护理临床研究中干预方案的制定

干预方案的设计是实验性研究中的一个重要环节,直接影响护理和研究的质量和结局。有效护理干预方案的制定须经历一个严谨的过程。本文借助笔者的设计经验提出护理临床研究中干预方案的制定的三个重要步骤：1围绕研究主题建立干预的概念框架;2建立以循证为基础的干预方案,包含目标群体、实施方法、干预特性、护理剂量（成分、数量、频次和周期）、干预者和干预管理;3实施前对干预方案进行审核和测试。     

Remodeling Adult Nursing

This article describes a nursing education experience in which a critical thinking approach was planned and implemented. Background discussion on critical thinking concepts and related research provides a foundation for presentation of the Mackie teaching model. The model uses a community-based, family-centered scenario as the basis for developing problemfocused nursing intervention skills from a holistic viewpoint. Role expectations of students and faculty are outlined, and related implementation difficulties, together with their resolution strategies, are described. Evaluation methods and outcomes are reviewed in the conclusion.     

Increasing value and reducing waste by optimizing the development of complex interventions: Enriching the development phase of the Medical Research Council (MRC) Framework

BackgroundIn recent years there has been much emphasis on ‘research waste’ caused by poor question selection, insufficient attention to previous research results, and avoidable weakness in research design, conduct and analysis. Little attention has been paid to the effect of inadequate development of interventions before proceeding to a full clinical trial.ObjectiveWe therefore propose to enrich the development phase of the MRC Framework by adding crucial elements to improve the likelihood of success and enhance the fit with clinical practiceMethodsBased on existing intervention development guidance and synthesis, a comprehensive iterative intervention development approach is proposed. Examples from published reports are presented to illustrate the methodology that can be applied within each element to enhance the intervention design.ResultsA comprehensive iterative approach is presented by combining the elements of the MRC Framework development phase with essential elements from existing guidance including: problem identification, the systematic identification of evidence, identification or development of theory, determination of needs, the examination of current practice and context, modelling the process and expected outcomes leading to final element: the intervention design. All elements are drawn from existing models to provide intervention developers with a greater chance of producing an intervention that is well adopted, effective and fitted to the context.ConclusionThis comprehensive approach of developing interventions will strengthen the internal and external validity, minimize research waste and add value to health care research. In complex interventions in health care research, flaws in the development process immediately impact the chances of success. Knowledge regarding the causal mechanisms and interactions within the intended clinical context is needed to develop interventions that fit daily practice and are beneficial for the end-user.     

An exemplar of the use of NNN language in developing evidence-based practice guidelines.

PURPOSE. To explore the use of standardized language, NNN, in the development of evidence-based practice (EBP). DATA SOURCES. Published research and texts on family interventions, nursing diagnoses (NANDA-I), nursing interventions (NIC), and nursing outcomes (NOC). DATA ANALYSIS. Research literature was summarized and synthesized to determine levels of evidence for the NIC intervention Family Integrity Promotion. CONCLUSIONS. The authors advocate that a "standards of practice" category of levels of evidence be adopted for interventions not amenable to randomized controlled trials or for which a body of research has not been developed. Priorities for nursing family intervention research are identified. IMPLICATIONS FOR NURSING PRACTICE. The use of NANDA-I nursing diagnoses, NIC interventions, and NOC outcomes (NNN language) as research frameworks will facilitate the development of EBP guidelines and the use of appropriate outcome measures.     

The development of evidence-based nursing interventions: methodological considerations

BACKGROUND: The call for evidence-based practice presents numerous challenges to nurses who are responsible for developing interventions and expanding the associated knowledge base. The challenge is compounded because there is limited literature concerning development of interventions and their evidence base. AIM: The purpose of this article is to present a model that has been successfully used to guide the process of developing and testing complex nursing interventions, especially those in which the experience of the client plays an important role. DISCUSSION: The model consists of four stages: problem definition, accumulation of building blocks for intervention design, intervention design and intervention validation. Each stage is described and examples from research studies are presented. Specific attention is given to the manner in which the model allows for the accumulation of empirical evidence and theory development during the development process. CONCLUSIONS: Use of the model could facilitate effective communication among nurses, researchers and educators when discussing the development and testing of nursing interventions.     

