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。     

Evaluating clinical competence during nursing education: A comprehensive integrative literature review

This paper explored concepts, definitions and theoretical perspectives evaluating clinical competence during nursing education. The questions were: (i) How is clinical competence evaluated? and (ii) What is evaluated? An integrative review of 19 original research articles from 2009 to 2013 was performed. Results showed that evaluation tools were used in 14, observations in 2 and reflecting writing in 3 studies. The students participated in all but one evaluation alone or together with peers, faculty members or preceptors. Three themes were found: (i) professional practice with a caring perspective; (ii) clinical skills and reflective practice; and (iii) cognitive, affective and psychomotor skills both with a nursing perspective. This review shows an emphasis on structured methods with a risk reducing nursing to tasks and skills why combinations with qualitative evaluations are recommended. A holistic view of competence dominated and in designing evaluations, explicit perspectives and operationalized definitions of clinical competence became evident.     

Mentors’ cultural competence at mentoring culturally and linguistically diverse nursing students in clinical practice: An international cross-sectional study

AimsThis study aimed to identify mentors’ cultural competence profiles at mentoring culturally and linguistically diverse nursing students in clinical practice and explore associating factors.BackgroundGlobalization has had a significant impact on healthcare, increasing the diversity of healthcare workforces and the number of culturally and linguistically diverse nursing students in clinical practice. The cultural competence of mentors is important to secure students’ safe and successful learning. The mentor role in clinical practice contributes toward enabling and ensuring students’ high-quality and goal-oriented development of competence.DesignThis study implemented a cross-sectional design with a final sample of 270 clinical practice mentors from Finland, Lithuania, Spain and Slovenia.MethodsThe data were collected using an online survey including the Mentors’ Cultural Competence Instrument, Mentors’ Competence Instrument and background questions during 2020–2021. The data were analyzed using a K-mean cluster algorithm to identify mentors’ competency profiles.ResultsThree significantly differing mentor competency profiles (Profile A 42%, Profile B 41%, Profile C 17%) were identified in this study. The cultural competence of the mentors in clinical practice varied between intermediate and high levels. Mentors rated their cultural competence as best in the area of cultural sensitivity and awareness, whereas the lowest scored area was cultural interaction and safety.ConclusionsThis study showed that the cultural competence of mentors in clinical practice varied and was influenced by mentors’ work experience, age, job title and frequency of mentoring. This study provides new knowledge that could help to develop cultural competence operating models and education to enhance the cultural competence of healthcare professionals.     

案例导入情景教学法在护理实习生专业胜任力培养中的应用

目的 探讨案例导入情景教学法应用于护理实习生专业胜任力培养中的效果.方法 在45名护理本科生进入临床实习前,采用案例导入情景教学法对其进行强化培训,在实习4个月时,对学生和带教老师分别进行问卷调查.结果 带教老师的评价显示,实习生在健康教育、执行核心制度、实施护理程序和护理查房及小讲课等方面的胜任力水平比较理想,"一般胜任"水平以上的学生分别占97.5%、97.5%、95.0%和96.8%.学生认为案例导入情景教学法对熟悉和适应临床工作非常有帮助.结论 案例导入情景教学法可以帮助学生熟悉病房环境,适应临床实习工作,提高他们的胜任力,但尚需完善,以提高学生的沟通和应变能力.     

The relationship between the levels of nurses’ competence and the length of their clinical experience: a tentative model for nursing competence development

Aims and objectives. To explore the relationship between the levels of nurses’ competence and the length of their clinical experience, in order to provide a tentative model of the continuing competence of nurses. Background. The professional development of employees has attracted great interest. This interest has led to the development of various models that illustrate how employees develop their competence throughout their careers. However, little is known of how nurses maintain and develop their competence throughout their career pathways. Design. A cross‐sectional design was used. Methods. Using a survey method, five dimensions of self‐assessed nursing competence and the length of the nurses’ clinical practice were measured (n = 325). Each dimension of competence was plotted against the length of their clinical experience using locally weighted scatterplot smoothing. Then, the shapes of the plots were analysed by fractional polynomial regression analysis. Results. Overall, the relationships between the levels of nursing competence and the length of clinical experience were illustrated by curves with a rapid increase in competence levels at the early stage of the nursing career and a slower increase later. These curves were modelled by either a logarithmic, square‐root function or its reciprocal. The results supported the learning curve model. Conclusions. The competence development of nurses may be characterised by two distinctive periods: a rapid growth period followed by stable periods. However, the modality of the growth may be different depending on which dimension of nursing competence is in focus. Relevance to clinical practice. The level of nursing competence directly affects the quality of care provided to patients. The findings of the study enable healthcare organisations to take proactive approaches to enhance nurses’ competence by identifying when and how to assist nurses.     

