我国临床护理人员循证护理实践研究进展

探讨了循证护理实践的概况及相关概念,从我国临床护理人员的角度剖析循证护理实践的必要性及意义,阐述了循证护理实践程序及注意事项,并分析了当前临床护理人员循证护理实践中存在问题的原因,提出了加强我国循证护理实践的对策。     

我国临床护士循证护理实践技能的研究进展

2012年,著名医学期刊《柳叶刀》有一篇题为护理实践的科学性(science for action-based nursing)的编者按,鼓励全球护理人员大胆迈步拥抱证据,让护士真正置身于全球循证实践的核心,文章强调对于转型中的中国,更要通过循证实践来提升护理服务水平[1]。护士作为循证护理实践的主体,其循证护理的实践技能对循证护理的顺利开展起关键性作用。笔者就国内临床护士循证护理实践技能的研究进展综述如下。     

循证护理的实践模式

循证卫生保健(Evidence-based Health Care,EBHC)来源于英国临床流行病学家Archie Co-chrane关于医疗卫生保健的疗效和效益问题的阐述,他认为卫生资源是极为有限的,因此这些资源就应该被有效地利用;应通过评价,证明利用这些资源达到了理想的效果.     

肿瘤护理的循证实践

本文介绍了以循证为基础的实践(Evidence Based Practice,EBP)的起源、发展、概念、方法和过程,以及循证实践与肿瘤护理的密切联系,目的在于让肿瘤护士了解EBP的历史背景、发展过程、护士在EBP中发挥的作用以及肿瘤护士在推广和应用EBP的实践过程中遇到的挑战,以期切实将EBP融入临床护理中,从而为患者提供安全、有效和经济的高质量护理。     

影响国外康复治疗师开展循证实践的因素及启示

循证实践（EBP）兴起于20世纪七八十年代的循证医学领域,目前已得到迅速的发展并应用于康复医疗服务领域,但其开展仍受各种内部和外部因素的影响。本文系统论述了国外康复医疗服务中影响康复治疗师开展EBP的因素,如组织环境、教育培训、实践时间等,并从中归纳出促进我国康复治疗师开展EBP的建议及对策,以期在我国康复医疗服务中为进一步开展EBP提供参考和帮助。     

循证护理实践

循证护理作为一种全新的、科学的工作方法,近年来在国内迅速发展,受到护理界的广泛关注.为推进循证护理在我国护理实践中的应用,对循证护理的定义、内涵,循证护理教育、循证护理信息资源、循证护理基本实践步骤以及循证护理实践中应注意的问题进行综述,以便为护理工作者奠定循证护理的理论和实践基础,将循证护理科学的运用于临床,为患者提供安全、优质、高效的护理服务.

Abstract：

As a newly and scientific method, evidence - based nursing had be rapidly developped. In this article, the definition, meaning, education, information resource, the step of basic practice and so on were summarized for advancing evidence - based nursing to be applied, so as to establish theory and practice foundation and provide safety, high quality and effective nursing to the patients     

循证护理培训对临床护理教师循证实践能力影响的研究

[目的]了解循证护理培训对临床护理教师循证实践能力的影响。[方法]选择乌鲁木齐市某三级甲等医院193名临床护理教师,采用自行设计问卷对培训前后其循证实践能力进行比较。[结果]循证护理培训前后临床护理教师循证护理知识和技能水平评分比较差异有统计学意义,培训前后循证护理态度评分比较差异无统计学意义,但条目得分均值较高。[结论]循证培训应结合临床现状,成立循证护理小组,突破证据检索与评价的瓶颈问题,促进循证护理实践的发展。     

循证护理:理论与实践

长期以来 ,护理实践的特点就是按照工作程序提供护理服务 ,在用科学证据指导临床护理决策和行动方面存在局限性。在讲求证据的年代 ,护士应积极寻求现时的证据来更新知识结构 ,增强解决问题的能力 ,为病人提供高效优质的护理 ,以满足 2 1世纪循证的要求 ,迎接所面临的挑战。循证护理实践就是实现此目标的一个很好的方法。文章从认识循证医学的内涵及以科学证据为基础的实践对临床护理服务影响的角度出发 ,主要讨论证据的质量分级、循证护理实践的主要步骤及其与临床路径的相互关系、我国循证护理实践现状、护理人员实施循证护理面临的挑战。     

我国循证护理实践中的问题及对策

循证护理 (Evidence—basednursing ,EBN)是伴随着循证医学的发展而出现的一种新的护理理念。如今 ,“循证”观念正在向许多其他学科渗透 ,如循证精神卫生、循证护理、循证卫生管理等。其中循证护理既是循证医学的重要组成部分 ,又是一独立的实践与研究领域 ,已引起世界上许多国家的重视。循证护理是护理人员在计划其护理活动过程中 ,将科研结论与临床经验 ,病人需求相结合 ,获取实证 ,作为临床护理决策的依据的过程[1] 。随着我国护理事业的发展 ,临床护理、护理科研和护理教育体系不断完善 ,以“实证”为基础的循证护理开始受到学术界和…     

