病例汇报考核法在心内科护理带教中的应用

目的 探讨病例汇报考核法在心内科护理带教中的应用效果.方法 将2010年1月至2011年12月、在我院心内科实习的护理专业学生158名分成试验组和对照组各79例.两组实习学生均在责任护士的带教下按实习大纲要求进行临床实习.试验组的考核采用病例汇报考核法,对照组采用传统试卷考核法.结果 试验组学生在学习兴趣、理论联系实际能力、表达与沟通能力、分析病情能力方面的提高优于对照组(P＜0.05或P＜0.01).结论 在心内科护理带教中应用病例汇报考核法,能促进实习学生主动学习和分析病情的能力,提高临床实习的效果.     

反思日记反馈教学法对护理专业学生实践行为的影响

目的探讨反思日记反馈教学法对护理专业学生实践行为的影响。方法将2005级、2004级2个年级的学生分为试验组和对照组,试验组2005级在临床实践过程中按照相关要求书写反思日记并由专业教师进行及时反馈,对照组2004级在临床实践过程中只要求书写见习小结。分别对两组学生进行实践行为量表测评。结果两组在应用相关学科知识、职业情感、自学能力、沟通能力及分析问题、解决问题的能力等方面比较,差异有统计学意义(P0.05)。结论反思日记反馈教学法能有效地改善本科实习学生的临床实践行为表现。同时,反思日记反馈教学法为师生双方提供了一个平等、真诚的教学交流和情感互动平台,是一种有效的教学方法。     

Embedding evidence-based practice among nursing undergraduates: Results from a pilot study

Evidence-based practice is currently one of the most important developments in health care. Research in nursing science is rapidly growing; however, translating the knowledge based on this research into clinical practice is often hampered, and may be dependent on reflective skills. The aim of this study was to see how undergraduate nursing students in nursing should increase their skills and knowledge related to evidence-based practice through participation in clinical research projects. A qualitative approach was used in collecting and analyzing the data. Students participated in a pilot clinical research project and a received guidance related to their bachelor thesis. After the project was completed, all students filled in a questionnaire.The students' motivation to participate in this study was reported to be high, but they reported low knowledge related to evidence-based practice. All students reported that their attitude towards evidence-based practice changed in a positive direction during their participation in the project. Evidence-based practice influenced nursing practices by putting more focus on critical thinking, increasing pride and giving a sense of ownership in the clinical field. The curricula and the pedagogical perspectives in nursing education can influence the attitude towards evidence-based practice and skills among nursing bachelor students.     

在护理本科生毕业实习中增加口腔科护理实习内容的实践

目的:评价在护理本科生毕业实习中增加口腔科护理实习内容的效果。方法:对2003级和2004级学生分别采取随机抽样和整群抽样的方法,共选取176名在天津医科大学口腔医院实习的本科生,通过调查问卷与访谈相结合的方法,评价实习效果。结果:对两个年级学生的问卷调查结果进行χ2检验,没有统计学差异,说明两届学生实习效果无统计学差异。实习医院教学意识强、条件好、内容安排合理、教学大纲完成良好、实习效果理想。结论:增加护理本科生口腔科护理实习内容,学生扩展了知识面,提高了综合能力,拓宽了就业领域,同时满足了社会对口腔科专业护士的需求。     

护理本科生临床实践行为表现自评与他评的比较研究

目的了解护理本科生对自我评价的认识,并进行学生自我评价与教师评价差异性比较。方法采用问卷调查法,对53名护理本科生及6名教学老师用统一问卷进行调查,从临床护理、管理、教学指导、科研、专业和自我发展、沟通交流、评判性思维7个维度与教师评价相比较。结果学生对自我评价的认同率为88．68％,在临床护理、教学指导、管理、评判性思维、科研以及沟通与交流6个维度,学生自我评价和教师评价差异无统计学意义（P〉0．05）;在专业和自我发展维度,差异具有统计学意义（P〈0．05）。结论学生认可自我评价的模式,对自己的临床实践行为评价具有一定的客观性,但有的方面与教师对其评价存在差距。     

反思性学习法对实习护生评判性思维能力的影响

目的 探索反思性学习法对实习护生评判性思维能力的影响,为临床护理教学模式的改革提供参考依据.方法 将本科和专科实习护生共102人随机分为实验组和对照组各51人,对照组按常规实习程序实习;实验组在常规实习的基础上,对其进行反思性学习相关知识培训,并要求书写反思日记及定期召开小组讨论会.实习前和实习结束时均采用"评判性思维能力量表"(CTDI-CV)对2组护生进行测试.结果 实习前对照组CTDI-CV总平均分为(286.26±28.15)分,实验组为(285.79±30.52)分,2组比较无显著差异;实习结束时,对照组CTDI-CV总平均分为(289.34±32.53)分,实验组为(305.63±22.46)分,2组比较差异显著.结论 反思性学习法有助于培养实习护生的评判性思维能力,值得临床护理教育工作者借鉴使用.     

