不同民族本科护生评判性思维能力的对比研究

目的比较不同民族护理本科生的评判性思维能力,为建立针对不同民族护理本科生的培养教育方式提供依据。方法采用彭美慈等修订的评判性思维量表,对新疆医科大学护理学院1—4年级本科护生（2005级-2008级）进行普查。评判性思维得分采用（平均数±标准差）表示,不同民族本科护生之间评判性思维能力的两两比较采用LSD法。结果汉族、回族、维吾尔族、哈萨克族、其他少数民族本科护生评判性思维能力得分分别是（283．65±26．75）、（279．92±30．71）、（266．94±27．99）、（266．40±30．82）、（270．70±18．80）分。汉族与维吾尔族本科护生评判性思维能力在总分和各维度得分方面的差异均有统计学意义（P〈0．01或P〈0．05）;汉族与哈萨克族本科护生评判性思维能力总分、分析能力和认知成熟度方面的差异均有统计学意义（P〈0．01或P〈0．05）;回族与维吾尔族、回族与哈萨克族除在认知成熟度方面的得分差异有统计学意义（P〈0．01）外,其他各项差异均无统计学意义;维吾尔族和哈萨克族本科护生在评判性思维自信心方面的差异有统计学意义（P〈0．05）。结论汉族本科护生评判性思维能力得分较高,不同民族本科护生评判性思维能力不同。护生评判性思维的养成与宗教信仰、民族个性、语言文化、风俗习惯以及整个护理教育过程息息相关,护理院校针对不同民族护生的特点采用不同的教学方法,进一步培养和提高各民族护生的评判性思维能力,对促进我国少数民族地区护理教育及临床护理工作的进步具有非常重要的意义。     

新疆不同地区汉族和维吾尔族本科护生评判性思维能力的对比研究

目的:比较不同地区本科护生评判性思维能力的差异,为进一步探讨本科护生评判性思维能力的影响因素提供依据.方法:采用中文版评判性思维情感倾向问卷,对本科护生(2005级 ~2008级)进行问卷调查.结果:南疆、北疆、内地汉族本科护生的评判性思维能力的平均得分别是(268.92±23.43)分,(287.49±25.37)分,(288.04±29.26)分.其中寻求真相得分小于40分,而分析能力和求知欲这两个维度的得分均大于40分.南疆护生与北疆和内地护生相比评判性思维能力总分有统计学差异(P<0.01).在各维度方面,南疆与北疆汉族护生在寻求真相、思想开放、分析能力等方面有统计学意义(P<0.05或P<0.01),且北疆得分高于南疆.南疆与内地护生相比较,在分析能力和认知成熟度方面有统计学差异(P<0.05),且内地得分高于南疆.南北疆维吾尔族本科护生评判性思维能力总分和各维度得分方面均无统计学差异.结论:不同地区护生评判性思维能力不同.经济发展水平和文化背景均与护生评判性思维能力有关.     

本科及专科实习护生评判性思维态度倾向性现况调查

[目的]了解北京协和医学院护理学院护理本科与专科实习护生评判性思维态度倾向性现状,比较本科与专科实习护生的差异。[方法]采用中文版评判性思维态度倾向性测量表(CTDI-CV)对北京协和医学院护理学院114名本科和专科实习护生进行调查,用SPSS 20.0统计软件进行分析。[结果]北京协和医学院护理学院本科实习护生评判性思维能力总得分283.70分±29.12分,专科实习护生总得分258.25分±28.81分,总分差异有统计学意义(P0.01);本科实习护生各维度得分均高于专科护生,且寻求真相、思想开放、认知成熟度3个维度得分差异具有统计学意义(P0.01)。[结论]北京协和医学院护理学院本科及专科实习护生评判性思维态度倾向性呈中上等水平,且本科与专科实习护生存在差异。     

