本科护理毕业生循证知识、态度和实践现状及其影响因素分析

目的调查并分析本科护理毕业生知识、态度和实践的现状及影响因素。方法采用整群抽样法对我中心2017年7月入职培训来自18所学校的196名应届本科毕业护士进行问卷调查。问卷内容包括一般资料、循证知识、态度和实践量表(EBPQ)。结果新入职护士循证护理态度、实践和知识的现状总分(4.82±1.32)分,得分由高到低依次是:循证态度(5.69±1.01)分、循证实践(4.61±1.39)分、循证知识(4.60±0.99)分。本科循证护理教育开展率为21%;单因素分析显示:影响循证态度的因素为文献阅读频率和写作兴趣;影响循证实践的因素为文献阅读频率与写作能力;影响循证知识的因素为文献阅读频率、写作兴趣与能力、循证教育(P<0.05)。多因素回归分析显示:文献阅读频率对循证知识、态度、能力影响显著;写作兴趣对循证态度、知识影响显著;写作能力对循证实践影响显著(P<0.05)。结论本科护理毕业生循证态度积极,循证知识和实践有待进一步提高;护理本科生循证护理教育开展不足,需要进一步加强;本科护理教育应大力发展文献阅读和写作能力,以促进护生循证素质的提高。     

A family nursing educational intervention supports nurses and families in an adult intensive care unit

The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses’ attitudes towards and confidence in providing family care, as well as families’ perceptions of support from nurses in an adult critical care setting. An academic–clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members’ experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic–clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in other critical care settings.     

护理人员循证护理知识、态度、行为、技能调查研究

目的；调查了解护理人员循证护理知识、态度、行为、技能状况，为临床开展护理人员的相关培训和循证护理教育的方向及管理灾践提供理论依据。方法：在参考国内外文献基础上自行设计调查问卷，对广州市5所医院的101名护理人员进行循证护理知识、态度、行为、技能状况调查。结果：63．7％的护理人员熟悉循证护理知识（人群集中在本科学历以上的护理人员），31．5％的护理人员对循证护理知识有一定的了解，只有4.8％的护理人员对循证护理一无所知；97．5％的护理人员对循证护理具有正向态度；护理人员的循证护理技能掌握较好的占18.4％，大部分人（58．3％）对检索知识、在实施循证护理过程与患者的沟通能力掌握较好，但在评价研究质量的优劣、决策能力技能方面能力不自信；20．80％的护理人员具有主动寻找解决问题的行为，而且集中在职称较高的人群；56．1％的护理人员会利用业余时间通过互联网获取需求知识，但有23．1％的护理人员墨守成规。结论：护理人员均对开展循证护理具有支持与正向的态度，但相当一部分护理人员对循证护理知识缺乏。     

以科室为单位强化ICU护士呼吸机相关性肺炎循证护理培训

目的开展ICU预防呼吸机相关性肺炎(VAP)循证护理培训教育并评价其成效。方法以2008年美国重症护理协会预防VAP循证护理实践指南为培训教材,并以此为导向设置课程,对17名ICU护士进行培训,采用预防VAP护理质量标准评价量表评价培训前后护士的认知和行为变化。结果护士培训后质量评价总体水平较培训前明显改善,差异有统计学意义(Z=-3.624,P=0.000)。质量评价的7个维度中,除洗手外,卧位护理、气道护理、肠内营养护理、气囊套管护理、口腔护理、呼吸机管道护理6个维度的认知和行为变化在培训后明显改善,差异有统计学意义(P0.01)。结论ICU预防VAP循证护理培训能有效提高护士的认知和行为水平,同时促进了预防VAP循证护理的全面推广和应用,使护理质量内涵得到大幅度提高,也为ICU专科培训和继续教育提供了反馈指导和经验借鉴。     

Emergency nurses’ Evidence-Based Practice attitudes,self-efficacy,knowledge, skills and behaviors before an educational intervention – Baseline of a Randomized Controlled Trial