Some issues in the assessment of clinical practice: a review of the literature

? This paper focuses on some issues in the assessment of clinical practice of particular interest to the author. ? The assessment of students of nursing in clinical practice is acknowledged as a long-standing and difficult problem. ? There is little consensus as to what is meant by the term competence when applied to clinical nursing practice, making the assessment of clinical practice a mainly subjective process. ? The English National Board (1989) has distinguished the term mentor as meaning counsellor and guide, nevertheless the roles of mentor and assessor are frequently confused. ? It is suggested that nurses are equally accountable for the accurate assessment of student nurses' clinical skills as they are for their own practice. ? The validity and reliability of tools used to assess clinical practice are difficult to establish, making objective assessment complex at best, and impossible at worst. ? The assessment of the reflective process has been suggested as one way out of the dilemma, but the ability to think and to write does not necessarily translate into competent clinical practice.     

Developing reflective competence between simulation and clinical practice through a learning transference model: A qualitative study

ObjectiveThis study sought to understand the effects of a pedagogical resource combining a multi-moment debriefing model with reflective journaling that is designed to develop reflective competence.DesignA qualitative educational study was used with an instrumental case study design. Participating in the study were 32 nursing students who wrote 96 individual reflective journals in accordance with each moment (M1, M2, M3) of the proposed reflective practice resource. The journaling was conducted during both the clinical simulation activity and the period of clinical practice.MethodsThe reflective journals resulting from the high-fidelity clinical simulation process were used to explore three moments of learning: debriefing immediately after simulation, post-scenario debriefing, and clinical practice. The typology of content analysis used was classical content analysis, which followed a deductive logic, since to assess reflection levels the 5Rs Reflective Writing Scale was used.ResultsIn the post simulation moment (M1), students produced a greater number of meaningful units associated with a level of strategic narrative reflection. During clinical practice however reflection was more analytical, with the highest level of reflection.ConclusionNursing students developed reflective competence through an iterative process of reflective practice establishing a continuum between simulation experience and clinical.     

Reflective practice and clinical supervision: an interprofessional perspective

BACKGROUND: In the United Kingdom, the drive to encourage reflective practice through clinical supervision, as a means of ensuring quality of provision in nursing and other health care professions, is now well-embedded, not only in policy but also in practice. However, debate and critique of these concepts is limited. AIM: The aim of this paper is to draw on research, conducted with undergraduate occupational therapy students and qualified physiotherapists, in order to contribute to the debate about the functions of clinical supervision and reflective practice in nursing and other health care professions. DISCUSSION: Upholding the notion that clinical supervision has the potential to constitute a form of surveillance, we counter the assumption that it is inevitably confessional in nature. A social constructionist perspective is used to illustrate how clinical supervision might involve a complex interplay of factors that dispel notions of predictability, control and rationality. CONCLUSION: Despite acknowledging tensions, we argue that clinical supervision is both necessary and beneficial. It can be advantageous to individual practitioners and professional groups in enhancing practice and accountability, and promoting professional development.     

我院护理本科生临床实习出科考核现状调查及分析

目的了解护理本科生临床实习出科考核的现状,为规范实习生出科考核提供依据。方法以《毕业实习鉴定手册》中"内外科出科考试成绩评定表"为问卷设计基础,对8家三级甲等医院160名护理实习生中已进行一轮内科或外科出科考核的80名学生进行调查,将所有参与学生的不同点列出作为问卷的选项,经专家审议和20名学生预试验后成为正式调查问卷,对160名护理本科实习生进行调查。结果护理本科生内外科出科考核内容不规范,评价标准不统一,监管体系欠完善。结论应针对护理本科生内外科出科考核的现状,不断完善学生的出科考核系统,使之更加客观地反映学生临床实践综合能力,促进教学相长。     