新疆不同民族实习护生问题解决能力比较及影响因素分析

目的：分析新疆维吾尔族、汉族和回族实习护生解决问题的能力及其影响因素。方法随机抽取乌鲁木齐市3所三级甲等综合医院实习的应届护理大专/本科维吾尔族、汉族和回族实习生共210名作为研究对象进行问卷调查。分析护生解决问题的能力,并分析其影响因素。结果正性问题定向条目汉族护生得分为（9．4±3．2）分,回族护生为（9．6±0．7）分,均高于维吾尔族护生的（8．6±2．8）分,差异有统计学意义（F＝3．010,P＝0．019）。理性问题解决条目维吾尔族护生得分为（21．5±5．6）分,高于回族护生的（19．0±4．1）分和汉族护生的（20．2±6．6）分,差异有统计学意义（F＝5．114, P＝0．003）。冲动/疏忽风格条目汉族护生得分（13．1±3．2）分,回族护生得分为（13．4±4．1）分,均高于维吾尔族护生的（12．0±2．0）分,差异有统计学意义（ F＝4．991,P＝0．004）。回避风格条目维吾尔族护生得分为（11．2±2．8）分,回族护生得分为（10．0±4．0）分,汉族护生为（10．6±2．1）分,差异有统计学意义（ F＝6．765,P＝0．001）。影响维吾尔族、汉族和回族实习护生问题解决能力的因素有学历、喜欢本专业程度、有无评判性思维培训经历、有无自主学习培训经历及对临床带教方式的满意度。结论在临床带教过程中,应结合维吾尔族、汉族和回族实习护生问题解决能力的特点采取有针对性的、灵活多样的教学方式,加强实习护生的爱岗培训,提高实习护生的专业满意度,同时增加自主学习和评判性思维能力的培训来提高实习护生问题解决能力。     

4所学校本科护生评判性思维能力比较研究

目的:比较不同学校本科护生的评判性思维能力,为加强不同学校护理本科生评判性思维能力培养提供依据。方法:利用评判性思维态度倾向性调查表对四川省2008年4所大学护理专业毕业实习10～12个月的本科生进行问卷调查。结果:其评判性思维能力总平均分为(287.37±32.52)分;与不同学校本科护生评判性思维能力总分及各维度的得分情况比较,差异有统计学意义(P<0.01)。结论:四川省4所大学护理专业本科护生评判性思维能力为正性;不同学校护理本科生评判性思维能力具有统计学差异,其部属重点大学比普通院校护理教育更有利于学生评判性思维能力的培养。     

本科护生评判性思维能力与应对方式的相关性研究

目的调查本科护生评判性思维与应对方式的现况,并分析两者之间的关系。方法采用评判性思维量表中文版(CTDI-CV)与简易应对方式问卷(SCSQ),对252名本科护生进行横断面研究。结果本科护生的评判性思维能力总分为(275.72±28.44),积极应对得分为(2.00±0.50),消极应对得分为(1.35±0.47);应对方式得分与评判性思维能力得分存在相关性,有显著性差异(P0.05,P0.01)。结论护生应对方式对评判性思维能力的发展具有一定正向影响,本科护生的评判性思维能力有待进一步提高。     

基础护理教学中本科护生评判性思维能力的培养

目的：了解不同民族本科护生评判性思维现状,探讨如何在基础护理教学中培养本科护生的评判性思维能力,为教学改革提供依据。方法在《基础护理学》课程教学中分别采用传统教学法和案例教学法对少数民族和汉族护理本科生69名进行授课,用评判性思维能力测量表（ CTDI-CV）进行测评并进行分析。结果91．3％以上的本科护生认同培养和提高批判性思维意识和能力的实践意义;实验前、后不同民族本科护生评判性思维总分分别为（251．21±22．94）分和（256．65±31．46）分,均＜280分;各维度得分为正性（＞40分）的是自信心和求知欲;实验前、后本科男护生的评判性思维能力总分分别为（254．28±34．20）,（289．71±54．62）分,分别高于本科女护生（250．87±21．68）,（252．91±25．89）分;男护生实验前、后得分为正性（＞40分）的有：分析能力、评判性思维的自信心、求知欲和系统化能力;女护生实验前、后得分为正性（＞40分）的均为评判性思维的自信心这一维度。结论本科护生对于培养批判性思维意识和能力的认同率均较高;少数民族和汉族本科护生评判性思维总体能力均为中等;男护生的整体评判性思维能力总分高于女护生,实验后男护生具有正性的评判性思维倾向,表明改革后的教学法对提高男护生的评判性思维能力效果显著,但对提高本科护生整体评判性思维能力效果不太明显,需在今后的教学中探讨多种方法的综合运用,将护生评判性思维的培养作为一项长期、系统的工程,努力提高护生的评判性思维能力。     