BackgroundEmergency nurses are expected to follow recent research findings and ensure that their practice is based on evidence. Yet, during busy work-shifts in overcrowded emergency departments, evidence-based practice (EBP) is not always implemented.AimTo describe emergency nurses’ EBP attitudes, self-efficacy, knowledge, skills and behaviours at the baseline of a RCT.MethodsA baseline study as a part of a randomised, single-blind controlled multicentre intervention trial (RCT). The study population consisted of 300 emergency nurses employed in two university hospitals’ emergency departments in Finland. The total sample size (n = 80) was estimated using a simulation approach. The data were collected from voluntary emergency nurses by using four structured questionnaires.FindingsEmergency nurses’ EBP attitudes, self-efficacy, knowledge and skills were above the average level, and their EBP behaviour was below the average level when measured with the other of the two sum variables measuring behaviour. A significant correlation was found between age, years since graduation, the length of working experience in health care and EBP attitudes, behaviour, knowledge and self-efficacy. Younger emergency nurses who had recently graduated and had shorter work experience showed more positive attitudes towards EBP than older counterparts. No correlation was found between gender, educational background or prior exposure to EBP and EBP attitudes, self-efficacy, knowledge, skills or behaviours.ConclusionsThis study showed that to promote emergency nurses’ use of EBP in future, tailored educational interventions on EBP are needed. This would ensure implementation of EBP in daily clinical practice for quality and effective patient care.     

Educating Emergency Department Registered Nurses (EDRNs) in screening,brief intervention,and referral to treatment (SBIRT): Changes in attitudes and knowledge over time

Alcohol and other drug (AOD) diagnoses in the ED co-occur with injury-related presenting conditions including: falls, motor vehicle accidents, poisonings, and both intentional and unintentional injuries. Clinical attention to ED admissions resulting from hazardous AOD use can significantly improve patient care and reduce high cost utilization of ED visits and treatment. The EDRN-SBIRT project is designed to improve the knowledge and attitudes of ED nurses working in a large academic medical center to identify and address risky AOD use as it relates to an ED visit. ED nurses’ knowledge and attitudes toward patients with AOD use can be improved through SBIRT education. SBIRT education can establish an evidence-based standard of nursing practice to improve healthcare outcomes, but it must be reinforced with ongoing ED review and supportive educational sessions until practice is firmly established.     

Israeli nurses' knowledge of health care reforms

Israeli nurses’ knowledge of health care reforms Objectives. This study examines health care reforms’ implementation processes from the perspective of nurses’ knowledge regarding the reforms. The research has been carried out in the Israeli context, where health care reforms were initiated in 1995. Three specific research questions were formulated: (a) What is the level of nurses’ knowledge regarding the recommendations of the Netanyahu committee? (b) What is the level of nurses’ knowledge concerning the basic principals of the National Insurance Law? and (c) Are there knowledge differences relating to employment setting (hospital, community, and educational settings), nurses’ roles (managerial vs. staff nurses), years of experience, and level and type of education? Method. The stratified nonproportional random sample consisted of a total of 468 nurses. Of these nurses, 206 were employed in community settings (136 in curative care, and 70 in preventive care), 137 were employed in hospital settings, and 125 worked in schools and departments of nursing. Research tools, developed for the purpose of this study, included the nurses’ knowledge questionnaire comprised of five subscales, and the knowledge relevancy questionnaire. Results. Overall, data demonstrated a low to moderate level of knowledge on all knowledge scales. Knowledge level on the criteria questions was particularly low. Contrary to the low level of knowledge, nurses regarded health care reforms’ knowledge as highly relevant to their work life. Curative setting, an extensive work experience, managerial position, and non‐nursing academic degree were all positively related to higher levels of reforms’ knowledge. Conclusion. These findings should encourage both policy makers and managers in various health care organizations to develop programs for informing health care providers on central aspects of health care reforms considered most relevant to the practice setting.     

Portuguese nurses' knowledge of and attitudes toward hospitalized older adults

Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses′ education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross‐sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence‐based guidelines in their practice.     

Investigating factors associate to nurses' attitudes towards perinatal bereavement care

Aim. The purpose of this study was to explore nurses’ attitudes towards perinatal bereavement care and to identify factors associate with such attitudes. Background. Caring for and supporting parents whose infant has died is extremely demanding, difficult and stressful. It is likely that the attitude of nursing staff can influence recovery from a pregnancy loss and nurses with positive attitude to bereavement care can help bereaved parents to cope during their grieving period. Method. Data were collected through a structured questionnaire; 334 nurses were recruited (63% response rate) from the Obstetrics and Gynaecology unit in five hospitals in Hong Kong during May–August 2006. Outcome measures including attitudes towards perinatal bereavement care, importance on hospital policy and training support for bereavement care. Results. Majority of nurses in this study held a positive attitude towards bereavement care. Results showed that only 39·3% (n = 130) of nurses had bereavement related training. By contrast, about 89·8% of nurses (n = 300) showed they need to be equipped with relevant knowledge, skills and understanding in the care and support of bereaved parents and more than 88·0% (n = 296) would share experiences with colleagues and seek support when feeling under stress. Regression model showed that age, past experience in handling grieving parents and nurses’ perceived attitudes to hospital policy and training provided for bereavement cares were factors associate with nurses’ attitudes towards perinatal bereavement care. Conclusions. Hong Kong nurses emphasized their need for increased knowledge and experience, improved communication skills and greater support from team members and the hospital for perinatal bereavement care. Relevance to clinical practice. These findings may be used for health policy makers and nursing educators to ensure delivery of sensitive bereavement care in perinatal settings and to enhance nursing school curricula respectively.     

