护士灾难准备及相关培训的研究进展

我国幅员辽阔,自然灾害频发,伴随着中国的快速城市化,70%以上的城市分布在气象、地震、地质、海洋等自然灾害严重的区域,除了自然灾害近年来大规模突发事件、恐怖袭击的发生频率也有上升的趋势,灾难应对以及防范形势更显严峻。护士被认为是灾难救援中不可或缺的一支队伍,护士的贡献贯穿整个灾难期,其中灾难发生前的预防和准备显得尤为重要,因为灾前的准备程度是灾难护理能力的重要体现。     

护士灾害应急救护规范化培训效果研究

目的探讨护士灾害应急救护规范化培训效果。方法选取204名临床护士为研究对象,2014年前采用常规方法进行灾害应急救护能力培训,2014年后采用规范化培训,包括组建培训小组、制订培训计划、设置培训方案、实施培训方案。培训结束后,比较护士培训前后考核成绩、心理健康状况及满意度。结果规范化培训后,护士的考核成绩、满意度较培训前提高,差异有统计学意义(P<0.01);恐怖症状和敌对症状测评得分显著降低(P<0.01)。结论加强护士灾害应急救护能力培训,可以提高护士的急救意识及急救技能,提升护士心理稳定性和承受能力,确保应急救护质量和效率。     

Disaster preparedness among Hong Kong nurses

Title.  Disaster preparedness among Hong Kong nurses
Aim.  This paper is a report of a survey to explore Hong Kong nurses' disaster preparedness.
Background.  Increasingly frequent global disasters are posing threats to human health and life. The World Health Organization has called for countries to have detailed plans at all levels in order to be prepared for disasters that may arise.
Method.  A questionnaire was distributed to convenience samples of practising Registered Nurses studying in Master's degree programmes at a Hong Kong university in 2007.
Results.  Of a possible 174, 164 questionnaires were returned (Response rate 94%). Almost all nurses (97·6%) considered the government health department to be the organization most involved in disastrous situations. The majority (84·8%) were aware of the existence of a protocol on disaster management at their workplace. About one-third would respond in accordance with protocol (38·4%) or rely on directions from their immediate supervisors (34·8%) if a disaster occurred. Almost all the nurses (97%) considered themselves not adequately prepared for disasters. They recognized that a protocol for disaster management (85·4%) and training and drills for disasters (both 84·1%) are useful tools.
Conclusion.  Nurses in Hong Kong are not adequately prepared for disasters, but are aware of the need for such preparation. Disaster management training should be included in the basic education of nurses.     

Major Incident Medical Management and Support (MIMMS): A practical,multiple casualty,disaster‐site training course for all Australian health care personnel

Major Incident Medical Management and Support is a 3‐day major incident training course designed specifically for doctors, nurses and ambulance personnel. It teaches a systematic, ‘all hazards’ approach to the principles of pre‐hospital, multiple‐casualty incident medical management. This article explores the origins and development of the course in Australia, it outlines the nature and content of the course, details the demographic profile of those who have successfully completed the course to date and, finally, looks at the future directions of the course in Australia. See Commentary, page 143.     

构建急诊护士应对灾害培训模式的探讨

通过分析急诊护士掌握灾害救治知识与技术的现状及构建急诊护士应对灾害培训的必要性，提出急诊护士应对灾害培训的模式，并阐述了培训模式包括的内容与方式。培训内容主要包括理论与技术；培训方式包括扩大继续教育内涵、定期组织模拟演练及建立多种学习途径等。同时，建议护理管理者转变观念，加强平时灾害救治知识与技能培训，以提高急诊护士应对灾害的能力：     

Conceptualizing Interprofessional Teams as Multi-Team Systems—Implications for Assessment and Training

