呼吸科临床带教的教学问题及对策

目的总结呼吸科的临床带教中的问题，提出对策，以提高教学质量。方法对80名实习护生进行临床带教中存在的问题进行分析，采取相应对策。结果在带教过程中发现护生存在害怕心理、不善于病情的观察、轻视基础护理、缺乏沟通能力；带教老师年青化，缺少教学经验。经采取相应措施后问题得以改善或解决。结论按计划循序渐进教学、注意培养护生的思维能力、强化职业道德教育、提高护生沟通能力、加强带教老师培训，可提高呼吸科临床教学质量。     

如何让护生完成知识向能力的转化

临床实习是护理教学中的最后阶段，是非常重要的教学环节。通过实习可以使护生将理论与实践结合起来，使所学习的知识得到进一步充实、巩固、提高。临床带教老师在护生完成临床实习的过程中，担负着重要的角色和责任，而护生实习的过程是护生理论和实践相结合，由知识向能力转化的过程，是学校教育的深化和延续是护生由学校走向社会的重要过渡阶段，临床带教对提高护生的综合能力，使之发展成为实用型护理人才有着举足轻重的影响。如何使护生顺利完成知识向能力的转化，成为临床带教的重中之重。现将本人近几年来的临床带教体会总结如下。     

实习护生对临床护理教学满意度的调查与分析

临床实习是护理教育的重要组成部分,是理论联系实际、培养学员职业意识、分析问题和解决问题能力、养成良好作风的重要学习阶段.护生对带教老师教学活动以及教学环境的满意度是衡量临床护理教学质量的重要指标.为了解我院临床护理教学情况,不断提高临床实习带教质量,2013年7月至2013年11月我们对在院实习的大专、本科护生进行了临床护理带教满意度调查,并对反馈的意见和建议进行了分析,现报道如下.     

心内科护理临床带教中存在问题及对策

目的根据心内科工作特点,提高护理临床带教质量,调动护生学习的积极性,提高综合能力,对护理工作意义的认识得到进一步的加深。方法对当前带教中存在的问题并提出对策予以改进。结果护生护理操作及考核成绩,工作积极性和主动性,带教老师的自身素质和带教水平显著提高,患者满意率及临床护理质量随之提高。结论实习带教中存在问题的对策制定合理、有效,保证了实习效率,提高了护生的教学质量,教学相长。     

临床路径与传统带教方法对糖尿病护理教学质量的对比研究

选择我校内科实习的专科护生74名,随机平分为实验组(采用临床护理路径带教)和对照组(采用传统带教方式),实习期均为4周。结果实验组实习护生出科成绩及对带教满意度均高于对照组(P0.05)。结论对内科实习护生采用临床护理路径教学可提高教学质量。     

目标教学法在心血管内科护理教学中的应用研究

目的研究并探讨目标教学法在心血管内科护理教学中的应用效果。方法将2016年1月1日~2017年12月31日期间在我院心血管内科进行护理实习的100名实习护生纳入研究,在计算机中采取数字随机表法随机将实习护生分为两组,50名/组,对照组实习护生接受传统教学法护理教学,观察组实习护生接受目标教学法护理教学,比较两组的综合能力考核情况、教学质量满意度、带教老师满意度。结果综合能力考核结果显示,观察组实习护生的理论知识、基础护理技能、专业护理技能、综合护理技能等考核成绩均优于对照组实习护生(P0.05)。在教学质量满意度方面,观察组实习护生总满意率高于对照组(P0.05)。在带教老师满意度方面,观察组实习护生总满意率高于对照组(P0.05)。结论在心血管内科护理教学中应用目标教学法的教学效果优于传统教学法,可更加显著的提高实习护生的理论知识和护理技能掌握度,使其对教学质量和带教老师更加满意。     