Towards a nursing minimum data set for Ireland: making Irish nursing visible

AIM: The aim of this study was to identify patient problems, nursing interventions and nursing outcomes to be included in a nursing minimum data set for Ireland. BACKGROUND: In 2002, a research programme funded by the Irish Health Research Board, was established to develop and test a nursing minimum data set to capture the nursing contribution to patient care in Ireland. A nursing minimum data set is comprised of the smallest number of information items required to capture the range of patient problems, nursing interventions and nursing outcomes recorded by nurses on a regular basis. Nursing minimum data sets have been developed in several countries for a range of applications such as workforce planning, financing nursing care, examining patient profiles and forecasting trends in nursing diagnoses. METHOD: Eleven focus groups were conducted with 59 registered general nurses to explore their conceptualizations of patient problems, nursing interventions and nursing outcomes. In addition, data relating to nurses' recordings of patient problems, nursing interventions and nursing outcomes were collected from a sample of 45 sets nursing records. The research took place between January 2003 and April 2004. FINDINGS: A range of patient problems, nursing interventions and outcomes were identified that were similar to those found in existing nursing minimum data sets. However, several new items and categories of items were also identified, justifying the empirical approach taken to generate the initial list of items. Data from nursing records supported several points raised in focus groups and also highlighted some inconsistencies between nurses' perceptions and recordings of what they do. CONCLUSION: Our research identified several new types of indirect interventions and managing/organizing activities in addition to items found in existing nursing minimum data sets. The importance of these aspects of the nursing contribution to patient care will be tested further in the development of the Irish nursing minimum data set.     

High fidelity simulation evaluation studies in nursing education: A review of the literature

Simulation is an experiential learning process which provides a safe environment for learning, preventing the risk of patient harm. A review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach to explore the question: What is the state of the science on the evidence of learning outcomes in high-fidelity simulation in undergraduate nursing education?This synthesis included 20 research studies focusing on evaluating outcomes of high-fidelity simulation in undergraduate pre-licensure baccalaureate nursing students. Studies were excluded if they did not use high-fidelity simulation for the intervention group, or they evaluated faculty outcomes.Simulation design and practices are identified and discussed regarding dose and fidelity. Outcome measures reviewed include increasing levels of thinking: Remembering/Understanding/Applying (knowledge/skills), Analyzing/Perception, and Evaluating/Creating outcomes. Design of high-fidelity simulation in the nursing literature is being grounded in outcome variables with increasing levels of thinking (Bloom's Taxonomy) and based in pedagogical and nursing judgment theoretical frameworks. Reliable measurement tools are used. There is a need for a more comprehensive measurement of clinical competence that extends evaluation to clinical practice outcomes. Additional research is needed on retention of simulation learning over time and assessing transference of simulation learning into clinical nursing practice.     

An Exemplar of the Use of NNN Language in Developing Evidence‐Based Practice Guidelines

PURPOSE. To explore the use of standardized language, NNN, in the development of evidence‐based practice (EBP). DATA SOURCES. Published research and texts on family interventions, nursing diagnoses (NANDA‐I), nursing interventions (NIC), and nursing outcomes (NOC). DATA ANALYSIS. Research literature was summarized and synthesized to determine levels of evidence for the NIC intervention Family Integrity Promotion. CONCLUSIONS. The authors advocate that a “standards of practice” category of levels of evidence be adopted for interventions not amenable to randomized controlled trials or for which a body of research has not been developed. Priorities for nursing family intervention research are identified. IMPLICATIONS FOR NURSING PRACTICE. The use of NANDA‐I nursing diagnoses, NIC interventions, and NOC outcomes (NNN language) as research frameworks will facilitate the development of EBP guidelines and the use of appropriate outcome measures.     

Critical thinking and nursing science: judgment,or vision?

