Nursing and midwifery education, practice, and issues in Israel

Nurses deliver most of Israel's healthcare services, yet its nurse per population ratio is only 5.9 per 1000, one of the lowest in the developed world. For several years, the managers of the profession have been pushing to upgrade nursing and to move it into the academic sphere. The semiskilled qualification of the practical nurse has been eliminated and training programs for registered nurses are being transformed from diploma training to academic degree programs. A midwifery license is accessible only to registered nurses who take a further 1 year of advanced training and sit the State Midwifery Licensing Examination. Most deliveries in Israel are carried out by midwives. Alongside the Western-standard hospital system there operates both a well-developed community nursing network and a strong mother-and-child clinic system. The acute shortage of nurses in Israel is now coinciding with a rising number of academic job-seekers, which has encouraged the Ministry of Health to offer university graduates a career-change program. Special scholarships are on offer in return for a 4 year commitment to work in nursing after completing an accelerated training curriculum (2.5 years instead of the usual 3 years), plus a starting monthly wage that is higher than the national average wage.     

Clinical major option: a model for implementing critical care nursing into baccalaureate preparation

What was initiated as a directive from a provincial government in an attempt to increase the number of critical care nurses has evolved into an exciting educational opportunity for many nurses and student nurses in the year 2000. Between 1993 and 1997 there has been significant downsizing of acute care beds across Canada (Code Blue: Critical Care Nursing in Nova Scotia, 1998). At the same time patient acuity has increased, due to shorter hospital stays, and the number of nurses working full-time has decreased with the increased use of casual nurses. Several studies at both the provincial and national levels report current and future shortages of specialized nurses (emergency, critical care and perioperative). It is expected that this shortage will continue into the future, a shortage that is driven by technological advances, as well as an aging general and nursing population. Continued shortages of these acute care nurses will result in fierce competition for skilled nurses as well as aggressive recruitment and retention strategies (Code Blue: Critical Care Nursing in Nova Scotia, 1998). It is generally agreed within the nursing community that specialty nurses in critical care require a unique body of knowledge that is not acquired in a basic undergraduate nursing program (Fitzsimmons, Hadley, & Shively, 1999). This specialized knowledge can be gained informally through experience; however, it is largely developed in additional formal education programs. The purpose of this article is to outline a strategy for the delivery of specialty education at three educational levels in acute care nursing with three streams: emergency, critical care and perioperative nursing. This clinical major option is to be delivered in partnership among the Queen Elizabeth Hospital II, the Health Science Centre and Dalhousie University School of Nursing, Halifax, Nova Scotia, Canada. This model of offering specialty education in university preparation could be a template for preparing nurses in the new millennium.     

上海市急诊专科护士核心能力现况调查

目的 调查分析上海市急诊专科护士的核心能力，为进一步构建急诊专科护士延续性培训方案提供依据。方法 采用整群抽样法，于2020年7月2-9日，应用自行设计的急诊专科护士核心能力自评表对上海市63所医院的1 097名急诊专科护士进行调查。结果 上海市急诊专科护士核心能力总得分为（240.49±31.84）分，条目均分为（4.45±0.16）分；6个维度条目均分由高到低分别为评判性思维能力、专业实践能力、专业态度、沟通协调能力、管理能力和专业发展能力。多元线性回归分析结果显示：医院等级、本人目前职务、最终学历对急诊专科护士核心能力的影响有统计学意义（P<0.05），而工作编制、性别、年龄、急诊工作年限、获得急诊急救护理适任证书的年限对核心能力的影响无统计学意义（P>0.05）。结论 上海市急诊专科护士总体核心能力处于中等偏上水平，其评判性思维能力较好，管理能力与专业发展能力相对较薄弱。护理管理者应在制订延续培训方案中加强管理能力与专业发展能力的建设，并建立急诊专科护士电子档案，纳入个人继续教育培训信息，以进一步完善急诊专科人才建设。     

