Development of undergraduate nursing entrustable professional activities to enhance clinical care and practice

BackgroundNursing education adopts a time-based approach to assess the multifaceted competencies of student nurses. The competency-based approach is preferred historically as it is practical and ensures that individuals deliver effective healthcare practice. However, there remains a gap on how these competencies are actually applied in nursing practice. To facilitate the connection between competencies, competency-based education, and nursing practice, entrustable professional activities (EPAs) can be utilized to translate competencies into clinical practice. EPAs have shown promising results across multiple healthcare specialties and have become the current driving force to facilitate nursing care and practice. Given the limited information of EPAs in nursing education, it is an opportune time to develop EPAs specific to nursing care and practice.ObjectivesTo provide a detailed breakdown on the development of EPAs in nursing education to inform clinical care and practice.MethodsThe development stages of EPAs included: i) the formation of a team, ii) the development of the conceptual framework, and iii) the pooling, reviewing, and revising of core EPAs.ResultsA total of ten core EPAs were developed, with sub-EPAs nested within these core EPAs. The EPAs include: 1) patient engagement, 2) patient care and practice, 3) care management, 4) common procedures, 5) safety, 6) urgent care, 7) transition care, 8) patient education, 9) interprofessional collaboration, and 10) palliative care.ConclusionThe development of EPAs specific to nursing care and practice may offer nursing programs a guide to assist with curricula planning and a basis for developing entrustment assessment tools. The unfamiliarity of EPAs in nursing education may pose as implementation challenges to EPAs. Future research is warranted to evaluate and improve the developed EPAs.     

Evaluation of an undergraduate nursing entrustable professional activities framework: An exploratory qualitative research

BackgroundEntrustable professional activities (EPA) are mainly used in graduate medical education and professional development and have not been widely implemented in nursing undergraduate settings. Nursing EPAs were therefore developed by the Alice Lee Centre of Nursing to translate theoretical nursing competencies into clinical practice and as forms of standardized clinical assessment tools. Feedback from various stakeholders is required to further refine the framework.ObjectivesTo explore the perceptions and experiences of using the new EPA framework in nursing students and hospital and university clinical instructors.DesignAn exploratory qualitative study using focus group interviews.ParticipantsSeven year-one nursing undergraduates, 12 year-two undergraduates, seven university clinical instructors, and 18 hospital clinical instructors participated in this study.MethodsThe students formed five groups, while the clinical instructors formed seven groups, each consisting of three to four participants. Semi-structured interviews were conducted to explore stakeholders' experiences and perceptions of the EPA assessment framework. Thematic analysis was used to analyze the data.ResultsDespite initial mixed reactions of confusion and relief, many students and clinical instructors commended the comprehensive and structured EPA framework and its emphasis on holistic patient-centered care. EPAs also allow flexible assessment methods, encourage critical thinking among students, and promote team-based care and peer teaching. However, the assessment using a two-dimensional matrix with multiple competencies for the EPAs, subjective assessment criteria, the lack of standardization using checklists, subjective assessment criteria, and the lack of, manpower, and time may potentially affect the accuracy of the clinical assessments. The effectiveness of the EPA framework was also dependent on the quality of feedback, students' intrinsic motivations, and learning environments. The refinement of EPAs and entrustment levels, a physical checklist, and an incorporation of EPAs into school curricula were recommended to improve practitioners' learning experiences.ConclusionsThe use of EPAs in nursing education continues to be a novel and evolving process. There remains a need for a further refinement of the EPA framework to tailor to instructors' expectations and students' capabilities.     

护理本科生临床专业实践行为评价问卷的编制

目的编制适合评价护理本科生临床专业实践行为的问卷。方法在文献复习的基础上设计问卷,经专家反复修订后,对345名护理本科生进行调查,采用鉴别度检验、同质性检验和探索性因子分析筛选问卷条目,确定正式问卷。然后对正式问卷的各项指标进行评价。结果正式问卷包括5个维度28个条目,分别为应用护理程序(5个条目)、护理操作及在操作中遵循伦理原则(6个条目)、健康教育(4个条目)、沟通交流(5个条目)、评判性思维(8个条目)。该问卷信度Cronbach’sα为0.937,各维度Cronbach’sα在0.822~0.881;初始问卷的内容效度均值0.94;正式问卷的因子结构理想,以特征值>1为标准,用主成分分析法共提取5个公因子,累计贡献率为61.976%。结论正式问卷具有良好的信效度,可以用来评价护理本科生的临床专业实践行为。     