护理专业本科学生评判性思维能力及影响因素的研究

[目的]调查护理专业本科学生评判性思维能力现状,并分析其影响因素。[方法]采用一般资料问卷和评判性思维测量量表(CTDI-CV)中文版,对齐齐哈尔医学院482名本科护生进行问卷调查。[结果]本科护生评判性思维总分为243.03分±13.72分,评判性思维水平中等,各维度得分由高到低分别是寻求真相、认知成熟度、求知欲、开放思想、分析能力、系统化能力、自信心;不同学生类别中,专升本学生评判性思维总得分高于本科四年制学生,但差异无统计学意义(P0.05);不同学习动机的护生评判性思维能力差异有统计学意义(P0.05)。[结论]本科护理专业学生评判性思维中等,教育者要优化课程设置、改进教学方法,进一步培养和提高学生的评判性思维能力。     

中医院校护理本科生评判性思维态度倾向性调查

[目的]了解广州市某中医院校护理本科生评判性思维现状,为进一步提高护生评判性思维能力提供依据.[方法]采用中文版评判性思维态度倾向性调查表(CTDI-CV)对广州某中医院校168名二三年级中医护理专业和国际交流专业护生进行调查.[结果]中医院校护生评判性思维能力总体得分为244.17分±18.76分,属于中等评判性思维水平,除认知成熟度为正性水平,其他因子均处于中等水平;三年级总分、分析能力、自信心比二年级高;国际交流专业与中医护理专业相比较,总分差异无统计学意义.但国际交流专业护生思想开放和分析能力方面比中医护理高,而求知欲、认知成熟度得分比中医护理低.[结论]广州某中医院校护生评判性思维态度倾向性呈中等水平,年级、专业影响评判性思维水平.     

本科实习护生评判性思维态度倾向现状调查及影响因素

目的 了解本科实习护生评判性思维态度倾向现状,分析其影响因素。 方法 采用中文版评判性思维倾向问卷(critical thinking disposition inventory-Chinese version, CTDI-CV)对武汉市某三甲医院284名临床实习本科护生进行问卷调查。 结果 武汉市某三甲医院本科实习护生CTDI-CV总分为(301.47±27.03)分,＜280分者占21.1%,求知欲得分最高,为(47.37±6.36)分,寻求真相得分最低,为(38.90±4.82)分。4年制护生与5年制护生CTDI-CV总分及开放思想、系统化能力、认知成熟度3个维度得分比较,差异均有统计学意义(t=-2.641,P=0.009; t=-2.126,P=0.035; t=2.550,P=0.012; t=-2.193,P=0.030)。不同学校类型的护生求知欲维度得分比较,差异有统计学意义(F=2.798,P=0.042)。不同就读意愿的护生在寻找真相、开放思想、自信心3个维度得分比较,差异有统计学意义(F=2.995,P=0.021; F=2.744,P=0.031; F=2.516,P=0.044)。 结论 本科实习护生具有正性评判性思维态度倾向,但仍有进一步提升的空间。学制、学校类型和就读意愿对本科护生评判性思维倾向均有影响,护理教育者应关注本科护生评判性思维倾向的培养和塑造,做到因人施教。     

Putting policy into practice: pre- and posttests of implementing standardized languages for nursing documentation

Aims and objectives. To describe the change in documentation of the nursing process in all inpatient wards in a 900‐bed university hospital. Major research question was what are the differences between before and after implementation of documentation policy related to the steps of the nursing process? Background. Implementation of standardized languages has been shown to be difficult to accomplish in clinical practice. Patients are the source of data and their conditions, responses and well‐being should be reflected in the nursing record. As such, nursing documentation can create the premises for the development of new knowledge in nursing and the improvement of nursing performance and can provide data and information necessary for nursing researchers to evaluate the quality of interventions and participate in the formulation of healthcare policy. This study is part of longitudinal project to prepare nurses for electronic documentation within the interdisciplinary health record and to improve documentation of nursing using standardized languages. Design and method. A cross‐sectional study design was used: a pretest (n = 355 nursing records) for baseline status of nursing documentation, an intervention and a post‐test (n = 349 nursing records) to obtain data on nursing documentation. The year‐long intervention comprised planned work in groups, and educational and supporting efforts. Results. A statistically significant improvement was found in the use of Functional Health Patterns for documentation of nursing assessment, NANDA for nursing diagnoses and Nursing Interventions Classification for nursing interventions in documentation of daily nursing care for inpatients. Conclusion. At all organizational levels intervention aimed at putting policy regarding documentation into clinical practice considerably improved daily use of standardized nursing languages. Relevance to clinical practice. Nurses need to use standardized language to document patient care data in the electronic health record and to demonstrate contributions to nursing care.     