Evolving towards professionalism in emergency nursing in Hong Kong

This paper aims to share with the readers about the experience of emergency nursing development and related roles in Hong Kong. The roles of emergency nurses are evolving and triggered by three major historical milestones. The three milestones consist of: (1) Transition of nursing education from hospital training to nursing degree program at universities in 1990; (2) The re-evolution after the establishment of Hospital Authority in 1993; (3) Hong Kong's return to China in 1997. These milestones have contributed immensely to the development of quality nursing education, nursing professionalism with emphasis on specialty knowledge and skill training in Accident and Emergency departments (AED) in Hong Kong. Since 1991, the emergency nursing role has been expanded and extended. Wound management remains one of the major extending roles for emergency nurses, who confine themselves to manage simple wounds. Nurse initiated tetanus immunization, intravenous access; investigations such as electrocardiogram, blood glucose, and urinalysis are well implemented in all AEDs under the governance of guidelines and protocols. Initial triage analgesic for the minor musculoskeletal injury and fever are also part of the triage care in some AEDs in Hong Kong now. To meet the demand and challenge, innovative role development such as lecturer practitioners and emergency nurse practitioners have been piloted and implemented recently. Besides the normal duty, emergency nurses also participate in the work outside the hospitals such as involvement in emergency medical teams to assist in various rescue missions or volunteer for Flight Nursing (Government Flying Services). However, the nursing shortage is another common problem faced by the Hong Kong health care body. With the help of advanced technology, better pre-graduate and specialty-training programs, Hong Kong health care strives to achieve the highest standards of quality care. Emergency nursing role development in Hong Kong is evolving and starts to chart its way to meet the demand.     

危急重症亚专科护士培训方案的探讨

目的 通过制定危急重症亚专科护士培训方案,以期培养出一支精通相关亚专科知识和技能的护理专家及专业化的护理团队;规范全院亚专科领域技术的相关制度、流程,以期培训、指导全院亚专科领域技术的临床应用.方法 通过严格考核选拔一批ICU专科护士,根据专业发展方向成立五大亚专科小组,每个亚专科小组定期组织相关的学术活动、专科理论和技术培训、专项人才短期进修培养;制定本专业领域的操作规范与流程,随时提供全院范围重症监护领域的临床技术指导;比较亚专科护士培训前后专业理论、技能、核心能力的差异.结果 通过近1年的亚专科领域技术的培训,相关亚专科护士专业理论、技能及核心能力均优于培训前,差异有统计学意义（P＜0.01）.结论 危急重症亚专科护士培训方案推动了全院危急重症亚专科技术的应用和指导,值得在各区域性医院推广.     

Emergency Department Mental Health Triage and Consultancy Service: an advanced practice role for mental health nurses

This paper describes a four-month preparatory training program for mental health nurses to provide an Emergency Mental Health Triage and Consultancy Service in the emergency department. The emergency department is an important gateway for patients presenting with psychiatric/psychosocial problems and mental health professionals need to provide prompt and effective care to this group of patients. Prior to the implementation of the service, it was acknowledged that occupational stress and burnout could affect the turnover of mental health nurses in the department. Therefore, a training program was employed to prepare a number of experienced mental health nurses to work at an advanced practitioner level. The four-month training program developed at Fremantle Hospital in Western Australia provided support, guidance and clinical supervision. In the first 12 months of the service, five mental health nurses completed the program, thus creating a pool of nurses who were able to provide the service. The results demonstrated that providing mental health nurses with a structured program was instrumental in facilitating their movement to an advanced practitioner level. The nurses were able to apply advanced knowledge and skills to assess and manage clients with complex mental health /psychosocial problems. Furthermore, on leaving the emergency department these nurses were able to utilise the advanced skills in other areas of mental health nursing practice.     