护理学本科专业认证的发展现状

护理学本科专业认证是保障高等护理教育质量的重要措施。本文对国内外护理学教育标准的发展及现状、护理学教育标准的内容、护理学本科专业认证的发展及现状进行综述,为规范我国护理学本科教育、推广我国护理学本科专业认证工作提供依据。     

护理学本科专业认证发展现状及实践思考

专业认证是保证和提高护理学专业本科教育质量的重要手段,自2009年认证标准制订以来,各护理院校均在积极筹备迎接专业认证。本研究借鉴已通过专业认证院校之经验,结合我院护理专业特色,探讨护理学本科专业认证发展现状并分析专业认证实践过程中存在的问题,以加快护理专业认证步伐,促进我国护理专业教学整体水平提高。     

护理本科生阅读专业信息情况调查分析

目的 了解和提高护理本科学生的专业信息素质。方法 采用问卷的方式对148名接触专业课后的护理本科生就阅读专业信息情况及其影响因素进行调查,其中2000级64人,2001级84人。结果 护理本科生阅读专业信息情况,即献阅读量较少．2000级学生阅读献的情况优于2001级,其中阅读专业专与网上阅读两项有显性差异。制约护理本科学生阅读专业信息的因素主要有：献种类多,不易选择;阅读献不能提高成绩;学习负担重。结论 护理本科生专业信息素质有待进一步提高。     

三级综合医院急诊科护士置信职业行为指标的构建与验证

目的 构建三级综合医院急诊科护士置信职业行为指标并进行初步验证,为评价三级综合医院急诊科护士岗位胜任力提供参考。方法 通过文献研究、研究小组会议及专家咨询法确定急诊科护士置信职业行为指标,并于2022年5月使用三级综合医院急诊科护士置信职业行为评价指标满意度问卷对无锡市某三级综合医院40名急诊科护士进行问卷调查,以初步验证指标的应用效果。结果 对21名专家进行2轮咨询,咨询问卷的有效回收率均为100%;专家权威系数分别为0.881、0.898;肯德尔和谐系数分别为0.509、0.535（P<0.01）,最终形成了18个三级综合医院急诊科护士置信职业行为指标条目及说明,并确定各指标在不同年限的预期置信级别。急诊科护士对置信职业行为评价指标较满意,满意度得分为（22.25±3.04）分。结论 该研究形成的三级综合医院急诊科护士置信职业行为指标具有科学性和实用性,可为评价三级综合医院急诊科护士岗位胜任力提供参考。     

护理本科实习生职业认同感的认知干预研究

目的探讨认知干预方案对护理本科实习生职业认同及职业自我效能感的影响。方法便利选取A、B两所在规模、工资薪酬、医院环境、带教资质水平大致相近的综合性三级甲等医院,以抛硬币法将其随机分为实验组和对照组的实习医院。便利抽取A医院75名本科实习生作为实验组,B医院69名本科实习生作为对照组。以合理情绪疗法的ABC理论和扩展-构建理论为理论依据构建干预方案。实验组在接受常规实习培训的同时接受每2周1次、共5次的职业认同集体认知干预,主要形式有专家现场授课和视频授课、现场答疑、课堂互动式讨论等;对照组接受常规实习培训的同时参加医院组织的专业讲座。结果共138名学生完成干预,干预后实验组职业认同感及职业自我效能得分均优于对照组,差异具有统计学意义(P<0.05)。结论采用认知干预方案对护理本科实习生进行培训,可提高学生的职业认同感水平及职业自我效能感。     

Social media and professional boundaries in undergraduate nursing students

Social media use and professional boundaries are growing challenges for nurse educators. The current undergraduate nursing student population is a technology savvy generation that enjoys the constant stimulation and social connections created by social media. Professional standards in nursing are dictated by the ANA's Code of Ethics, and educators are responsible for instilling professional values into impressionable nursing students. Professional boundaries have become blurred with increased use of social media as students struggle to differentiate between personal and professional identities. Increased exposure to professional expectations along with clearly defined policies and procedures regarding social media use can foster the development of an ethical conscience in students that can be carried into future practice. The establishment of clear professional boundaries upon entry into nursing programs can support safe use of social media and promote a positive image for the future of the nursing profession.     