Structure and content in Norwegian nursing care documentation.

In 1994, the Norwegian Board of Health (NBH) published recommendations for nursing care documentation. The two-fold purpose of the present study was to see if 5 wards in 2 Norwegian hospitals fulfilled the proposed NBH recommendations and guidelines regarding documentation, and to evaluate them in terms of the proposed structure and key words of the VIPS model. Results showed that all nursing records (n = 55) had an admission assessment. A nursing care plan was present in 62% of the records. Nursing goals were lacking in the remaining 38%, diagnosis and planned interventions were absent in 18%, and 45% of the diagnoses lacked information concerning patient progress or outcome. The nursing care plans were updated in only 40% of the records and discharge notes were present in 35%, confirming that NBH recommendations were not met in this sample. The key words of the VIPS model covered all information present in the records, and high interrater reliability was obtained for the majority of key words categorized by two independent researchers. It is suggested that the VIPS model components and key words can contribute to a reliable and uniform model for nursing care documentation and enhance comprehensive and systematic documentation, which is presently lacking in Norwegian records.     

提升护理服务综合价值的研究

目的:研究护理综合价值的提升。方法:分析护理价值研究背景,阐述护理价值研究进展结果:提出护理价值研究途径。结论:有利于达成一种共识,使广大护理人员认识护理价值、研究护理价值、开发护理价值,重视护理综合价值研究和提升。 护理服务价值是护理服务劳动产品的价值和服务本身所创造的价值的总和,即使用价值与价值的统一。目前日本、美国、德国和中国都在加强护理价值研究的探索,但仍存在使用价值与价值研究分离问题。因此,我们应不断加强护理综合价值研究,以适应卫生事业改革对护理管理的挑战。本研究主要在分析国内外护理价值研究的基础上,提出综合护理价值研究途径,以达到合理评价护理价值的目的。     

Research and the configuration of nursing services

• ? This paper is concerned with the way in which nursing research has influenced changes in the organization of nursing services, particularly the shift from so-called traditional nursing to new nursing. To this end published research and professional literature are selectively reviewed.
• ? The case is made to support the view that change in nursing has been driven forward by the evangelical zeal of opinion leaders rather than evidence.
• ? It is suggested that holistic care as embodied in new nursing is no longer affordable. Market pressures have precipitated a revisiting of the task basis of nursing. An effective anchor would have been a solid body of research evidence pointing up the value new nursing may have. Regrettably not enough research was done prior to the diffusion of new nursing. What was done was not always adequate, and what was adequate was not effectively deployed by nurse leaders.
• ? Nursing is the largest workforce in the NHS and has attracted a great deal of policy interest. It is suggested that it will become increasingly important for nursing to be more strategic, and develop its own professionally driven research agenda.
• ? The future of the nursing profession is uncertain. It is clear that evidence-based practice is centre stage, and there is a need for nursing to re-negotiate its professional boundaries and to develop intellectual partnerships in order to move the knowledge base of practice forward.

     