Governing nursing conduct: the rise of evidence-based practice

Drawing on the Foucauldian concept of 'governmentality' to analyse the evidence-based movement in nursing, we argue that it is possible to identify the governance of nursing practice and hence nurses across two distinct axes; that of the political (governance through political and economic means) and the personal (governance of the self through the cultivation of the practices required by nurses to put evidence into practice). The evaluation of nursing work through evidence-based reviews provides detailed information that may enable governments to target and instruct nurses regarding their work in the interest of preserving the health of the population as a whole. Political governance of the nursing population becomes possible through centralised discursive mechanisms, such as evidence-based reviews that present nursing practice as an intelligible field whose elements are connected in a more or less systematic manner. The identity of the evidence-based nurse requires the modern nurse to develop new skills and attitudes. Evidence-based nursing is an emerging technology of government that judges nursing research and knowledge and has the capacity to direct nursing practice at both the political and personal level.     

成人护理教学课程设置需求的调查与分析

目的 了解成人护理专升本学生、用人单位护士长对教学内容、授课方式、考核方式、最缺乏的知识和能力及需要加强的专科护理能力方面的评价,为教学改革提供一定理论依据.方法 采用自行设计的调查问卷对成人护理专升本在校生159人、毕业生134人及用人单位护士长97人进行调查.结果 调查对象较认同的授课方式为案例教学;考核方式为传统笔试,实践组织形式为边理论边实习;最缺乏的知识和能力为科研能力;学生最需要加强的专科护理能力为急诊急救护理;用人单位护士长最需要加强的专科护理能力为重症监护.学生对临床管理能力、沟通能力、临床教学能力、健康教育能力、临床教学能力、中医护理技能、中医护理知识、西医护理知识的需求均高于护士长(P＜0.01或P＜0.05),并且学生认为最需要加强的重症监护和精神科护理能力均高于护士长(P＜0.01或P＜0.05).结论 成人护理专升本教育仍存在教学内容重复的问题,对于授课方式、考核方式有待进一步调整.     

护理人员循证护理实践基本素质构成及研究现状

目的探讨护理人员循证护理基本素质构成及研究现状。方法通过国内外学者对护理人员循证护理基本素质构成分析,明确护理人员循证护理基本素质的构成,并分析目前的现状。结果循证护理的基本素质包括循证知识、循证技能、循证行为与循证态度;护理人员均具备有较高的循护理态度,但在知识及技能方面较缺乏。结论通过对护理人员循证护理素质的阐述,建议可通过进一步对临床护理人员的循证护理基本素质进行调查研究。并明确护理人员在实践循证护理过程的困难,可为开展循证护理教育、管理及实践提供了理论依据,促进循证护理的发展。     

Dissemination of Nursing Knowledge: The Application of the Model of Change

Despite the dramatic growth of nursing research and the development of nursing theory over the last 25 years, concern remains that nurses frequently fail to base their practice on the findings and recommendations of research. It is through research conducted by nurses that new knowledge can be obtained in order to implement good quality care in clinical practice. However, even when new knowledge is gained, its dissemination remains low. Several barriers to the dissemination of nursing knowledge in clinical practice have been identified. These include: lack of awareness of nursing research, lack of knowledge of the research process and the inability to understand research reports. These factors may contribute to negative attitudes among nurses regarding the use of nursing research in their clinical practice. However, research must filter down from academia to practicing nurses at all levels but it cannot make practicing nurses use research. One of the main priorities in the dissemination of nursing knowledge in clinical practice is to make research findings more “user friendly.” The use of a clinical nurse specialist or research nurse (that is a nurse with a defined role within research), combined with an action research approach, could increase the utilization of research findings in clinical nursing. The use of Journal club, research seminars, research workshops and nursing conferences are some of the enabling process in order to increase the dissemination of knowledge. The use of the model of change would enable us to understand whether nurses have the readiness to change and implement new nursing knowledge in to practice.