我国护理硕士研究生临床实践能力研究的文献计量学分析

目的了解我国护理硕士研究生临床实践能力研究的现状与发展趋势。方法从CNKI、中国生物医学文献数据库(CBM)、万方数据库和维普中文科技期刊数据库中检索1992年—2019年7月有关护理硕士研究生临床实践能力的文献,并对文献的年份、期刊、作者、地区与机构、基金支持、研究方法、研究内容等进行文献计量学分析。结果纳入有效文献67篇,含46项研究;41篇期刊文献分布于18种期刊上,《护理研究》载文量最多;核心作者有10名,文献合著率为64.18%,合作度为2.72;第一作者来自16个省、直辖市、自治区,研究机构多为医学院校;基金支持率为52.17%;前7位关键词为专业学位、临床实践模式、德尔菲法、培养模式、教育、评价指标和层次分析法;研究内容主题可分为5大类。结论我国护理硕士研究生临床实践能力研究总体呈波动上升趋势,研究地区和机构分布失衡,核心作者群尚未形成,合作研究重视程度不高;研究内容丰富,但研究质量和深度仍有待提升。     

Reflective practice in the Accident and Emergency setting

The object of this paper is critically to analyse the issue of reflective practice within the writer's own professional arena. The writer is a senior nurse within an Accident and Emergency (A & E) department.It has long been recognised that a gap exists between theory and practice in nursing. There has been much discussion in the nursing literature about the development of the reflective practitioner and how reflection in practice can assist in closing the theory-practice gap.Nurses have always experienced great difficulty in identifying a theory of practice.Jarvis (1992) states that reflective medicine is a frequently used but infrequently defined concept in nursing at the present time. For both qualified nurses and students alike, reflection can be utilised as a learning process to help them expand and develop their clinical knowledge and skills to directly benefit client care (Dewing 1990).Schon (1987) has identified reflection as a process of knowledge acquisition originating in practice and best suited to solving complex practice based problems. Reflection is an active process of exploration and discovery which often leads to unexpected outcomes (Boud et al 1985).Reflection that occurs in the process of an experience is referred to as reflection-in-action (Schon 1987). Nurses have the ability to think about their actions while they are carrying them out and change the actions should the professional's assessment of the situation change (Schon 1983). Reflection can lead to new understanding and appreciation which can be put to use in future experiences (Dewing 1990).This paper will commence with a brief explanation of how nurse education is developing reflection and experience to assist the student nurse to close the theory-practice gap.     

实施临床护理实习总带教老师的效果及评价

目的提高临床护生的实习效果，寻求规范化、系统化的实习管理方法，保证实习教学质量。方法实施聘任临床实习总带教老师，并采取科学的管理方法对总带教老师进行审查、培训、考核、聘任，制定工作职责，使其完成护理实习总带教工作。结果实施总带教老师制度后，护生以及护理部对总带教老师评价满意，护生的临床实习成绩提高。结论实施临床护理实习总带教老师制度，规范了实习教学工作，促进了教学质量的提高，值得推广。     

Using reflection strategies to link course knowledge to clinical practice: the RN-to-BSN student experience

Reflection is viewed as an essential element of professional practice. However, there is limited research exploring practice changes as a result of reflection within the context of new knowledge. In addition, literature suggests that nursing students may have difficulty linking course knowledge to their practice; reflection may facilitate this process. Colaizzi's phenomenology was used to describe the experience of 10 RN-to-BSN students using reflection strategies to facilitate a change in thinking or practice actions within the context of course knowledge. Seven themes emerged: facing emotional barriers, weighing the choices for reflection, making sense, percolating insights, letting go, blending insights into practice, and looking back and acknowledging growth. Structured reflection facilitated changed perspectives and practice actions. Students were able to transcend emotions to begin reflection. Faculty assumed the role of reflective guide. A consistent reflective structure across courses may facilitate learning and use of reflection.     

TSP/OSCE模式在康复护理本科学生临床实践教学指导与考核中的应用

目的:探讨教师标准化病人(teachers standardized patients,TSP)结合客观结构化临床考试(objective structured clinical examination,OSCE)在康复护理本科学生临床实践教学与考核中的应用效果。方法:采用类实验研究方法选取2018年6月—2019年5月在康复科进行临床实习的护理本科学生39人为对照组,采用传统带教;2019年6月—2020年5月在康复科进行临床实习的护理本科学生46人为观察组,在传统带教基础上增加TSP/OSCE带教。两组学生均在康复科接受6周临床实习,采用TSP/OSCE模式考核得分评价两组学生专业核心能力,采用自制问卷调查两组学生的临床教学满意度。结果:观察组学生专业核心能力得分高于对照组(P<0.05),观察组学生对临床教学的满意度高于对照组(P<0.05)。结论:在康复护理本科学生临床实践教学中采用TSP/OSCE模式,能提高本科学生专业核心能力和临床教学满意度。     

