobile Learning in Nursing Education: A Systematic Review and Meta-analysis

Purpose

A systematic review and meta-analysis was conducted to evaluate the effects of smartphone-based mobile learning for nurses and nursing students.

Nursing workload and patient-focused outcomes in intensive care: A systematic review

The aim of this systematic review was to examine the association of nursing workload on patient outcomes in intensive care units. The primary outcome measure was patient mortality, with adverse events (AE), the secondary outcome measures. Electronic search of databases including MEDLINE, CINAHL, Cochrane, EMCARE, Scopus, and Web of Science were performed. Studies were excluded if they were in non-ICU settings, pediatric, neonatal populations, or if the abstract/full text was unavailable. Risk of bias was assessed by the ROBINS-I tool. After screening 4129 articles, 32 studies were identified as meeting inclusion criteria. The majority of included studies were assessed as having a moderate risk of bias. The nursing activities score (NAS) was the most frequently used tool to assess nursing workload. Our systematic review identified that higher nursing workload was associated with patient-focused outcomes, including increased mortality and AE in the intensive care setting. The varied approaches of measuring and reporting nursing workload make it difficult to translate the findings of the impact of nursing workload on patient outcomes in intensive care settings.     

发展性教学评价在护理本科学生实习前技能培训中的应用

目的 探讨发展性教学评价在护理本科生实习前技能操作培训中的应用效果.方法 将2008级103名护理本科生作为试验组,2007级105名护理本科生作为对照组.对照组采用常规的教学评价,试验组采用发展性教学评价.比较两组学生的操作考试成绩,并对试验组学生进行问卷调查.结果 试验组、对照组学生操作考试成绩分别为(86.39±5.91)分和(83.08±6.43)分,差异有统计学意义(P＜0.05).结论 发展性教学评价有助于调动护理本科生的学习积极性,提高综合能力.     

仿真模拟教学系统对护理教学有效性的系统评价

目的采用Meta分析评价仿真模拟教学系统对护理教学的效果。方法计算机全面检索国内主要的医学数据库中有关仿真模拟教学的干预性研究。按照纳入及排除标准筛选文献,提取资料并评价纳入研究的方法学质量后,采用Rev Man 5.0分析软件进行Meta分析。结果共纳入12篇文献,合计2465名护理专业学生。Meta分析结果显示:仿真模拟教学系统在提高护理专业学生理论及操作技能方面优于对照组(P<0.01)。结论仿真模拟教学系统应用于护理教学中的效果优于传统护理教学法。但因纳入研究的质量不高,仍需大样本高质量的随机对照试验进一步验证。     

PBL联合CBL教学法在麻醉护理实习生临床教学中的应用

目的 分析以问题为基础的教学（problem-based learning,PBL）联合以案例为基础的教学（case-based learning,CBL）法在麻醉护理实习生教学中的应用效果。方法 选取苏州卫生职业技术学院分别于2020年和2021年在某院进行麻醉护理实习的2个年级学生作为研究对象，根据学生入院学习时间分为观察组和对照组各36名，观察组采用PBL联合CBL的教学方法，对照组采用以传统授课为基础的（lecture-based learning, LBL)教学方法，观察2组学生在理论考试、临床实践考核以及对教学方法满意度的情况。结果 观察组理论考试成绩和临床实践考核成绩均高于对照组学生的成绩，差异有统计学意义（P<0.05）;2组学生在对教学方法满意度的比较时，观察组的总体满意度、学生对教学模式的接受度、课堂效果及对知识的掌握程度均优于对照组，差异有统计学意义（P<0.05）。结论 PBL联合CBL教学法可有效提高麻醉护理实习生的自主学习能力，促使实习生主动参与学习，深入研究分析，提高临床思维能力，教学效果更佳。