我国循证护理实践的发展现状及相关障碍

循证护理作为一种新护理理念,已经渗透到护理实践的各个领域,在临床护理、护理教育、护理管理、健康教育等方面都有不同程度的应用,本文主要对近年来我国循证护理实践的现状及障碍进行分析和探讨,从而为促进我国循证护理实践提供借鉴。     

A critical realist approach to knowledge: implications for evidence-based practice in and beyond nursing

This paper will identify some of the key conceptual tools of a critical realist approach to knowledge. I will then apply these principles to some of the competing epistemologies that are prevalent within nursing. There are broadly two approaches which are sometimes distinct from each other and sometimes inter-related. On one side, there is the view that all healthcare interventions should be judged on the principles of randomised controlled trials and the other is a preoccupation with language in which healthcare interventions are subjected to a discursive interrogation. These debates are configured through the idea of a hierarchy of knowledge that is accorded uncritical acceptance by some and virulent distaste by others. I will argue that the notion of hierarchy is problematic and is largely argued for in unproductive epistemological terms. What is required is a shift towards a theory that emphasises the contextual nature of the ways that knowledge is produced and disseminated. In other words, there is no single hierarchy of knowledge, but there are multiple hierarchies of knowledge.     

Nursing based evidence: moving beyond evidence-based practice in mental health nursing

Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplines favour knowledge developed using quantitative methodologies so they and evidence-based practice (EBP) and evidence-based nursing (EBN), increasingly called for in mental health nursing, fit seamlessly together. Nevertheless, as these movements dismiss qualitative approaches to knowledge (evidence) development, I argue against the move toward EBP/EBN in mental health nursing. This is because the specialty's primary interests - human experiences of illness/health care and human relationships, often do not lend themselves to being quantitatively researched. Using nursing examples, I demonstrate how qualitative research, wholly unacceptable in relation to EBP/EBN quality of evidence scales, is indispensable to mental health nursing. The need for evidence arising from qualitative research in no way precludes the need for quantitatively derived evidence. Indeed, the specialty's twofold interest - the work of nurses with clients and the explication of phenomena which inform practice, require diverse knowledge and thus, diverse research approaches. This twofold interest defines the area of mental health nursing practice, and knowledge informing it is referred to as nursing based evidence (NBE). Because it values multiple approaches to knowledge development, NBE provides a way to articulate the specialty's distinct contribution to the health care of people experiencing mental illness and advances mental health nursing.     

循证护理在国内的研究进展

综述了循证护理在我国的研究进展，包括循证护理的概念、方法、在我国的开展情况及在国内发展的影响因素，并指出在国内开展循证护理势在必行。     

Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing: independent nurse prescribers' views

Aim. The purpose of this study was to explore nurses’ conceptions of evidence and evidence‐based practice, whether there are differences between evidence‐based practice and evidence‐based medicine and to identify the uptake of research evidence in the workplace. Background. The use and comprehension of the term ‘evidence‐based practice’ in relation to nursing shows remarkable variation. Numerous definitions are provided, some tend to be closely related to the concept ‘evidence‐based medicine’. Independent nurse prescribers need to be able to understand the concept of evidence‐based practice to utilize and apply this concept in order to provide adequate medication management of their patients. Method. Data were generated by focus group interview and open question questionnaire and analysed by analytical abstraction. Results. Nurses offered a variety of views on the use and uptake of evidence in the workplace. Some nurses acknowledged that they did not read research papers but were aware that they used a lot of evidence in their practice. Nurses had difficulty differentiating evidence‐based practice from evidence‐based medicine. Conclusions. Nurses were familiar with the research process but not the canons of evidenced‐based practice. The data generated indicate different levels of evidence are used by nurses. This may be a reflection of the level of intrigue of the nurses involved. Relevance to clinical practice. The education and training of independent nurse prescribers should include the exploration of evidence from randomized controlled trials and from naturalistic studies and their contribution to evidenced‐based practice and evidence‐based medicine. Both concepts need to be explored in relation to the medication management of patients.     