临床护理带教现状调查分析与对策

目的全面评估护理临床教学效果，适应素质教育，提高临床教学质量。方法对2006、2007两个学年的中专和大专及本科护生125人实习期间采取问卷调查，制定”临床护理带教质量评价表”由学生出科后填写。结果护理教学中主要存在的问题；实习指导工作不系统；理论与实际相脱离；传授知识技能的机会少；关心尊重学生不够；护理教学查房质量低、次数少；护士长教学意识差；教师专业理论水平较低；教学能力欠缺等。结论分析临床护理教学中存在的问题，及时提出对策，以便不断改进临床教学质量。使带教老师的自身素质和带教水平显著提高。使护生对患者的服务意识增强，对护理工作意议的认识得到进一步的加深。     

护生临床带教的管理方法与体会

临床带教是临床护理工作的一个重要组成部分，1998-2004年，我科接受实习护生1000名，临床带教质量较好，现将管理方法与体会报告如下。 资料与方法：i000名实习生中，高等护理生120名，大专450名，中专430名。对入科新生安排专职固定带教老师一对一带教；选择责任心强、技术水平高、沟通能力强、乐于带教的护师以上职称人员带教；发放双向评估调查表，及时发现带教双方存在的问题，及时纠正；实习中有计划考核，实习结束时认真总结；开展典型病例护理查房，巩固专业知识。通过以上措施，提高了带教质量和护生素质，密切了护患关系，提高了患者对护生的满意度，我们发放1000份评估表，收回991份，护生出科满意度达100％。     

情景模拟带教用于心血管介入治疗护理带教中对教学质量的提升效果

目的 探讨情景模拟带教用于心血管介入治疗护理带教中对教学质量的提升效果。方法 选取2021年1月至2021年6月、2021年7月至2021年12月我院心血管内科两批实习护生各32名,设为对照组和研究组。对照组护理带教中应用传统教学方法,研究组护理带教中应用情景模拟带教方法,对比两组实习护生学习态度评分、考核成绩、综合能力评分,对比两组实习护生对于心血管介入治疗护理带教的满意度。结果 对学习兴趣、学习积极性、学习主动性进行评估,研究组实习护生各项评分均比对照组高（P <0.05）。对比两组实习护生理论知识考核结果和临床操作技能考核结果,研究组实习护生的考核成绩比对照组实习护生更高（P <0.05）。带教后,两组实习护生发现问题能力、解决问题能力、团队协作能力、应急事件处理能力评分均比带教前明显提高,且与对照组实习护生对比,研究组实习护生各项评分均更高（P <0.05）。在心血管介入治疗护理带教结束后,研究组实习护生总满意度比对照组实习护生更高（P <0.05）。结论 情景模拟带教方法用于心血管介入治疗护理带教中,可改善实习护生学习态度,提高对理论知识和实践操作技能...     

骨科临床实习教学的PBL教学模式设计及应用

目的探讨骨科临床实习教学的PBL教学模式设计及应用.方法随机选取2015年3月-2017年10月在本院我科实习的学生86名,依据带教方法将这些学生分为传统的以问题为中心(SBL)的灌输式教学法带教组(SBL组,n=43)和问题式学习法(PBL)带教组(PBL组,n=43).对两组学生的理论知识、实践操作、操作知识评分、实习的积极性及对临床路径带教的满意情况进行统计分析.结果和带教前相比,两组学生带教后的理论知识、实践操作、操作知识评分均显著较高(P0.05);带教后和SBL组相比,PBL组学生的理论知识、实践操作、操作知识评分均显著较高(P0.05).和带教前相比,两组学生带教后的实习的积极性良好率均显著较高(P0.05);和SBL组相比,带教后PBL组学生的实习的积极性良好率显著较高(P0.05).和SBL组相比,PBL组学生对掌握临床路径的意义、增强临床能力、增强查阅文献的兴趣、满意教学氛围、提高沟通能力、满意带教方法、了解制定临床路径的依据、增强科研的兴趣等临床路径带教的满意度均显著较高(P0.05).结论骨科临床实习教学的PBL教学模式应用效果显著.     

How do precepting physicians select patients for teaching medical students in the ambulatory primary care setting?