Implementing faculty practice: a question of human and financial resources

Two issues confronting nursing education are: improving the relationship between nursing service and nursing education, and achieving status as an academic discipline. The concept of faculty practice addresses both of these problems. By definition faculty practice requires demonstration of clinical competence through practice, and scholarly outcomes of practice which satisfy the research requirement of the nursing faculty role. While scholarly practice by nursing faculty members may benefit the nursing service-education relationship, it is a myth that nursing faculty members were more effective teachers prior to nursing education's move into institutions of higher education. While few argue against the need for clinical competence of nursing faculty members for effective teaching, the need to attain educational preparation for effective teaching must not be overlooked. The vast majority of nursing faculty members hold master's degree as their highest earned credential. To establish itself as an equal in academe and to increase teaching effectiveness, nursing education needs faculty prepared at the doctoral level. If nursing faculty members add faculty practice and doctoral study to the standard faculty role requirements of teaching, research and service, chronic overload will result. Nursing faculty members cannot solve all the problems confronting nursing education by continuously increasing their workload. Nursing programmes need to assess their resources and priorities. For all of its merits, faculty practice should not be implemented until a programme has adequate resources to support it.     

The clinical performance of new degree graduates

Since the transfer of nursing education from hospitals to tertiary institutions, debate regarding the competence of new graduates has continued. To date this issue has not been thoroughly researched. The lack of research related to the competence of degree graduates in New Zealand provided the impetus for this study, which was aimed toward identifying how graduates perceived their clinical performance during their first year of practice. A convenience sample of 30 graduates was surveyed after 3 months and 7 months in practice, using an adapted form of a questionnaire devised by Ryan and Hodson (1992). The results showed that over time, graduates generally required less direction in all areas of clinical competence. After 7 months in practice, the majority of the graduates rated their performance in nursing skills, communication skills, and professionalism at the expected level or above. However, some still required direction with using theory and research in practice, with meeting client's psychosocial needs and with teaching clients. In the leadership competency, after 7 months, most graduates saw themselves functioning at the expected level related to client care and needed less direction in unit management skills. However, many of the unit management skills were rated as 'not applicable' indicating that new graduates are not initially placed in a management role. Implications for nursing education and limitations of the research are discussed.     

Capability: How is it recognised in student nurses undertaking postgraduate studies in neonatal intensive care?

Historically, nursing practice has been evaluated by assessing competence. While competence is a necessary component of clinical practice it does not provide an holistic picture of performance in practice; Capability is more comprehensive. This paper presents the findings from research, using the iterative principles of grounded theory to gather qualitative data to elicit nuances implying Capability in neonatal nurses. Semi-structured interviews with experienced mentors of students enrolled in any Postgraduate Certificate in Neonatal Intensive Care (PG Cert NIC) in Australia were undertaken to clarify what it is that students demonstrate, which provides evidence of being Capable in practice. The implications drawn from these interviews is that Capability is evaluated through various verbal and non-verbal behavioural cues. Although this research focuses on registered nurses in Australia undertaking PG Cert NIC, ideally these findings could be applied internationally, to any post-registration qualification in the specialty area of neonatal intensive care nursing.     

The paradox of an expected level: The assessment of nursing students during clinical practice – A qualitative study

AimThe aim of this study is to increase knowledge about the assessment of nursing students’ clinical practice, particularly concerning how teachers and clinical supervisors identify and assess the expected level of competence in mid-term evaluations and students, teachers and supervisors’ experiences of mid-term assessment. Assessment is important to assure the quality of students’ clinical competence and studies show that further research on this topic is required.DesignThis study has an explorative qualitative design.MethodsThirty semi-structured interviews were conducted with nursing students, teachers and clinical supervisors along with 16 observations of mid-term assessments during clinical practice, as part of a bachelor’s programme in nursing.ResultsTwo main challenges concerning establishing an expected level of competence were identified from the analysis of the interviews and observations: 1) a general formulation of learning outcomes and 2) vague expectations of what is the expected level of achievements at different points in time. Both challenges were at institutional level. Furthermore, at performance level, certain patterns were identified related to these challenges, such as teachers and supervisors needing to concretise the general formulation of learning outcomes and their discretion to set the expected level. Additionally, non-verbal language during mid-term assessment seemed to affect how the assessment situation was perceived.ConclusionWe suggest that the institutional guidelines need to be critically reviewed to include greater focus on clarifying what students are expected to achieve, as well as what constitutes the expected level. We have emphasised that discretion is a necessary premise to identify an expected level of clinical competence at mid-term assessment, in particular when there is lack of a clear standard and the assessment form is vague, but also when there is no clear definition of the expected level of competence at different points in time. The consequences are that the student feel insecure about how the assessment ought to be perceived, what level they are at in their learning process, and subsequently, their level in the process of developing necessary clinical competence.     

