Enhancing a public health nursing shelter program

The Shelter Nurse Program offers important nursing care and resources that help meet the health needs of the homeless population and improve the health of homeless individuals and families. However, formalized program goals and objectives, along with an evaluation plan that demonstrates population outcomes, had never been developed even as the program has evolved over time. Thus, the agency sought our assistance as public health nursing consultants to enhance the overall program to improve the health of the homeless population. To accomplish this, we worked with the agency and the shelter nurses throughout each step of the process to assess the needs of the program, develop appropriate goals and objectives, and develop an effective outcome evaluation plan for the existing Shelter Nurse Program. Lessons learned included the value and applicability of the selected program development model, the importance of agency ownership and active participation by front‐line workers, and the value of educating the workers and introducing resources throughout the process.     

实习生整体护理观与护理程序应用能力评价指标体系的构建

目的探讨临床实习生整体护理观与整体护理能力评价指标体系的构建。方法在查阅相关文献资料的基础上,通过调研和咨询,初步拟订临床护生整体护理观与护理程序应用能力评价指标体系草案,然后采用德尔菲法对体系草案进行两轮相关专家专业咨询;以权威程度、协调程度、积极系数检验专家咨询的可靠性;采用优序图和层次分析法确定指标权重。结果两轮积极系数均为1．0;专家权威系数0．936;变异系数0．000～0．2245;协调系数0．414-0．924。经两轮专家咨询后,意见趋向集中,汇总评价体系共包涵5个一级指标,21个二级指标。结论专家意见协调程度及专家权威程度高,结果可取;所构建的实习生整体护理观与护理程序应用能力评价指标体系,可作为衡量护生临床所具备的整体护理素质和能力的测评工具。     

Friendship fosters learning: The importance of friendships in clinical practice

This paper reports on one of the key findings from a recent ethnographic study (Roberts, D., 2007. Friendships and the community of students: peer learning amongst a group of pre-registration student nurses. Unpublished PhD Thesis, University of Salford, UK) and aims to highlight the importance of friendships for student nurses in clinical practice. An interpretive ethnographic approach was taken in order to reveal the student experience during their pre registration programme. Data was collected using ethnographic interviewing (Sorrell, J.M., Redmond, G.M., 1995. Interviews in qualitative nursing research: differing approaches for ethnographic and phenomenological studies. Journal of Advanced Nursing 21, 1117–1122.) and participant observation. Within this paper I argue that student nurses exist on the edge of the community of practice (of the qualified staff) and therefore form their own parallel community where students are all seen as being in the same boat. In particular students use the friendships they develop in clinical practice to enable them to learn; developing an ‘ask anything’ culture where all students are perceived as valuable sources of knowledge. Furthermore, it appears that knowledge is contextually bound and not therefore linked to seniority, or length of time served on the course.     

新加坡护理大专课程描述

通过对新加坡南洋理工学院大专护士的入学背景、教师背景、课程结构等情况的描述和分析,在结合我国护理教学实践与经验基础上,在课程的总体构架、课程名称、课程分类、临床实践和带教等方面提出了改善我国护理大专课程设置的一些可行性建议。     

Stepping up,stepping back,stepping forward: Student nurses' experiences as peer mentors in a pre-nursing scholarship

Mentorship is an essential part of the registered nurse's role, yet few opportunities exist for student nurses to mentor others during pre-registration programmes. This paper reports student nurses' experiences of mentoring school pupils during a pre-nursing scholarship. Focus groups were conducted with fifteen final year student nurses (14 female, 1 male) in two university campuses in Scotland. Discussions were audio recorded and transcribed verbatim, and data analysed thematically. Three interconnected themes emerged: 1) stepping up; 2) stepping back; 3) stepping forward. ‘Stepping up’ was a process through which student nurses rapidly assumed responsibility for mentoring pupils, facilitated through the attitudes and actions of students' mentors and students' control over pupils' practice experiences. ‘Stepping back’ encapsulated attitudes and behaviours that enabled student nurses to mentor pupils that involved considerable judgement around how unfolding events in practice could provide learning and development opportunities, and emotional acuity to support pupils through, sometimes challenging, practice situations. ‘Stepping forward’ described how students' mentoring experience allowed them to appraise and affirm nursing knowledge and skills, and gain greater appreciation of the reality and complexity of mentorship in clinical practice. Peer mentoring may prepare student nurses for future mentoring roles and aid their transition into clinical practice.     