SGEA 2015 CONFERENCE ABSTRACT (EDITED) Evaluating Interprofessional Teamwork During a Large-Scale Simulation Courtney West, Karen Landry, Anna Graham, and Lori Graham. Construct: This study investigated the multidimensional measurement of interprofessional (IPE) teamwork as part of large-scale simulation training. Background: Healthcare team function has a direct impact on patient safety and quality of care. However, IPE team training has not been the norm. Recognizing the importance of developing team-based collaborative care, our College of Nursing implemented an IPE simulation activity called Disaster Day and invited other professions to participate. The exercise consists of two sessions: one in the morning and another in the afternoon. The disaster scenario is announced just prior to each session, which consists of team building, a 90-minute simulation, and debriefing. Approximately 300 Nursing, Medicine, Pharmacy, Emergency Medical Technicians, and Radiology students and over 500 standardized and volunteer patients participated in the Disaster Day event. To improve student learning outcomes, we created 3 competency-based instruments to evaluate collaborative practice in multidimensional fashion during this exercise. Approach: A 20-item IPE Team Observation Instrument designed to assess interprofessional team's attainment of Interprofessional Education Collaborative (IPEC) competencies was completed by 20 faculty and staff observing the Disaster Day simulation. One hundred sixty-six standardized patients completed a 10-item Standardized Patient IPE Team Evaluation Instrument developed from the IPEC competencies and adapted items from the 2014 Henry et al. PIVOT Questionnaire. This instrument assessed the standardized or volunteer patient's perception of the team's collaborative performance. A 29-item IPE Team's Perception of Collaborative Care Questionnaire, also created from the IPEC competencies and divided into 5 categories of Values/Ethics, Roles and Responsibilities, Communication, Teamwork, and Self-Evaluation, was completed by 188 students including 99 from Nursing, 43 from Medicine, 6 from Pharmacy, and 40 participants who belonged to more than one component, were students at another institution, or did not indicate their institution. The team instrument was designed to assess each team member's perception of how well the team and him- or herself met the competencies. Five of the items on the team perceptions questionnaire mirrored items on the standardized patient evaluation: demonstrated leadership practices that led to effective teamwork, discussed care and decisions about that care with patient, described roles and responsibilities clearly, worked well together to coordinate care, and good/effective communication. Results: Internal consistency reliability of the IPE Team Observation Instrument was 0.80. In 18 of the 20 items, more than 50% of observers indicated the item was demonstrated. Of those, 6 of the items were observed by 50% to 75% of the observers, and the remaining 12 were observed by more than 80% of the observers. Internal consistency reliability of the IPE Team's Perception of Collaborative Care Instrument was 0.95. The mean response score—1 (strongly disagree) to 4 (strongly agree)—was calculated for each section of the instrument. The overall mean score was 3.57 (SD = .11). Internal consistency reliability of the Standardized Patient IPE Team Evaluation Instrument was 0.87. The overall mean score was 3.28 (SD = .17). The ratings for the 5 items shared by the standardized patient and team perception instruments were compared using independent sample t tests. Statistically significant differences (p < .05) were present in each case, with the students rating themselves higher on average than the standardized patients did (mean differences between 0.2 and 0.6 on a scale of 1–4). Conclusions: Multidimensional, competency-based instruments appear to provide a robust view of IPE teamwork; however, challenges remain. Due to the large scale of the simulation exercise, observation-based assessment did not function as well as self- and standardized patient-based assessment. To promote greater variation in observer assessments during future Disaster Day simulations, we plan to adjust the rating scale from “not observed,” “observed,” and “not applicable” to a 4-point scale and reexamine interrater reliability.     

Video of a disaster drill is effective in educating registrars on the hospital disaster plan

Objective: To test whether an instructional video of edited footage from a disaster drill is effective in educating registrars on the hospital disaster plan. Methods: This was a prospective pre‐ and post‐intervention study. Forty hospital registrars were shown a 15 min video based on footage obtained at a simulated mass casualty incident. The video provided information on the ED disaster response plan and principles of hospital disaster management. A survey was developed to assess disaster plan knowledge before and after viewing the video. The survey had a predetermined ‘pass mark’ of 14/20 (70%). Results: Thirty‐nine registrars completed the surveys. Three of 39 (7.7% 95% confidence interval [CI] 7.0–8.3%) registrars achieved the pass mark in the pre‐video survey and 35/39 (89.7% 95% CI 81.2–98.3%) registrars achieved the pass mark in the post‐video survey (χ²‐test P < 0.001) with an absolute increase in the pass rate of 82% (95% CI 75.8–88.2%). Conclusion: This finding justifies compulsory viewing of the video in the registrar orientation package locally and might encourage more widespread use of educational video in hospital disaster preparedness.     