For decades, critical thinking has been widely regarded as a concept and process of central importance in the practice of nurses and in their education. Numerous nursing textbooks heavily emphasize the development of critical thinking skills in students. The attention given to critical thinking in nursing parallels a reform movement that has had an impact on virtually all fields. Close attention to the ways in which critical thinking is addressed in nursing, however, reveals a starkly delimited view of its meaning within the discipline. This article questions whether the vision of critical thinking as a cornerstone of practice in nursing may need to be expanded. The discussion centers on three points: nursing theories and frameworks as ways to enrich critical thinking in nursing practice; the inadequacy of the model of critical thinking as an individual, analytical process; and possibilities that are cocreated when critical thinking is conceived as a creative/constructive, relational/dialogical process.     

Critical thinking and accuracy of nurses' diagnoses. Part I: Risk of low accuracy diagnoses and new views of critical thinking

Interpretations of patient data are complex and diverse, contributing to a risk of low accuracy nursing diagnoses. This risk is confirmed in research findings that accuracy of nurses' diagnoses varied widely from high to low. Highly accurate diagnoses are essential, however, to guide nursing interventions for the achievement of positive health outcomes. Development of critical thinking abilities is likely to improve accuracy of nurses' diagnoses. Newer views of critical thinking serve as a basis for critical thinking in nursing. Seven cognitive skills and ten habits of mind are identified as dimensions of critical thinking for use in the diagnostic process.     

Development and testing of a caring-based intervention for older adults with heart failure

The clinical and cost burdens of heart failure (HF) continue to rise, creating an immediate need for cost-effective interventions geared toward improving health outcomes. This article describes the development and testing of a caring-based nursing intervention for older adults with advanced HF who have been recently discharged from acute care. The developmental process and components of the intervention are presented. A methodology for testing the intervention is also introduced. Through a phased development process including research, this intervention can be refined and used to guide clinicians, administrators, and policymakers in the provision of high-quality care to older adults with HF.     

Conceptual models for population-focused public health nursing interventions and outcomes: the state of the art

The conceptual basis of public health nursing (PHN) has evolved particularly over the past three decades. In October 2010, a national research agenda setting conference was held with grant support from the Agency for Healthcare Research and Quality. From the conference, public health nursing intervention models emerged as one of four top priorities. The need for a stronger theoretic base that can guide population-focused nursing practice and research was strongly emphasized. The purpose of this review, in concert with this priority, is to analyze the current status of PHN conceptual models. Based on the review, a set of recommendations is presented related to future conceptual development and testing, with an emphasis on PHN interventions and outcomes. A key recommendation is the refinement of the existing conceptual models with perhaps some consolidation of models, thereby establishing strong grand, middle-range and practice theories that include explicit PHN intervention and outcome components. Another recommendation calls for rigorous comparative analysis and testing. Professional support from the PHN community along with funding agencies will be needed to implement the recommendations related to PHN theory development and testing.     

Methodological issues in researching palliative care nursing practice.

The purpose of this integrative review was to describe the research conducted by nurses since the mid-1990s on nursing practice in the context of palliative/end-of-life care, identify promising methodological developments as well as methodological challenges, and propose strategies to support the development of this field of nursing research. A search of databases resulted in 121 research reports published between 1995 and 2003. Studies were included if the lead author was a nurse and the focus was nursing practice or nurses' attitudes about providing palliative or end-of-life care. Relatively few studies included patients, there were limitations in the data-collection methods used, and there was a lack of studies evaluating palliative care nursing. An emphasis on the interdisciplinary nature of palliative care may be hindering nurses from examining the effectiveness of nursing interventions. Increased attention should be given to examining the efficiency and effectiveness of nursing interventions to ensure the best outcomes for patients and their families.     