临床护理路径优化妊娠期糖尿病孕妇的护理程序研究

[目的]探讨临床护理路径对妊娠期糖尿病孕妇在住院期间的应用效果,优化妊娠期糖尿病孕妇在住院期间的护理程序。[方法]选择产科病区收治的120例妊娠期糖尿病孕妇,随机分为观察组和对照组。对照组实施常规护理,观察组实施系统的临床护理路径,比较两组孕妇的住院天数、孕妇对护理的满意度、健康知识掌握程度和血糖控制达标情况。[结果]观察组住院天数低于对照组;孕妇的满意度、健康知识掌握程度和血糖控制达标情况显著优于对照组。[结论]对妊娠期糖尿病孕妇实施临床护理路径,可以缩短孕妇住院天数,提高健康教育的效果,提高病人对护理的满意度、健康知识掌握程度和血糖控制达标率。     

Belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment: A scoping review

AimThe aim of this scoping review was to map the literature investigating belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment.BackgroundThe concept of belongingness, which encompasses feelings of acceptance, connection and value alignment, has been tied to positive outcomes in undergraduate/pre-licensure nursing students including increased learning, participation, confidence and professional socialization. It is critical for educators and clinical staff to foster a sense of belongingness for nursing students to promote positive and effective clinical learning experiences.DesignThe scoping review strategy established by the Joanna Briggs Institute was followed. The databases searched were CINAHL Complete (EBSCO), Education Source, Medline Complete (EBSCO), APA PsycINFO (EBSCO) and Epistemonikos.MethodsFollowing a search of the five databases, studies were screened by title and abstract by two independent reviewers for inclusion. Data including population, concept, context, methods and key findings relevant to the review question were extracted and synthesized using an instrument developed by the reviewers.ResultsA total of 47 articles with varying methodologies were critically appraised. Three overarching focus areas emerged: outcomes resulting from feelings of belongingness versus alienation, factors that contribute to a sense of belongingness in the clinical learning environment and interventions to promote a sense of belongingness while students are immersed in the clinical learning environment.ConclusionsBelongingness in the clinical learning environment is an important concept that lends itself to positive learning experiences and increased satisfaction of undergraduate/pre-licensure nursing students. Environmental, relational and experiential factors can be maximized and specific interventions employed to promote belongingness. This review identifies a lack of evidence on measured interventional effectiveness at the student, school and clinical unit level. Future research to address these gaps is recommended.Tweetable abstractScoping review suggests environmental, relational and experiential factors promote positive outcomes in belongingness of nursing students.     

基于同伴互助的本科护生临床实践行为研究

目的：探讨同伴互助活动对本科护生临床实践行为的影响。方法：采用随机对照法将随机抽取的90名本科实习护生分为两组,每组45名。对照组采用常规带教方法实习;实验组在此基础上开展同伴互助活动。并于实习1周及实习6个月后,采用护理本科生实践过程行为评价表测评两组护生的临床实践行为。结果：实习6个月后,两组护生临床实践行为总分及证实自己的专业能力、应用护理程序、与患者的沟通交流、应用相关学科知识、明确自己的学习需求、明确患者的权利与义务、分析影响患者的因素等方面比较,差异有显著性意义（P〈0．01,P〈0．05）。结论：同伴互助活动能有效地改善本科护生的临床实践行为。     

The development and evaluation of a 'blended' enquiry based learning model for mental health nursing students: "making your experience count"

To meet the demands required for safe and effective care, nurses must be able to integrate theoretical knowledge with clinical practice (Kohen and Lehman, 2008; Polit and Beck, 2008; Shirey, 2006). This should include the ability to adapt research in response to changing clinical environments and the changing needs of service users. It is through reflective practice that students develop their clinical reasoning and evaluation skills to engage in this process. This paper aims to describe the development, implementation and evaluation of a project designed to provide a structural approach to the recognition and resolution of clinical, theoretical and ethical dilemmas identified by 3rd year undergraduate mental health nursing students. This is the first paper to describe the iterative process of developing a 'blended' learning model which provides students with an opportunity to experience the process of supervision and to become more proficient in using information technology to develop and maintain their clinical skills. Three cohorts of student nurses were exposed to various combinations of face to face group supervision and a virtual learning environment (VLE) in order to apply their knowledge of good practice guidelines and evidenced-based practice to identified clinical issues. A formal qualitative evaluation using independently facilitated focus groups was conducted with each student cohort and thematically analysed (Miles & Huberman, 1994). The themes that emerged were: relevance to practice; facilitation of independent learning; and the discussion of clinical issues. The results of this study show that 'blending' face-to-face groups with an e-learning component was the most acceptable and effective form of delivery which met the needs of students' varied learning styles. Additionally, students reported that they were more aware of the importance of clinical supervision and of their role as supervisees.     

