实习护生护理软技能现状及其相关因素分析

目的 了解实习护生的护理软技能现状及其相关因素,以提高护生护理软技能水平.方法 采用护理软技能测评量表对某医科大学2所附属医院311名实习护生进行调查.结果 实习护生护理软技能总均分为(3.35±0.27)分,其中职业情操维度得分最高(3.50±0.34)分,组织管理技能维度得分最低(3.24±0.37)分.父母文化程...     

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.     

Using portfolios for clinical practice learning and assessment: the pre-registration nursing student's perspective

Portfolios have been introduced to help to integrate theory and practice and thereby address the issue of the theory-practice divide. Although there has been much theoretical discussion about portfolio use in clinical placements, few studies have focused on the students' perceptions regarding their use. To obtain adult branch pre-registration nursing students' perspectives on using portfolios for their clinical practice learning and assessment, postal questionnaires were sent to 253 diploma of nursing students with a reminder to all students three weeks later. The response rate was 69% (174/253). This paper reports on the qualitative findings of the study, which employed both quantitative and qualitative methods. Although students stated that portfolios helped them in their development of self-awareness and independent learning, they indicated that portfolios do not sufficiently address the assessment of their clinical skills and the integration of theory and practice. They considered that portfolios could be greatly improved in three areas, namely in the conflict between using portfolios for both assessment and learning, the amount of support and guidance students feel they receive with their portfolio use and the portfolio design.     

Being strategic: utilising consumer views to better promote an expanded role for nurses in Australian general practice

Australian consumers have articulated their perceptions of the role of the nurse in general practice. Practice Nurses (PNs) and General Practitioners (GPs) have also highlighted the issues they believe currently and potentially impact on this role in Australia. This paper identifies and discusses the nexus between the consumers' perceptions and expectations and health professionals' issues. Data collected from focus groups and interviews in 2 Australian studies of consumer perception of nursing in general practice, are re-considered alongside findings reported in the Royal Australian College of General Practitioners and the Royal College of Nursing, Australia report; General Practice Nursing in Australia. Consumers, doctors and nurses working in general practices in Australia, raised similar issues. However, consumers considered these issues in relation to their health care needs, whereas the GPs and PNs tended to focus more on professional and structural tensions related to the current and potentially expanded role of the PN. Understanding consumer views vis-a-vis issues raised by PNs and GPs about the role of nursing in general practice provides direction for both professions to better work with consumers to enhance their understanding of what general practice services could be and how changes, like expanding the role of nurses, may bring about improvements in the health outcomes of consumers. Health professionals can benefit from reflecting on the experiences and expectations of consumers if they desire to make general practice services more responsive to individual consumer's needs and at the same time adopt a primary health care focus.     

Using counselling skills to enhance the confidence of mentors' decision making when assessing pre-registration nursing students on the borderline of achievement in clinical practice

The concept of counselling as a helping process, focusing attention on the interrelatedness of individuals and their world, is a critical aspect of contemporary nursing. Counselling skills also have implications for nurses involved in mentoring pre-registration nursing students, particularly where accurate, credible and accountable assessment hinges on how well students and mentors have invested in a learning dialogue. Such concerns become especially relevant to those students on the borderline of achieving clinical learning outcomes. This paper highlights a reconstructed narrative between a mentor and this author concerning a student on the borderline of achievement in clinical practice. The use of counselling skills in helping mentors to focus on complex assessment issues relating to pre-registration nursing students are subjected to a detailed critical analysis. The fragility of such encounters is underlined, as well as a need for mentors to engage in reflexive practice.     

The first experiences of clinical practice of psychiatric nursing students in Taiwan: a phenomenological study

Aims and objectives. The purpose of this study is to understand the experiences of psychiatric nursing students during their first encounters with psychiatric patients in a clinical setting. The objective is to assist educational professionals in mental health to improve teaching strategies. Background. In clinical settings, student psychiatric nurses have to face complex problems and situations that can result in distress. Sometimes the student nurse will be uncertain of their own ability and this is reflected in a sense of fear on the part of some nurses. However, little research has been conducted into the first clinical experiences of such nursing students in Taiwan. Design. A qualitative phenomenological study was devised to explore what psychiatric nursing students perceived during their first experiences of clinical practice and narratives were analysed using Colaizzi’s seven‐step method. Method. A phenomenological approach and purposive sampling were used in the study. Face‐to‐face interviews were conducted to collect the data and during the process of data analysis we established epochs (bracketing) and focused on the reality of the student nurses’ experience to keep the data objective. Results. Four themes were identified: breaking the stigma of mental illness, developing a trusting relationship with the patient, gaining professional knowledge and skills and the process of student growth. Conclusion. The findings from this study demonstrate that it is important to understand the perceptions of students during their first experiences of psychiatric nursing in a clinical setting and highlight the importance of educational programs. Relevance to clinical practice. By understanding the emotional process that psychiatric nursing students may go through during their clinical practice, educators can be better able to design suitable training courses in the future.     