Disaster 101: A Novel Approach to Disaster Medicine Training for Health Professionals

Background: Despite efforts to improve preparedness training for health professionals, disaster medicine remains a peripheral component of traditional medical education in the United States (US) and is a rarely studied topic in the medical literature. Objectives: Using a pre-/post-test design, we measured the extent to which 4^th-year medical students perceive, rapidly learn, and apply basic concepts of disaster medicine via a novel curriculum. Methods: Via a modified Delphi technique, an expert curriculum panel developed a 90-min didactic training scenario and two 40-min training exercises for medical students: a hazardous material scene and a surprise mass casualty incident (MCI) scenario with 100 life-sized mannequins. Medical students were quizzed before and after the didactic training scenario about their perceptions and their disaster medicine knowledge. Results: Students rated their overall knowledge as 3.76/10 pretest compared to 7.64/10 after the didactic program. Students' post-test scores improved by 54% and students participating in the MCI drill correctly tagged 94% of the victims in approximately 10 min. The average overall rating for the experience was 4.85/5. Conclusions: The results of this educational demonstration project reveal that students will value and can rapidly learn some core elements of disaster medicine via a novel addition to a medical school's curriculum. We believe the principle of a highly effective and well-received medical student course that can be easily added to a university curriculum has been demonstrated. Further research is needed to validate core competencies and performance-based education goals for US health professional trainees.     

Development,Implementation andOutcomes of a Training Program for Responders to Acts of Terrorism

Introduction. Responding to acts of terrorism requires the effective use of public-safety andmedical-response resources. The knowledge, skills andattitudes necessary to respond to future threats is unfamiliar to most emergency responders. Objectives. The purpose of this report to describe the development, implementation andevaluation of a multidisciplinary, interactive andsimulation-enhanced course to prepare responders to acts of terrorism. Methods. We used a 5-step systematic process to develop a blended-learning, simulation-enhanced training program. Learners completed a self-confidence questionnaire andwritten examination prior to the course anda self-confidence questionnaire, written examination andcourse evaluation when they finished the course. Results. From July 7, 2003 to March 8, 2005, 497 consenting learners completed the course. After course completion, learners demonstrated significant increases in their knowledge of terrorism response (t = ?64.3, df = 496, p < 0.05) andtheir confidence in responding to terrorist events (t = ?45.5, df = 496, p < 0.05). Learner feedback about the course was highly positive. Conclusions. We successfully implemented a two-day course for professionals likely to respond to terrorist acts that included scenario-based performance training andassessment. Course participants increased their knowledge andwere more confident in their ability to respond to acts of terrorism after participating in this course.     

Development and evaluation of a multimodality simulation disaster education and training program for hospital nurses

Aim: To develop a multimodality simulation program for hospital nurses to enhance their disaster competency and evaluate the effect of the program. Methods: The program implementation started in October 2016 and ended in December 2016. It was developed using the ADDIE model (analysis, design, development, implementation, and evaluation). Evaluation consisted of formative assessment and summative assessment. Formative assessment was performed during triage, crisis management, and problem‐solving simulation programs through direct feedback and debriefing from the teacher. Summative assessment was performed using the Kirkpatrick curriculum evaluation framework. Results: Needs assessment using the modified Delphi survey resulted in these competencies for hospital disaster nursing: triage, incident command, surge capacity, life‐saving procedures, and special situations. Each competency was matched with the appropriate simulation modalities. A total of 40 emergency nurses participated in the study program. The evaluation of the program resulted in improvement in perception, crisis management, problem solving, and technical skills in disaster nursing. Conclusion: Multimodality simulation training program was developed to enhance the competency of hospital nurses in disaster response. All participants improved their disaster response competencies significantly. The program that was developed in this study could be used as a fundamental tool in future research in disaster curriculum development.     

四川省护理人员对灾害护理培训内容重要性的认同度分析

目的 了解四川省护理人员对灾害护理培训内容重要性的认识,确定灾害护理培训效果,为后期培训设置提供参考.方法 采用问卷调查法,在培训结束后收集学员对培训内容重要性的认识,包括地震伤员急救护理、地震伤员骨科护理、灾民和救护人员心理护理、地震伤员康复护理和灾后灾民健康管理5个维度.结果 学员对灾害护理培训内容重要性认识的总分...     