Clinical intervention research in nursing

As a healthcare profession nursing has a duty to develop practices that contribute to the health and well being of patients. The aim of this paper is to discuss current issues in clinical research within nursing. The paper defines clinical interventions research as a theoretically based, integrated and sequential approach to clinical knowledge generation. The paper provides specific criteria for defining a clinical intervention together with an overview of the stages involved in clinical research from problem identification to implementing knowledge in practice. The paper also explored the extent to which nursing research was focussed on clinical issues, through a snapshot review of all the original research papers in Europe’s three leading nursing research journals. In total of 517 different papers were included and classified in the review. Of these 88% (n = 455) were classified as non-clinical intervention and 12% (n = 62) as clinical intervention studies. The paper examined the intervention studies in detail examining: the underpinning theory; linkage to previous (pre-clinical) work; evidence of granularity; protocol clarity (generalisable and parsimonious); the phase of knowledge development; and evidence of safety (adverse event reporting). The paper discusses some of the shortcomings of interventions research in nursing and suggests a number of ideas to help address these problems, including: a consensus statement on interventions research in nursing; a register of nursing intervention studies; the need for nursing to develop clinical research areas in which to develop potential interventions (nursing laboratories); and a call for nursing researchers to publish more research in nursing specific journals.     

Enhancing the evaluation of nursing care effectiveness.

Evaluating the effectiveness of nursing care is necessary for developing a sound knowledge base to guide practice. Several studies have been conducted to evaluate the effectiveness of nursing care or interventions in producing the desired outcomes. While the results of these studies are encouraging, they do not provide a comprehensive and realistic evaluation of the contribution of nursing. Factors related to patient characteristics and implementation of care are not accounted for. The outcomes selected do not reflect the direct benefits of nursing care or interventions. In this paper, research methods for conducting effectiveness research in a way that would identify the unique contribution of nursing care delivered under the conditions of the real world of everyday practice are discussed. Examples are provided to illustrate the points of discussion.     

Intervention fidelity

BACKGROUND: Although an assumption of consistency in intervention delivery is key to the conclusion that the findings are valid, attention to both interventionist adherence and competence has not become a standard in nursing intervention research. OBJECTIVES: The purpose of this article is to describe the technology model of intervention fidelity as it applies to psychosocial interventions, and to propose its application in nursing intervention research as a way to support accurate conclusions about validity. METHODS: The features and methods of the Technology Model of intervention fidelity were reviewed. The review included development of a manual, training and supervision of interventionists, measurement of intervention fidelity, and inclusion of intervention fidelity as an independent variable in the analysis. RESULTS: The Technology Model and the associated methodologies that have been used to monitor psychosocial intervention fidelity in psychiatry can be adapted and applied by nursing. Monitoring costs can be managed through use of a general system that can be applied across programmatic or related studies. CONCLUSIONS: Application of the Technology Model of intervention fidelity could advance the maturation of nursing intervention research and evidence-based clinical practice.     

Cognitive therapy integrated with life review techniques: an eclectic treatment approach for affective symptoms in older adults

Background. An important aspect of nursing theory development has been the adaptation of theory from other disciplines within the metaparadigm of nursing. This eclectic approach to theory development enhances the broad humanistic theory base on which effective, professional nursing practice is based. Aims and objectives. The aim of this article is to describe the process of integrating two distinct psychotherapeutic approaches into one coherent mental health nursing intervention for the treatment of affective symptoms in older adults. Guidelines for using this integration process in psychiatric mental health nursing clinical practice are presented and illustrated through the case study approach. Methods. A case study is presented describing a clinical situation in which life review techniques were used to enhance the outcomes of a cognitive therapy experience for older adults enrolled in outpatient psychotherapy treatment for acute adjustment disorder with an affective component. Conclusions and relevance to clinical practice. The advanced practice psychiatric mental health nurse who approaches psychotherapeutic interventions with older adult clients from an eclectic approach can achieve successful outcomes by having a clear understanding of (i) the dynamics of the various psychotherapeutic approaches, (i) the skill level of the practitioner, (iii) the psychosocial sophistication of the client, and (iv) the pathology being treated. In addition, active involvement by the client in a treatment process that matches his/her psychosocial skill and coping resource level will contribute to effective resolution of pathology. A cognitive therapy approach supplemented by life review techniques is an excellent example of an effective, eclectic treatment approach of affective disorders in older adults.