在护理安全管理中引入循证思维的做法与体会

目的用循证思维方式对护理安全进行科学控制和管理,确保病人安全。方法对护理安全管理中存在的问题,应用循证的分析方法,利用文献寻找护理安全管理的依据和决策,经过科学论证后组织实施。结果降低了护理差错发生率（P〈0．05）,病人对护理工作满意度明显提高（P〈0．01）。结论在护理安全管理中引入循证思维,可以为护理安全提供科学的管理方法,提高工作质量,有效保障病人安全。     

A review of evidence-based practice, nursing research and reflection: levelling the hierarchy

Aim. This paper examines the evidence‐based practice movement, the hierarchy of evidence and the relationship between evidence‐based practice and reflective practice. Background. Evidence‐based practice is equated with effective decision making, with avoidance of habitual practice and with enhanced clinical performance. The hierarchy of evidence has promoted randomized control trials as the most valid source of evidence. However, this is problematic for practitioners as randomized control trials overlook certain types of knowledge that, through the process of reflection, provide useful information for individualized and effective practice. Method. A literature search was undertaken using CINAHL, medline and Ovid electronic databases in early 2006. The search terms used were: evidence‐based practice, research evidence, evidence for practice, qualitative research, reflective practice, reflection and evidence. Other sources included handpicking of books on evidence‐based practice, reflection and research. Only material written in English was included. Findings. The hierarchy of evidence that has promoted randomized control trials as the most valid form of evidence may actually impede the use of most effective treatment because of practical, political/ideological and epistemological contradictions and limitations. Furthermore, evidence‐based practice appears to share very similar definitions, aims and procedures with reflective practice. Hence, it appears that the evidence‐based practice movement may benefit much more from the use of reflection on practice, rather than the use of the hierarchical structure of evidence. Conclusion. Evidence‐based practice is necessary for nursing, but its’ effective implementation may be hindered by the hierarchy of evidence. Furthermore, evidence‐based practice and reflection are both processes that share very similar aims and procedures. Therefore, to enable the implementation of best evidence in practice, the hierarchy of evidence might need to be abandoned and reflection to become a core component of the evidence‐based practice movement. Relevance to clinical practice. Provides an elaborated analysis for clinical nurses on the definition and implementation of evidence in practice.     

循证护理对临床护理管理的启示

循证护理作为护理学科的新领域,对护理学科的发展起到十分重要的推动作用,可以在包括护理行政管理、查房管理、带教管理、科研管理、健康教育等多个方面为临床护理管理提供启示,作为临床护理管理者要掌握并灵活运用循证护理以促进护理学科的发展.     

Using action research to construct national evidence-based nursing care guidance for gerontological nursing

Aim. This paper explores the development of a low‐cost, involving methodology for constructing nursing‐focused evidence‐based national care guidance, known as Best Practice Statements, the intended users of which are gerontological nurses practising throughout Scotland. Design. The Best Practice Statement construction methodology forms one cycle in a five‐year longitudinal action research study that aims to achieve evidence‐based nursing, facilitate professional networking to support practice development and promote the principles and practice of gerontological nursing. Achieving these aims involved designing a virtual Practice Development College. Methods. A Community of Practice comprising practising gerontological nurses, expert advisors, academic teaching and research nurses collaborated in face‐to‐face meetings and in the virtual Practice Development College to delineate and refine the procedural model for Best Practice Statement construction. Focus groups, telephone interviews, analysis of on‐line archives and documentary outputs formed the analytic dataset. Results. Qualitative analysis indicated that, from the perspective of the community of practice, the emerging methodology facilitated the melding of knowledge sources reflecting the dominant evidence hierarchy with other forms of evidence valued by gerontological nurses, in the Best Practice Statement. Relevance to clinical practice. Current methods of care guidance construction rarely address the concerns of nurses and the evidence from which guidelines are developed is narrowly defined with regard to inclusion and acceptability. In contrast this model focuses on nursing issues, embraces a wider definition of evidence and ensures that the published Best Practice Statements are credible and achievable in gerontological practice, where they are tested and refined as an inherent aspect of the development process.     

循证护理在护理实践中的运用

循证护理就是慎重、准确和明智地应用当前所能获得的最好的研究证据，同时结合护理专业技能和多年临床经验，考虑患者的价值和愿望，将三者完美地结合，制定护理措施。循证护理实践是依据科学证据基础的临床实践，是指整合患者主客观资料与科学证据为最佳状态，它既是服务对象的需求，又是护理学发展的必然，它证明了护士自身价值，使护理活动更加科学化、专业化、为护理学科提高权威性、独立性，促进学科的发展提供了机遇。本文对循证护理的概念与产生背景，循证护理促进独立学科体系的形成，循证护理方法的认识及应用方面存在的一些误区进行分析，认为循证护理是一种模式或工作形式，同时循证护理在护理实践运用中护理问题期待研究证据，整个过程进行系统评价，以及护理实践所面临的新使命及合理运用，着重阐述了循证护理必须从问题出发，重视证据、重视整体观，注重个体化差异，只有这样，才能切实推进循证护理在我国护理实践中的运用。