Developing a postbasic gerontology program for international learners: considerations for the process

BACKGROUND: A private university in Chile was seeking opportunities to acquire expertise in developing distance education programs using new media technology, especially in health-related fields. An initiative was undertaken to develop a distance postbasic gerontology program for technical nurses in Chile by partnering with a Canadian school of nursing. METHOD: The instructional design process was used as a systematic approach throughout the development of the program. Attention to cultural considerations was emphasized throughout each phase of the process. RESULTS: The developed program consists of 13 self-paced print modules with web-based components and is primarily asynchronous with scheduled milestones. A 6-week preceptored clinical experience follows completion of the theory portion to support learner mastery of program outcomes. CONCLUSION: Developing international nursing education programs is an enriching experience that presents unique challenges and issues. These challenges can be overcome by using a creative, systematic approach to program development that reflects cultural considerations. Developing flexible working relationships that respect the cultural differences of international team members facilitates international initiatives.     

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：     

急救模拟训练对提高手术室护士急救技能的作用

目的通过对急救模拟训练前、后手术室护士急救技能水平的比较,探讨手术室急救技能教学方法的改进。方法对在手术室工作1-3年的护士进行急救模拟训练,由过去的单纯理论讲课改为和医生一起对急救的各个阶段进行综合模拟训练,并对训练前、后手术室护士急救技能水平进行比较。结果模拟训练后手术室护士掌握急救知识和操作技能均较训练前水平有明显提高(P<0.01)。结论(1)急救模拟训练可以明显增加手术室护士对急救知识的了解,并能够主动配合手术医生应对手术室的各种急救;(2)使手术室教学由抽象变为实际,更加易于理解和掌握。     

戴明循环在重症监护室轮转新护士培训中效果的观察

目的探讨戴明循环(又称PDCA循环,plan-do-check-act cycle)对提高重症监护室(intensive care unit,ICU)轮转新护士的护理技能、理论水平及应急能力的培训效果的作用。方法便利抽样法选择2008年7月至2011年7月在温岭市第一人民医院ICU轮转的60名新护士为研究对象,按随机数字表法将其分为观察组和对照组,每组30名。观察组护士采用PD-CA循环方法,即按计划(plan,P)、执行或实施(do,D)、检查(check,C)、处理(action,A)等4个阶段进行培训;对照组护士采用传统的一对一带教模式。比较两组护士培训结束时,护理操作技能、护理理论及模拟应急急救能力。结果观察组护士护理操作技能、护理理论、模拟应急急救能力均明显高于对照组,差异有统计学意义(P<0.05)。结论 PDCA循环培训法是一个有效、持续改进的方法,促进了ICU新护士综合素质的提高。     

The helicopter emergency medical service and essential related nursing skills

Nurses play a critical role in Taiwan's helicopter emergency medical service, an essential healthcare response service for residents of outlying islands. The care skillsets required of nurses in special care and urgent care environments are significantly more specialized than those in other professional care environments. This article discusses the development of the civil helicopter emergency medical service (HEMS) and elements essential to HEMS nursing care efficacy. These elements can be grouped under the categories of pre-flight preparation, assessment for flight-readiness and in-flight care, decision-making abilities, personal physical characteristics, training and experience. These categories should be referenced to improve the effectiveness of relevant education / training programs, enhance HEMS nurse readiness and effectiveness, and maximize the role of HEMS nurses in the civil helicopter medical service.     

Opening a doctoral program in nursing: factors to consider

As nursing education has evolved from hospital-based training schools to the college campus, the need for doctoral nursing faculty and other leaders has increased. The greatest needs are for nurses capable of conducting research in nursing and for faculty to teach in baccalaureate and master's nursing programs. Therefore, schools of nursing across the country are considering initiation of new doctoral programs. This decision is a complex one that depends on numerous factors related mostly to resources. Ideally, new programs will develop only after the necessary resources have been identified and secured. Another critical decision is the type of doctoral program a school chooses to offer. Nursing should make an attempt to determine whether there actually are substantial differences between the present professional and research degree programs. In addition, the roles that doctorally prepared nurses will be expected to fulfill in the health care system should be defined. Overall, in spite of the documented need for many more doctorally prepared nurses and the inability of existing doctoral nursing programs to meet that need, new programs should be initiated with utmost caution. Thorough, extensive data gathering should provide information about available alternatives. The positive and negative consequences of each alternative should be identified and carefully weighed. Finally, once a school has decided to initiate a program, it should plan carefully for implementation. Thorough preparation will assure that the program selected is well matched to the resources available to support it.     