Undergraduate nursing students’ stigma and recovery attitudes during mental health clinical placement: A pre/post‐test survey study

Undergraduate nursing students have been reported to hold negative and stigmatizing attitudes towards mental health consumers and to be under‐prepared for mental health clinical placement. This study aimed to investigate undergraduate nurses’ stigma and recovery attitudes to mental illness, and describe their understandings of personal recovery on entry and exit to traditional mental health clinical placement. A pre/post‐test survey was administered to N = 249 nursing students in Australia. Demographic data, attitudes towards mental health nursing and clinical placement, the Opening Minds Scale for Healthcare Providers (OMS‐HC), Recovery Attitudes Questionnaire (RAQ‐7), and an open‐ended question on understandings of personal recovery from mental illness were collected on entry (T1) and exit (T2) to placement. At T1, students reported moderate stigma and positive attitudes towards recovery (OMS‐HC mean = 34.6; RAQ‐7 mean = 4.0). At T2, there was a reduction in stigma (social distance P = 0.02, d = 0.26) and improvement in recovery attitudes (P < 0.01, d = 0.40). Attitudes towards mental health nursing and placement also improved (P < 0.01). Having a family member with mental illness predicted improvements in stigma and recovery attitudes. On entry to placement, most students described accurate understandings of personal recovery, which were maintained during placement. The findings indicate that mental health clinical placements are effective in improving students’ mental health stigma and recovery attitudes and provide a prime opportunity to attract students into the field. Co‐produced or consumer‐led education provided by peer workers during clinical placements may improve students’ stigmatizing attitudes and stimulate their interest to work in the field.     

Advancing the clinical perspective: a practice development project to develop the nurse practitioner role in an acute hospital trust

Aims. The aims of this project were to investigate awareness and foster understanding of the concept of the nurse practitioner and to facilitate and support the development of nurse practitioner roles within an acute hospital trust. Background. A limited understanding of and minimal support for the development of the Nurse Practitioner (NP) role were identified within an acute hospital trust in the south of England. This was the impetus for pursuing the project outlined in this paper. Theoretical perspective. The project used practice development theory synonymously with action research methodology comprising of four action research cycles. Method. Data were collected in a variety of ways within the four overlapping cycles using formal and informal methods, which were analysed concurrently during the project. Techniques included questionnaires, semi‐structured interviews, meetings, discussions and the project leader's field notes’ diary. Outcomes. A better understanding of the concept and support for NP posts were enhanced across the trust. A Nurse Practitioner Development Group (NPDG) was established, which helped to facilitate the development of NP posts. An example of such a post was established within a NP‐led gynaecology pre‐operative assessment clinic, which was a pilot project and constituted Action Research cycle 3. Conclusion. It is concluded that the development of NP roles, with the support of a NPDG, within an agreed strategy offers a robust process for NP development within an acute hospital setting. Relevance to clinical practice. This project demonstrated how practice development and action research might be used together as a systematic process for developing and supporting professional roles that aim to improve the quality of patient care and the effectiveness of health care services.     

Evidence-based care and the case for intuition and tacit knowledge in clinical assessment and decision making in mental health nursing practice: an empirical contribution to the debate

This paper provides empirical evidence that challenges the view that methods of clinical assessment and decision making should not rely solely on logical positivist approaches. Whilst the National Health Service (NHS) Executive currently takes a hard positivist line on what constitutes evidence-based practice, data reveal that it is not always appropriate to disregard the tacit knowledge and intuition of experienced practitioners when making assessment decisions in mental health nursing practice. Data support the case for a holistic approach which may draw on intuition and tacit knowledge, as well as traditional approaches, to meet the requirements of clients with complex mental health problems. A model based on Schon's notion of reflection in and reflection on practice is proposed which demonstrates the value of intuition and tacit knowledge. This model allows the generation of insights which may ultimately be demonstrated to be acceptable and empirically testable. It is accepted that an element of risk taking is inevitable, but the inclusion of a formal analytical process into the model reduces the likelihood of inappropriate care interventions. The cognitive processes which experienced nurses use to make clinical decisions and their implications for practice will be explored.