OBJECTIVE: To study how clinical preceptors select patients for medical student teaching in ambulatory care and to explore key factors they consider in the selection process. DESIGN: Qualitative analysis of transcribed interviews. SETTING: Harvard Medical School, Boston, Mass. PARTICIPANTS: Nineteen physicians (14 general internists and 5 general pediatricians) who serve as clinical preceptors. MEASUREMENTS: Responses to in-depth open-ended interview regarding selection of patients for participation in medical student teaching. MAIN RESULTS: Preceptors consider the competing needs of the patient, the student, and the practice the most important factors in selecting patients for medical student teaching. Three dominant themes emerged: time and efficiency, educational value, and the influence of teaching on the doctor-patient relationship. These physicians consciously attempt to select patients whose participation in medical student teaching maximizes the efficiency of the clinical practice and optimizes the students' educational experiences, while minimizing any potential for harming the relationship between preceptor and patient. CONCLUSIONS: These findings may help validate the frustration preceptors frequently feel in their efforts to teach in the outpatient setting. Becoming more cognizant of the competing interests-the needs of the patient, the student, and the practice-may help physicians to select patients to enhance the educational experience without compromising efficiency or the doctor-patient relationship. For educators, this study suggests an opportunity for faculty development programs to assist the clinical preceptor both in selecting patients for medical student teaching and in finding ways to maximize the efficiency and educational quality of the outpatient teaching environment.     

Resumption of home activities following cardiac events

Patients resume home activities at different paces after uncomplicated cardiac events, and respond to education in a variety of ways. Forty patients recovering from either myocardial infarction (MI) and coronary artery bypass surgery, or MI with coronary angioplasty who were enrolled in a randomized clinical study were interviewed and completed questionnaires regarding their experience resuming home activities. Responses indicated that uncomplicated patients can easily resume those activities important to them. Based on these findings, a Home Activity Assessment Tool was finalized to provide the practicing nurse with practical ways to guide discharge teaching. Use of this tool may facilitate patient's resumption of home, social and work activities.     

高校教学比赛中《人体寄生虫学》获奖作品探析

教学比赛是提高课堂教学质量以及提升教师教学水平的有效途径,本文结合自身参加及观摩近年来全国高校医学类微课教学比赛及全国医学(医药)院校青年教师基本功比赛的实践和体会,探讨其中《人体寄生虫学》获奖作品的共性,包括选题、教学设计、教学方法等方面,为高校人体寄生虫学专业教师提高教学水平提供参考。     

Asthma Knowledge and Asthma Management Behavior in Urban Elementary School Teachers

Background. Although schools are an important setting for asthma care in youth, teachers’ asthma knowledge and symptom management is poor. This study investigated the knowledge, prevention and management behaviors, and communication regarding asthma of teachers of low-income, ethnic minority students. It was hypothesized that relative to colleagues whose students did not have active asthma (i.e., did not have symptoms during the day), teachers of students with active asthma would have better asthma knowledge and that more would take asthma prevention steps and communicate with parents and school nurses. Methods. Drawing from 25 elementary schools in New York City, 320 pre-Kindergarten through 5th grade classroom teachers with at least one student with asthma completed measures assessing their asthma knowledge, steps taken to manage asthma, communication with the school nurse or parents, information they received about asthma, and whether or not they had at least one student in their class experience asthma symptoms. t test and chi-square were used to test hypotheses. Results. Asthma knowledge varied among teachers. Most could identify potential triggers, yet few knew that medication taken prior to exercise could prevent symptoms and that students with asthma need not avoid exercise. Communication between teachers and school nurses and between teachers and parents was lacking. Relative to colleagues whose students did not have active asthma, teachers whose students had active asthma had better asthma knowledge, more took steps to prevent students from having asthma symptoms, communicated with parents, and more initiated communication with the nurse. Conclusions. Teachers’ knowledge about asthma and asthma management is limited, especially among those whose students did not have active asthma. Teachers respond reactively to students who have symptoms in class by increasing prevention steps and communications with parents and the school nurse. A more proactive approach to managing asthma in schools is warranted.     