护理本科生不同实习阶段临床能力需求调查

目的:了解护理本科生不同实习阶段对临床能力的需求情况,为不同实习阶段临床科室对护理本科生临床能力培养提出建设性意见。方法:采取方便抽样的方法,选取哈尔滨医科大学护理系2005级本科生100名在其临床实习初期、中期和末期进行临床能力需求的问卷调查。结果:在不同实习阶段,护理本科生对各临床能力需求的百分比在81.43%～100.00%之间。不同实习阶段临床能力需求比较,护理本科生对临床处置能力、护理沟通能力、临床科研能力和职业心理素质的需求存在差异(P0.05)。结论:各科室应适当地参照不同实习阶段护理本科生的心理状态和学习需求状况进行相关能力的锻炼和培养,对护理本科生的临床教学做好系统地规划与定位。     

Facilitating reflective practice and self-assessment of competence through the use of narratives

Reflective practice is a skill that is central to nursing students' professional development. Although there is an abundance of literature on the value of reflective practice there are few concrete methods that facilitate self-assessment of competence through the use of reflective practice. One such method is narrative reflection. A nursing narrative is a brief recount of an actual situation or episode in clinical practice that is significant because it resulted in new learning and/or new understanding. Narratives provide important opportunities for uncovering nursing practices that often go unnoticed and a new appreciation of the knowledge and skills of clinical practice. Nursing narratives reveal the richness of the clinical knowledge embedded in practice and provide a way for knowledge and practice to be linked together in meaningful dialogue, promoting interpretive analysis and reflection. A narrative approach contextualises knowledge and values and builds upon the clinical experiences of the student. Narratives afford opportunities for nursing students to: Learn from practice through reflection. Describe and critically analyse episodes of their clinical practice. Illuminate and assess their own level of competence by applying competency standards as a benchmark. Identify areas of strength and those requiring development. Develop practice-driven clinical learning objectives. Narratives have proven to be a successful means of developing students' ability to reflect upon and assess competence in a clinically relevant and motivating way. This paper will explore the possibilities that narratives hold for developing clinical acumen, promoting reflective practice, and assessing competence. It will provide an overview of narrative writing, and discuss some of the challenges encountered in the implementation of this clinical learning innovation at the author's university in Australia.     

护理专业毕业生实际与期望临床能力的比较研究

目的调查用人单位对护理专业毕业生临床能力的期望及实际临床能力,并比较二者的差异。方法采用自设问卷,调查97名带教教师和护理管理者对护理专业毕业生临床能力的期望;并以自评和他评方式,评价132名护理专业实习生的实际临床能力。结果用人单位对本科生和大专生临床能力的期望排序一致,前3位的均为职业心理素质、临床处置能力和临床管理能力,而对临床教学能力和临床科研能力的期望最低;对本科生临床处置能力、护理沟通能力、临床科研能力和临床教学能力的期望高于大专生(P<0.05);本科生和大专生的实际临床能力均低于用人单位的期望(P<0.01)。结论护理专业毕业生实际临床能力尚不能满足用人单位的需求,应加大对其职业心理素质和临床处置能力的培养,并体现出本科生的优势。     

Applying self-determination theory for improved understanding of physiotherapists’ rationale for using research in clinical practice: a qualitative study in Sweden

Abstract

Physiotherapists are generally positive to evidence-based practice (EBP) and the use of research in clinical practice, yet many still base clinical decisions on knowledge obtained during their initial education and/or personal experience. Our aim was to explore motivations behind physiotherapists’ use of research in clinical practice. Self-Determination Theory was applied to identify the different types of motivation for use of research. This theory posits that all behaviours lie along a continuum of relative autonomy, reflecting the extent to which a person endorses their actions. Eleven focus group interviews were conducted, involving 45 physiotherapists in various settings in Sweden. Data were analysed using qualitative content analysis and the findings compared with Self-Determination Theory using a deductive approach. Motivations underlying physiotherapists use of research in clinical practice were identified. Most physiotherapists expressed autonomous forms of motivation for research use, but some exhibited more controlled motivation. Several implications about how more evidence-based physiotherapy can be achieved are discussed, including the potential to tailor educational programs on EBP to better account for differences in motivation among participants, using autonomously motivated physiotherapists as change agents and creating favourable conditions to encourage autonomous motivation by way of feelings of competence, autonomy and a sense of relatedness.     