大专护生毕业实习中后期压力源的比较研究

目的了解大专护生毕业实习中后期的压力源，为制订护理教学措施提供依据。方法采用问卷调查法，对50名大专护生在毕业实习的第4个月和第8个月月初分别进行压力源调查。结果大专护生毕业实习第8个月对“发生差错、就业、家庭期望与人际关系等”方面承受的压力更大（P〈0．05）；实习中期、后期两个阶段的整体压力程度差异无统计学意义（P〉0．05）。结论在临床护理教学中要关注和了解实习阶段大专护生面对的压力源，加强对护生的合理化引导，在保证护生身心健康的前提下顺利完成临床学习。     

Nursing students learning to utilize nursing research in clinical practice

The purpose of the study was to examine the significance of a learning assignment in relation to research skills and learning of nursing students in clinical practice. The learning assignment included an oral presentation of a nursing research article, which the students gave to their fellow students and ward nurses. The students also chaired the discussion after the presentation. The target group for the study was nursing students of a Finnish polytechnic who had been studying for 2-2 1/2 years and had accomplished a minimum of 120 ECTS credits of the total of 210 ECTS credits. When participating in the study, the students were completing a six-week clinical practice of optional studies. The data were collected with a questionnaire designed for the study. It consisted of six open-ended questions. Three of the questions were related to learning of research skills. Two questions were concerned with learning during the ongoing clinical practice. The final question inquired the students' views on the development of the learning assignment. The students received the questionnaire before the commencement of their clinical practice, and they returned it to the other researcher after their clinical practice. The questionnaire was given to 80 students, of which 50 returned it; the response rate was 63%. The data were analysed by content analysis question by question. According to the results, the learning assignment advanced the understanding of research concepts for the majority of the students. In particular, the students reported that the oral presentation clarified the research concepts, and the structure of a scientific article was also elucidated. The students stated that the assignment generated ideas concerning the development of nursing care. In relation to the ongoing clinical practice, the assignment advanced patient encounters and interaction, and bearing responsibility the most. Proposals for the further development of the learning assignment were expressed by more than half of the nursing students. Half of them suggested ensuring the interest in the topic from the ward.     

WORLD模式在眼科临床实习带教中的应用实践及效果

目的引用英国的一种先进护理实习模式-WORLD 模式(W:Working,与指导老师工作;O:Observing,观摩;R:Researching,研究相关课题;L:Learning,课外学习;D:Departmental visits,走访其他辅助科室)应用于眼科实习带教工作中,并评估临床应用效果,探讨其在临床应用的可行性。方法将在眼科实习的48名护生分为对照组和实验组,对照组采用常规实习带教模式,实验组采用 WORLD 模式,最终通过对实习效果的各项考评结果和护生的反馈信息对比两种实习带教模式,并进行统计学分析。结果从护理技术操作、专业理论知识、护理文书书写、个案研究及护生对带教情况的反馈5个方面考核,两组间差异具有统计学意义(P<0.01)。结论 WORLD 模式不仅扩展了护生的知识领域,而且培养了其自主思考和创造性解决问题的能力,摆脱了传统单一的说教和实践相结合的灌输式模式存在的诸多弊端。     

改良式PBL教学法在血液内科临床护理见习中的应用

[目的]探讨改良式基于问题的学习教学法(PBL)在血液内科临床护理见习中的应用效果。[方法]将42名护理本科生随机分为试验组和对照组,每组21人,分别以PBL联合案例教学法和传统教学法组织见习教学,采用实践考核、理论考试及问卷调查的方法分析教学效果。[结果]将改良式PBL教学方式应用在内科护理见习教学中,学生自认为能提高其学习主动性、临床思维能力、评判性思维能力等综合临床能力;在实践考核、阶段性理论考试成绩及其中应用型题的成绩方面,试验组优于对照组,但期末考试及阶段性理论考试中识记型和理解型题得分两组间差异无统计学意义。[结论]改良式PBL教学法在血液内科临床护理见习教学中取得较好的效果,但有待进一步改进,从而更广泛地应用于内科护理学教学。     

护理专业本专科学生临床实习初期适应情况及其影响因素调查研究

目的：了解护理专业本专科学生临床实习初期的适应情况和影响因素。方法：采用问卷调查法,对方便取样选取的北京市9家三级甲等教学医院的护理本专科实习满4周的339名学生进行调查,完成资料收集并进行统计学分析。结果：护理专业本专科的学生总体临床实习初期的适应水平得分为74．78±12．29分;并且在不同学历、是否重点学院、家庭所在地是否大城市和是否独生子女几方面,适应情况存在统计学差异,而是否北京生源对适应的影响不大。结论：护理教育者要在护理专业学生实习之前对其进行有针对性的岗前培训教育,选择优秀护士担任护理教师并且尽可能固定学生的带教老师,针对临床实习初期适应相对较弱的群体进行有针对性的指导。