护理本科生专业认同状况的调查分析

目的了解护理本科生专业认同现状。方法应用专业认同问卷对406名大学二年级至四年级护理专业本科生进行问卷调查。结果护理本科生专业认同总分及各维度得分处于较高水平;就读原因及家庭月收入为护理本科生专业认同影响因素(P0.01)。结论学校、家庭和社会各界应帮助护理本科生建立良好的支持系统,提高其专业认同,帮助其更好地做出专业选择的决定。     

Tracking the development of professional values in undergraduate nursing students

In the current nursing shortage, nurses are frequently making significant patient care decisions concerning value-laden clinical issues. A program evaluation study was conducted to track professional values over time from entry into a baccalaureate program to graduation. Nursing students completed a survey measuring professional values upon entry into and exit from the program. Comparative analysis of pretest and posttest group means demonstrated statistically significant increases in total scores. The highest pretest value items were also the highest on the posttest, with the addition of patient advocacy. Patient advocacy jumped 16 places from pretest to posttest to become the highest-ranked statement upon exit from the program. All of the values rated as least valued at pretest remained least valued at posttest; however, the means of all but two (participating in nursing research and providing consumer education about products/services) increased significantly. The value statements with mean scores that increased significantly centered on aspects of nursing practice less visible to the lay public and involving interaction with other health care providers.     

Integrating informatics into undergraduate nursing education: A case study using a spiral learning approach

A gap in informatics expertise amongst nursing students, practising staff and faculty has been noted globally, which reduces the potential for nurses to utilise technology to enhance patient care. National nursing education strategies and recommendations from professional associations have identified digital health as an area that needs investment. This case study describes how health informatics is being integrated into a Bachelor of Nursing programme in the United Kingdom. An international collaboration with a US-UK Fulbright Specialist Scholar enabled individual learning units corresponding to key health informatics competencies to be designed and incorporated into a pedagogic framework grounded in the spiral learning approach. This approach is proposed as one way to integrate informatics into nursing education, so students can become competent clinicians that are able to deliver technology enabled care in the health service.     

本科护生职业认同感现状调查

[目的]了解本科护生职业认同感及其影响因素。[方法]采用整群抽样的方法,选取山西医科大学2008级护理本科生212人进行职业认同感问卷调查。[结果]本科护生职业认同感总分为124.19分±18.59分,条目得分为3.27分±0.49分;单因素分析结果显示,不同高考志愿、选择护理专业不同原因、不同意愿、不同喜欢程度、是否是学生干部、毕业后改行与否、毕业后是否从事护理、毕业后希望从事不同领域工作护生的职业认同、父母不同职业、父母不同学历护生职业认同、不同家庭收入、是否为独生子女护生的职业认同总分差异有统计学意义(P0.05);多因素分析结果显示,影响护生职业认同的因素从大到小依次为高考志愿、暑期社会实践、护理人员地位、态度、家庭人均收入、毕业后是否会改行、独生子女、社区实习、是否从事护理、父亲职业、兼职、是否学生干部;调整后的R2=0.583,本研究所调查因素可以解释本科护生职业认同得分约60%的变异。[结论]护生总体的职业认同不高,其影响因素较多。     

本科护生专业承诺的现状调查

目的 了解本科护生专业承诺的现状,为护理教育提供参考.方法 采用连榕等编制的《大学生专业承诺调查量表》对在校的本科护生进行调查.结果 本科护生的专业承诺不高,呈中等偏上水平.其中,理想承诺得分最低,其次是继续承诺和情感承诺,规范承诺得分最高.不同年级、性别、录取志愿、生源地护生的专业承诺得分比较,差异有统计学意义(P＜0.05).结论 当前本科护生的专业承诺状况不容忽视,学校应重视并采取各种针对性措施提高本科护生的专业承诺水平.     

以问题为基础的教学在护理本科专业课中的应用研究

为了帮助学生建立关怀患者的理念和解决问题的能力,在护理本科生内、外、妇、儿科护理学每门课程进行6~8学时的PBL教学尝试。具体方法为:教师将典型病例重新设计成PBL教学案例,每个案例分为3~4幕展示给学生;教师和学生对病例进行分析,寻找核心概念和主要问题,学生查阅资料寻找答案;学生进行汇报、讨论,绘制概念图;学生集中展示各自概念图和分享PBL教学体会,教师进行综合总结。进行教学评价时,学生肯定了PBL教学可以帮助其确定"以患者为中心"的治疗性关系建立的作用。同时,提出了开展PBL教学存在的不足和对策。