Closing the gap: collaborative learning as a strategy to embed evidence within occupational therapy practice

RATIONALE: The principles of clinical governance apply as guidelines for good practice to all practitioners. However, evidence-based practice (EBP) is proving a challenge for practitioners who lack the confidence to consume published research. For therapists not wishing to undertake formal study there is a risk of becoming disempowered within a culture of EBP. Opportunities to develop skills in consuming research have focused on the information dissemination model that has limited effect. Mutual reflective learning processes are recommended to empower practitioners to bridge the theory-practice gap. AIM: An action research approach investigated practice based collaborative learning as a catalyst to increase therapist's competence and confidence in consuming research and to explore the transition toward EB practitioner. METHOD AND RESULTS: A diagnostic survey reaffirmed therapist's lack of confidence in EBP. Formative interviews (n = 5) found an over reliance on professional craft and personal knowledge. Research knowledge was not included in participants' construct of a good practitioner and engagement in higher order critical reflection was limited. Collaborative learning groups (n = 6) embedded in practice integrated research, theory, practice and critical reflection. Supported by the collegial learning environment, a learning package developed participants' confidence and competence in consuming published research. Summative interviews (n = 5) evaluated the group and found that therapists were empowered to incorporate propositional knowledge into their clinical reasoning, engage in critical reflection and challenge their practice. They felt confident to incorporate EBP into their continuing professional development plans. Sustainability of these changes requires commitment from the therapists and the workplace.     

Safety in numbers 2: Competency modelling and diagnostic error assessment in medication dosage calculation problem-solving

Accurately defining and modelling competence in medication dosage calculation problem-solving (MDC-PS) is a fundamental pre-requisite to measuring competence, diagnosing errors and determining the necessary design and content of professional education programmes. In this paper we advance an MDC-PS competence model that illustrates the relationship between conceptual competence (dosage problem-understanding), calculation competence (dosage-computation) and technical measurement competence (dosage-measurement). To facilitate bridging of the theory–practice gap it is critical that such models are operationalised within a wider education framework that supports the learning, assessment and synthesis of cognitive competence (the knowing that and knowing why of MDC-PS) and functional competence (the know-how and skills associated with the professional practice of MDC-PS in clinical settings).Within the context of supporting the learning and diagnostic assessment of MDC-PS we explore PhD fieldwork that challenges the value of pedagogical approaches that focus solely on abstract information, that isolate the process of knowledge construction from its application in practice settings and contribute to the generation of conceptual errors. We consider misconceptions theory and the concept of mathematical ‘dropped stitches’ and offer an assessment model and program designed to diagnose flawed arithmetical operation and computation constructs.     

Environmental elements affecting the decision-making process in nursing practice

Background. In their practice nurses constantly make decisions in a dynamic context including complex situations. Besides affecting elements related to the decision‐maker and the task itself, the setting where the decision‐making process takes place are of decisive importance to the quality of the decision‐making outcome. Aim. The aim of this study was to explore environmental elements related to the decision‐making process in nursing practice. Methods. Six expert nurses, from three Swedish nursing settings, participated voluntarily in the study, which were designed of participated observations in everyday nursing practice. Permission to carry out the study was given by the clinics and an ethical committee. A content analysis was used to analyse the field notes where themes emerged which were found to be environmental elements affecting decision‐making process of nurses. Conclusions. The most striking theme, environmental elements, included the sub‐themes interruptions and the work procedures are presented in this report. The implications of environmental elements, are discussed from a perspective of nurses' competence, where the elements could be seen as a facilitator or as a hindrance to developing nursing competence. It were concluded that environmental elements have to be well considered before knowledge can be reached about decision‐making in practice. Relevance to clinical practice. Interpersonal and technological interruptions were features highlighted in the study, features which could jeopardize the decision‐making outcome. Therefore, it is of greatest importance that nurses learn to use decision‐making strategies to guarantee patient care security and patient care quality.     