我国护理行业的改革与发展

从我国护理行业的现状、卫生体制改革以及基本国情出发 ,着重探讨护理管理、护理教育、护理环境、护理经济与管理体系、护理立法等方面的发展途径     

Innovations in United States genetics nursing: Practice and research

Aim: Clinical and research applications from human genome discoveries are growing and creating both opportunities and challenges to the integration of genetic concepts into practice and research. Nurses have a long history of caring for individuals, families, and groups with genetic conditions. In the past two decades, a small group of nurses in the USA have used a variety of strategies to further develop the field of genetics nursing. In this paper we identify innovative approaches to identifying genetics‐related nursing roles and opportunities, as well as successful collaborative efforts beyond nursing to address the emerging health and societal challenges related to human genetics discoveries. Methods: The information presented here comes from a variety of sources where the authors or genetics nurses directly participated, including: (i) a systematic literature review of genetics nursing; (ii) a comprehensive research study of models of delivering clinical genetics services and the roles of health professionals; and (iii) participation in numerous national research, planning, programmatic, and advisory groups involved with clinical genetics‐related health services, research, education, and public policy. Results: Genetics nurses in the US have developed innovative responses to genetics‐related challenges within and beyond the profession of nursing. These include: (i) establishing an organization for nurses in genetics and gaining formal recognition of genetics as a specialty of nursing; (ii) defining the scope of genetics nursing practice and developing a new genetics nursing credential; (iii) establishing a multiprofessional genetics education coalition and defining genetic competency for health‐care practice; (iv) creating new clinical practice roles for nurses that integrate emerging genetics concepts and skills into diverse clinical practice areas; (v) expanding nursing involvement in genetics‐related research; and (vi) participation in high‐level genetics advisory groups. Conclusions: The US experience shows that nurses have made substantial progress in expanding their involvement in genetic services through visionary leadership, innovative approaches to challenges, establishing support with nurse colleagues, and engaging in multiprofessional efforts. The most important first step is developing a supportive environment for nurse advancement. In the US, the genetics nurses’ organization known as the International Society of Nurses in Genetics (ISONG) has provided this base.     

整体护理病房三级护理查房的体会

我院自1999年7月开始在整体护理模式病房中实施三级护理查房。1年多来,对800例危重病人进行了护理查房,查房的形式为责任护士每天查,主管护师或护士长每周查,副主任护师以上或科护士长每月抽查,护理部主任每季抽查。通过查房,明显提高了危重病人的护理质量,病人得到了更为优质的服务,护理服务满意率提高;对护理人员来说,提高了业务水平,锻炼了口头表达能力;对护理管理来说,及时了解护士对护理程序的应用情况,掌握危重病人的护理质量,对护理中存在的不足及时提出指导意见。     

基层医院整体护理的实施与对策

目的:总结实施整体护理的经验,提高护理质量。方法:全面综合分析实施整体护理的对策和措施。结果:经验:领导的高度重视和大力支持,是实现整体护理模式转变的坚实基础;提高人员整体素质,确保整体护理的有效开展;多做少写,以点带面,实行非模式病房开展整体护理工作;积极开展健康教育,巩固整体护理效果;实施整体护理质量管理的措施。体会:领导的重视和支持,是开展整体护理工作的根本保证;提高了社会公众对护理工作的认可程度和护士的社会地位;显示了护士的自身价值;改善了护患关系,提高了病人满意度,同时也密切了医护关系;护理队伍整体素质提高,敬业精神增强。结论:实施整体护理,促进了护理学科的发展。     

Towards an aesthetics of nursing

Towards an aesthetics of nursing This paper re-appraises the work of Barbara Carper on aesthetics and the art of nursing. It identifies serious flaws in Carper's original arguments and the way in which she and subsequent authors have conflated the concepts of art and aesthetics in nursing. The paper explores a broader approach to aesthetics and proposes a way in which a theoretical approach to nursing aesthetics could be developed. The paper concludes that nursing is a fit object of aesthetic appreciation and that aesthetic quality is a necessary attribute of good nursing practice.     

晨间护理缺陷分析及对策

目的提高晨间护理质量。方法通过向住院病人和护士发放问卷调查及每周不定期检查各病区晨间护理质量,了解晨间护理工作中存在的缺陷,提出整改的措施。结果晨间护理工作中存在的主要缺陷:51.8%的病人认为护士与病人的沟通少,进病房时未向病人问好,整理病房时未向病人解释,口腔清洁率70.3%,头发清洁率45.3%,皮肤清洁率69.5%,病房安静整洁率67.3%,床单位整洁率86.5%,病情关注情况67.9%,健康教育执行情况48.6%,协助生活不能自理的病人进食、入厕、更衣、床上排便等占75.4%,时间安排满意度75.6%,护士认为晨间护理重要的占30%,晨间护理内容知晓率占60.9%,认为工作量大来不及做的占56.7%。结论提高护士对晨间护理的认识,规范晨间护理内容和程序,加强与病人的沟通,提供符合个体化需要的晨间护理,合理安排护理人员、工作重点和时间,持续质量改进,有助于提高晨间护理质量。