手术室护士灾害护理能力网络化培训模式的构建设想

为充分做好灾害应急准备，提高手术室护士抗灾、救灾、减灾能力，通过建立网络化培训平台、招募网络成员、选择适当培训方法、对培训效果进行评价及动态管理的方法，构建具备计算机及互联网技术支持和各医疗部门组织、管理保障，能够突破传统集中授课模式的时空限制，具有学习行为自主化、终身教育等优势的手术室护士灾害护理能力网络化培训模式。从而为手术室护士营造良好的学习环境和机会，促进灾害护理知识的交流、分享，推动于术室护士灾害护理能力培训工作的深入开展。     

灾难救护医护人员心理救援能力培训需求调查分析

目的：了解灾难救护医护人员对心理救援能力培训的需求,为组织和开展灾难救护心理培训提供依据。方法2013年10月至2014年1月采用目的抽样的方法对上海、四川两地4所三级甲等医院中参加过灾难（地震、交通事故、火灾等）救护的医护人员进行问卷调查,调查内容包括医护人员既往接受灾难救护心理培训的情况、对灾难救护心理培训内容的需求及对实施灾难救护心理培训模式的需求。结果247名医护人员中仅63名（25．5％）参加过相关心理培训,培训方式主要为参加讲座（37人次）;医护人员对灾难救护心理培训各项内容的需求均分均在4分以上,得分最高的是灾难情境避险及遇险应对（4．58±0．53）分;66．4％的被调查者希望通过参加讲座的形式接受培训,50．2％的被调查者希望每年能有1～2次的培训,培训的方式以有经验的救护人员分享其经历（57．1％）和分析现场救护相关资料（55．1％）为主,59．5％的被调查者希望培训安排在平时工作中。结论目前医护人员的灾难救援心理知识储备不足,只有拓宽培训内容、丰富培训方法、加强医护人员日常工作中的规范化培训,才能有效提升其灾难救护的心理救援能力。     

灾害救护一体化分组培训模式在批量重度烧伤救护中的应用

目的探讨灾害救护一体化分组培训模式在批量重度烧伤救护中的应用效果。方法运用灾害救护一体化分组培训模式对来自5个不同医院、不同专业的40名护士,进行持续4天的培训,以培训前后理论、操作技能考核与培训后护士满意度进行效果评价。结果与培训前相比,培训后护士的理论知识与操作技能考核合格率均高于培训前,差异具有统计学意义(P0.01);护士对此次培训满意度较高,总体满意度达95.00%。结论在批量重度烧伤救护中,运用灾害救护一体化分组培训模式对护士进行培训,能迅速提高护士应对突发灾害的核心能力和专项技能,为人力资源库的建设提供依据。     

我国灾难救护医护人员心理培训研究进展

介绍了灾难救护医护人员面临的心理应激及问题,主要综述灾难救护医护人员的心理干预和培训,并提出应加强医护人员自我心理调适方面的培训,特别是在灾难发生前、灾难发生时及救灾后恢复阶段对医护人员的心理培训,各时间点培训内容也应各有侧重点。     

厦门市社区护士台风灾害救护技能培训需求及影响因素分析

目的调查厦门市社区护士台风灾害救护技能培训需求的现状及影响因素。方法采用社区护士台风灾害救护技能培训需求调查问卷对厦门市5所社区服务中心的210名护士进行调查,并分析其影响因素。结果厦门市社区护士台风灾害救护技能培训需求总体处于高水平,为(4.12±0.07)分,其中"专业技术"的培训需求最高。多元逐步回归分析显示,年龄、婚姻状况、社区工作年限、参加过台风灾害救护是影响社区护士台风灾害救护技能培训需求的主要因素。结论各级管理者应重视和加强社区护士台风灾害救护技能的培训。同时,结合社区护士的层次,制订系统全面的、具有针对性的分层培训,以提高社区台风灾害救护质量。     

医护人员对灾难救援培训需求的文献分析

目的系统回顾国内外医护人员对灾难救援培训需求的研究。方法 2015年11-12月,计算机检索重庆维普科技期刊数据库(1978-2015)、万方全文期刊/学位论文数据库(1990-2015)、同方知网全文期刊/学位论文数据库(1915-2015)、PubMed(1874-2015)数据库、护理学及医疗相关文献累计索引(cumulative index to nursing and allied health literature,CINAHL)英文数据库,根据纳入和排除标准筛选文献、提取资料及质量评价,并对文献进行定性分析。结果共纳入26篇文献共计25项研究,其中7项研究为高质量、17项为中等质量、1项为低质量;2011-2015年发表16项研究(占64%),研究对象主要为在职医护人员;医学生倾向于采用非课程培训的方式,在职医护工作者更愿意参加理论与实践相结合、专业师资指导的小组培训,并且希望为短期培训,在工作日的白天开展;90%的护士希望通过邮寄信件的方式接到培训通知。结论对医护人员进行灾难救援的培训,培训项目的主题应限定为具体的灾难种类,开设培训项目时需尽量考虑医护人员对培训方式、时间等的需求,培训内容则应结合专家意见进行设计。