Assessment of clinical practice in intensive care: a review of the literature.

Nursing is a practice-based discipline, with clinical practice forming the heart of any programme of study. The major goal of all programmes should be on facilitating students to develop the skills necessary for competent and compassionate practice. Assessment of clinical competence is a fundamental aspect of programme development and as such deserves attention during the curriculum design process. The literature on assessment of students in clinical practice suggests that the tools used have evolved through various stages, ranging from the use of simple check list and rating scale to the development of competence assessment tools. Each stage has been fraught with difficulties and has taxed nurse educators, clinical assessors and students alike. The literature also indicates that there is a limited range of research available on clinical assessment tools, especially with an intensive care context. In part one of this two-part paper, the literature on assessment of clinical practice is explored, with specific emphasis on the assessment of competence with the Intensive Care environment. Part two of the paper reports on the findings of a study on students perceptions on a clinical competence assessment tool, used in an Intensive Care environment.     

Development of the professional competence and professional self-concept of undergraduate nursing students during the clinical practice period: A cross-lagged panel analysis

AimTo explore the relationship of the development of professional competence and professional self-concept of undergraduate nursing students during the clinical practice period.BackgroundClinical practice is one of the most important aspects of nursing education. Nursing students combine theoretical knowledge, psychomotor skills and emotions in a professional socialization process through clinical practice sessions.DesignA two-time point longitudinal design was performed. A cross-lagged model was employed to analyze the relationship between the development of professional competence and professional self-concept of undergraduate nursing students during their clinical practice period.MethodsA total of 210 undergraduate nursing students were included in this study. The questionnaire was distributed two months and six months after their clinical practice started. Professional Self Concept of Nurses Instrument and Professional Competence Scale for Undergraduate Nursing Students were the two main instruments.ResultsBoth the professional competence and professional self-concept of Undergraduate nursing students increase at the end of the sixth month compared with the end of the second month after their clinical practice started. The results of the cross-lagged analysis showed that the professional self-concept was partially responsible for the development of professional competence. The effect of professional competence on the development of professional self-concept, in contrast, was not found in this study.ConclusionsClinical nursing educators should pay greater attention to the development of the professional self-concept of undergraduate nursing students. More attention should be paid to creating a supportive clinical learning environment to facilitate the improvement of undergraduate nursing students’ professional self-concept and professional competence.     

Piloting of a nursing and midwifery competence framework in the cultural context of a middle eastern country

Clinical competence amongst nurses and midwives is vital for the delivery of safe and consistent patient care. However, worldwide there is a lack of agreement on definitions and notions about what constitutes competence and how it can be determined in everyday clinical practice. This situation poses professional dilemmas in situations where competing dialogues exist. This is particularly evident in countries that employ nurses and midwives from diverse national backgrounds with differing professional and educational experiences. To address potential misunderstandings, ensure a consistent approach to the confirmation of clinical competency and assure patient safety, a strategic decision was taken by the nursing and midwifery leadership of the country's major healthcare organisation to develop an organisationally and culturally sensitive competence framework model. This article reports on the design, development and piloting of an educationally led framework model. The model, referred to as ‘Q-PACE: Qatar's Practice, Appraisal, Competence and Education’, links previously fragmented activities regarding confirmation of clinical competence of staff into a unified holistic process that provides assurance regarding the competence of new and existing employees.     

A qualitative study of physiotherapy final year undergraduate students' perceptions of clinical reasoning

Clinical reasoning is a fundamental component of physiotherapists' clinical competence. However research examining how clinical reasoning is understood and developed in physiotherapy undergraduate courses is limited, particularly from the student's perspective. The aim of this study was to explore the current understanding of clinical reasoning held by final year undergraduate students, and how it is represented in the undergraduate musculoskeletal curriculum in Portugal. A qualitative research approach involving final year undergraduate students' from four different physiotherapy programmes was used. A total of 28 students participated in four focus group discussions, which were digitally recorded, transcribed verbatim, and analysed thematically.Four themes were identified: 1) an instrumental process; 2) a clinician centred process; 3) a knowledge dependent process; 4) a context dependent process. Findings of this study suggest that the primary purpose of clinical reasoning was to assist musculoskeletal physiotherapists in the diagnosis and treatment of clinical problems, and to facilitate efficient management of individual practices. The insights into the promotion of clinical reasoning in undergraduate musculoskeletal curricula may have important implications for curriculum design, teaching and learning strategies, and graduation profile in physiotherapy undergraduate courses.