Nursing students' experience in critical care: implications for staff development

The gap between preservice preparation of nurses for critical-care work and employers' expectations is a crucial factor in providing safe care in special-care units. In this study of senior nursing students from 32 Midwestern schools of nursing, it was found that about 75 per cent of the students had had some experience in critical care, with a mean of 46 hours of experience. Most students observed, did selected procedures, or helped a staff nurse. Only 3 per cent planned and carried out care for more than one patient at a time. Fifty-eight per cent considered themselves unprepared to work in areas of critical care and needed more practice and theoretical instruction. There was wide variation in adequacy of instruction in frequently-used assessment and management techniques.     

八年制学员在心血管内科临床实践培训的几点思考

本文通过对中美医学教育临床实习阶段的比较，分析了我国现行八年制教学模式在临床实习阶段存在的主要问题，并对如何改进八年制学员在心脏内科的临床实习进行了探讨。     

转化医学理念在《细菌学检验》教学中的应用

转化医学是近年来新兴的医学研究模式,其核心理念是将基础研究和临床进行统一和结合。《细菌学检验》是检验专业重要的专业课。本教研室在转化医学理念的指导下,对理论和实验教学进行教学改革,重点培养检验系学生的临床实践操作能力。本文介绍了该课程目前理论教学、实验教学和教师方面存在的问题,并在转化医学理念的指导下进行教学改革的具体方法,提高了教学质量,培养出兼具动手和分析能力,毕业即能胜任临床细菌学检验工作的人才。     

Effect of Physician Delegation to Other Healthcare Providers on the Quality of Care for Geriatric Conditions

The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician‐performed tasks, 0.55 for nurse practitioner (NP)‐, physician assistant (PA)‐, and registered nurse (RN)‐performed tasks; and 0.61 for medical assistant– and licensed vocational nurse–performed tasks. In multiply adjusted models, the independent pass‐probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults.     

Effect of hospital asthma nurse appointment on inpatient asthma care

While asthma nurses are funded by many health authorities within the U.K. National Health Service, for the improvement of clinical management in both inpatient and outpatient settings in secondary care, the effect of asthma nurse appointment on acute asthma care in hospitalized children has been inadequately studied. Here, we test the hypothesis that the employment of a full-time hospital asthma nurse improves quality of care for children admitted to hospital with acute asthma. Prospective in design, the study compares analyses of indicators of good clinical practice for hospitalized asthmatic children (2-16 yrs) before and after the appointment of a hospital asthma nurse. Both management [oxygen saturation check (35/106 vs. 111/126, P<0.05)] and discharge planning [self management plan/asthma education (17/106 vs. 49/126, P<0.05), follow-up arrangements with general practice (8/106 vs. 25/126, P<0.05)] improved. There was, however, no significant change in oral steroid administration, peak flow check, inhaler technique assessment, inhaled drug prophylaxis or arrangements for hospital follow-up at discharge. Employment of a hospital-based children's asthma nurse leads to significant improvement in aspects of routine in-patient asthma management. However, other important areas of in-patient asthma care did not improve following nurse-led interventions. A clearer evidence base may improve compliance with asthma management guidelines, and could make the role of hospital asthma nurse more effective.     

Providing specialist clinical skills in soft tissue and intra-articular injection through a postgraduate masters module

Current philosophy and policy changes in the National Health Service are encouraging healthcare practitioners to extend their clinical skills to create a more patient-centred approach thus allowing patients to be seen in a timely and more appropriate manner. This often requires further development of the practitioners' skills and knowledge. One approach to achieve this is through collaboration between employers and educational providers to ensure that educational experience is not only evidence based but also responsive to the needs of the current and future workforce. A postgraduate module was developed to raise critical and evaluative skills, as well as the technical skills of practitioners using injections in the management of joint and soft tissue pathology, while developing a professional responsibility towards injection practice. The module emphasized learning though experience by contextualizing the theoretical aspects of the module and by its student centred assessments. Further strengths of this module are that it has utilized academic and clinical expertise and knowledge to enable clinicians to gain additional skills and the multidisciplinary approach engendered good working practice Overall the module was evaluated positively by both tutors and students and not only met its aims but also addressed the current professional and policy issues around continuing professional development.