Primary care clinical placements: The views of Australian registered nurse mentors and pre-registration nursing students (part 2)

An increased burden of chronic and complex conditions treated in the community and an aging population have exacerbated the primary care workload. Predicted nursing shortages will place further stressors on this workforce. High quality clinical placements may provide a strategic pathway to introduce and recruit new nurses to this speciality. This paper is Part 2 of a two part series reporting the findings of a mixed methods project. Part 1 reported on the qualitative study and Part 2 reports on the quantitative study. Forty-five pre-registration nursing students from a single Australian tertiary institution and 22 primary care Registered Nurse (RN) mentors who supervised student learning completed an online survey. Students largely regarded their primary care placement positively and felt this to be an appropriate learning opportunity. Most RNs were satisfied with mentoring pre-registration nursing students in their setting. Furthermore, the RNs desire to mentor students and the support of general practitioners (GPs) and consumers were seen as key enablers of pre-registration nursing placements. Findings from this study provide a preliminary impression of primary care clinical placements from the perspective of pre-registration nursing students and registered nurse mentors. Further research should examine whether a broader scope of non-traditional health settings such as non-government organisations, charities, pharmacies, welfare and social services can also provide appropriate learning environments for pre-registration nursing students.     

神经症患者程序化心理护理的效果

目的 观察了解神经症患者实施程序化心理护理的临床效果.方法 将85例住院神经症患者随机分为研究组（n=44）和对照组（n=41）,对照组实施常规心理护理,研究组实施程序化心理护理,比较2组患者焦虑自评量表（SAS）以及患者心理需求问卷、患者满意度问卷评分的差异.结果 入组10 d后,研究组的满意度项目均分高于对照组,心理需求总量少于对照组,差异有统计学意义;20 d后,研究组SAS总分低于对照组.结论 程序化心理护理能较好地满足神经症患者心理需求,显著提高患者满意度,有效降低焦虑水平.     

国内外护理层级管理现状

对护理层级管理的概念及国内外护理层级架构的设置及应用现状进行了分析,剖析了国内护理层级管理中存在的问题,以期为公立医院改革及护理层级管理的推进提供借鉴。     

A cognitive learning model of clinical nursing leadership

Cognitive modeling of competencies is important to facilitate learning and evaluation. Clinical nursing leadership is considered a competency, as it is a "complex know-act" that students and nurses develop for the quality of care of patients and their families. Previous research on clinical leadership describes the attributes and characteristics of leaders and leadership, but, to our knowledge, a cognitive learning model (CLM) has yet to be developed. The purpose of our research was to develop a CLM of the clinical nursing leadership competency, from the beginning of a nursing program to expertise. An interpretative phenomenological study design was used 1) to document the experience of learning and practicing clinical leadership, and 2) to identify critical-learning turning points. Data was gathered from interviews with 32 baccalaureate students and 21 nurses from two clinical settings. An inductive analysis of data was conducted to determine the learning stages experienced: awareness of clinical leadership in nursing; integration of clinical leadership in actions; active leadership with patient/family; active leadership with the team; and, embedded clinical leadership extended to organizational level and beyond. The resulting CLM could have significant impact on both basic and continuing nursing education.     

社区护理临床教学内容与程序的研究

[目的]逐步建立和完善社区护理临床规范教学内容和程序,提高护生教学质量.[方法]以访谈和调查表的形式,对实施规范教学内容和程序带教前后的80名南昌大学医学院护理本科生实习效果进行调查,所得数据进行统计学分析.[结果]经统计学分析,实施规范教学内容和程序前后学生自评、老师评价、社会评价有统计学意义(P<0.01).[结论]实施科学规范教学内容和程序进行带教,能够提高社区护理临床教学质量,带动社区护理临床师资队伍建设,增强学生的专业情感.