急诊科护士胜任力与灾害护理能力的相关性研究

[目的]调查急诊科护士胜任力、灾害护理能力的现状及两者的相关性,为从胜任力角度制订灾害护理培训计划提供依据。[方法]使用一般情况调查表、临床护士胜任力自评问卷、灾害护理能力问卷对101名急诊科护士进行调查。[结果]急诊科护士胜任力总分为173.57分±43.48分,灾害护理能力评分为3.73分±0.51分,胜任力总分及各维度与灾害护理能力总分及各维度呈正相关(P0.01)。[结论]急诊科护士灾害护理能力和胜任力有待提高。护理管理者可从胜任力现状特点通过提高胜任力来提高灾害护理能力。     

江苏省急诊护士灾害护理能力现状及其影响因素研究

目的 了解江苏省急诊护士灾害护理能力的现状及影响因素,为构建江苏省急诊护士灾害护理培训模式提供指导依据。方法 采用便利抽样法,选取880名江苏省急诊护士,通过一般资料调查表和临床护士灾害护理能力评估工具进行横断面调查,分析江苏省急诊护士灾害护理能力现状及其主要影响因素。结果 江苏省急诊护士灾害护理能力总分为(210.90±35.23)分,处中高水平；各维度得分率从高到低依次为:备灾能力(77.9%),应对能力(77.0%),恢复/重建能力(75.6%),减灾/预防能力(73.7%)；多重线性回归分析结果显示:职称、医院等级、现有知识及技能能否适应灾害救援现场、是否接受过与灾害护理相关的培训、是否经历过灾害事件是江苏省急诊护士灾害护理能力的影响因素(标准化回归系数分别为:-2.980、-2.299、-7.443、-4.660、-2.330；P＜0.05)。结论 江苏省急诊护士灾害护理能力仍有待提高,应加快完善江苏省灾害护理人才体系及培训体系建设,均衡配置应急医疗救援资源,注重急诊护士灾害救援实战演练。     

New graduates in the burn unit

The nursing shortage is widespread. The shortage of available experienced registered nurses has led to an influx of new graduate nurses (GN) into the acute care setting. This influx of inexperienced nurses into highly specialized areas has established a need to develop effective GN training programs that promote sound clinical performance,encourage professional development, and strengthen recruitment and retention efforts.This article discusses the training needs of GNs in burn units and reviews the University of Colorado Hospital (UCH) GN residency program with a discussion of its successes and future challenges.     

Addressing the Community/Public Health Nursing Shortage through a Multifaceted Regional Approach

Despite increasing needs resulting from emerging societal and health care issues, the number of trained community/public health (C/PH) nurses in the United States is facing a precipitous decline. Numerous factors contribute to this shortage including an aging workforce, a poorly funded public health system, inconsistencies in C/PH nursing educational approaches and opportunities, and a shortage of sites for clinical training. Determined to address the C/PH nursing shortage in their region, a consortium of public health professionals, university deans and faculty, and state nursing leaders in southeastern Wisconsin came together to address these issues from three perspectives: (a) curricular analysis and redesign, (b) expansion of clinical placement opportunities, and (c) paid community/public health nursing internships for seniors in baccalaureate nursing programs. This article outlines briefly the activities undertaken related to curricular review and clinical placements, and then describes in detail the approach, challenges and results of the senior internship program. Together, these programs produced long‐lasting results including an unprecedented level of collaboration between academic institutions and public health nursing professionals, the expansion of both traditional and nontraditional clinical sites in the region, and a transformative learning experience for seventeen senior nursing students from five participating universities.