实习生整体护理观与护理程序应用能力评价指标体系的构建

目的探讨临床实习生整体护理观与整体护理能力评价指标体系的构建。方法在查阅相关文献资料的基础上,通过调研和咨询,初步拟订临床护生整体护理观与护理程序应用能力评价指标体系草案,然后采用德尔菲法对体系草案进行两轮相关专家专业咨询;以权威程度、协调程度、积极系数检验专家咨询的可靠性;采用优序图和层次分析法确定指标权重。结果两轮积极系数均为1．0;专家权威系数0．936;变异系数0．000～0．2245;协调系数0．414-0．924。经两轮专家咨询后,意见趋向集中,汇总评价体系共包涵5个一级指标,21个二级指标。结论专家意见协调程度及专家权威程度高,结果可取;所构建的实习生整体护理观与护理程序应用能力评价指标体系,可作为衡量护生临床所具备的整体护理素质和能力的测评工具。     

基于移动医疗的儿童1型糖尿病院外健康管理内容体系的构建

目的构建儿童1型糖尿病(T1DM)院外健康管理内容体系,为临床护理人员开展针对性的健康教育和评估提供依据。方法于2019年4月成立研究小组,以移动医疗为指导,通过文献回顾、半结构式访谈和专家会议构建儿童T1DM院外健康管理内容体系初稿。从北京市、上海市、河南省、浙江省等省/直辖市的11所三级甲等儿童专科/综合医院儿科病房遴选20名专家,应用德尔菲法进行2轮咨询,构建基于移动医疗的儿童T1DM院外健康管理内容体系并进行修订,形成终稿。结果经过2轮专家咨询后20名专家的意见趋于一致,2轮专家咨询问卷回收率均为100.0%,专家熟悉程度为0.96,专家判断依据为0.98,权威系数为0.97,最终构建的儿童T1DM院外健康管理内容体系包含6个一级指标,14个二级指标,69个三级指标。结论本研究构建的儿童T1DM院外健康管理内容体系科学、全面,能够为临床护理人员进行基于移动医疗的院外健康管理和评价效果提供理论参考。     

高职护生基础护理操作技能评价体系的初步构建

[目的]构建高职护生基础护理操作技能评价内容及权重。[方法]研究小组2016年2月—2016年12月通过理论分析、文献回顾、专家访谈等多种方法了解现有的高职护生基础护理操作技能评价的方法及不足之处,构建高职护生基础护理操作技能评价的初稿。运用两轮专家咨询明确高职护生基础护理操作技能评价的维度、条目及指标,应用层次分析法计算评价体系的各条目的权重。[结果]经历两轮专家咨询,入选专家20名。两轮咨询中专家共提出建议40条。最终确立了高职护生基础护理操作技能评价体系的结构,包括基本素质、评估准备、技能操作和综合评价4个维度和17个条目。4个维度中技能操作维度最重要;条目层中应变能力等所占权重高。[结论]通过系统的研究方法进一步明确高职护生基础护理操作技能评价的内容和权重。     

脑卒中吞咽障碍患者护理质量评价指标的构建

目的 构建脑卒中吞咽障碍患者护理质量评价指标,为临床脑卒中吞咽障碍患者护理质量评价提供依据。 方法 以“结构-过程-结果”三维质量管理模型为理论基础,通过文献回顾和头脑风暴法构建评价指标初稿,2021年3月—5月通过2轮德尔菲专家咨询对指标进行增、删及修改,使用层次分析法确定指标权重。 结果 共对21名专家进行2轮专家咨询,问卷回收率分别为100%和95.23%,专家权威系数分别为0.958、0.964,肯德尔和谐系数分别为0.216、0.340（P<0.001）,各级指标的重要性赋值均数为3.90~5.00分,最终构建的脑卒中吞咽障碍护理质量评价指标包括3个一级指标、9个二级指标和35个三级指标。 结论 该研究构建的脑卒中吞咽障碍患者护理评价指标科学、合理、全面且具有针对性,能够为脑卒中吞咽障碍患者的护理质量评价提供参考。     

基于徳尔菲专家咨询形成脑卒中后肩手综合征临床护理规范

目的采用德尔菲专家咨询法对系统检索与筛选的脑卒中后肩手综合征的最佳证据进行专家论证,形成符合临床情境的脑卒中后肩手综合征护理规范。方法按照证据等级的高低分别系统地检索和筛选相关指南、证据总结、系统评价、原始研究、专家共识,并由2名接受过JBI循证培训的研究者分别采用AGREEⅡ、JBI针对系统评价、随机对照试验/类实验性研究和专家共识的质量评价工具对纳入的指南、系统评价、原始研究和专家共识进行质量评价,并对纳入文献进行分类汇总,筛选提取脑卒中后肩手综合征相关的推荐建议和结论。根据文献汇总结果形成脑卒中后肩手综合征临床护理规范初稿,采用德尔菲法,选择25名相关领域专家进行2轮专家咨询,对初稿内容进行论证。结果本研究共纳入8篇指南、1篇证据总结、2篇系统评价、7篇原始研究、2篇专家共识。指南总体质量评价均为B级;1篇证据总结质量良好,为Grade B;2项系统评价的总体质量较低,7项原始研究的整体质量一般。脑卒中后肩手综合征临床护理规范初稿包括6项内容框架和29条推荐建议。进行2轮专家咨询,问卷回收率分别为89.28%和100%,专家权威系数分别为0.864和0.894,第2轮专家咨询中重要性的内容框架和推荐建议的Kendell's W分别为0.118(P<0.05)和0.188(P<0.001)。根据专家咨询的论证结果,形成脑卒中后肩手综合征临床护理规范,包括6项内容框架,共31条推荐建议。结论脑卒中后肩手综合征临床护理规范基于现有最佳证据并进行专家论证,符合我国临床情境,能够更好地用于临床护理工作。     

基于建构主义学习理论构建护士的死亡教育方案

目的以建构主义学习理论为视角,构建护士的死亡教育方案,为对护士进行死亡教育提供参考。方法2020年7月开始通过文献内容分析法,初步拟订死亡教育方案草案,选取23名专家开展2轮专家函询,形成死亡教育方案初稿,通过预试验验证其可行性,并进一步修订形成死亡教育方案终稿。结果第2轮专家函询专家判断依据、专家熟悉程度、专家权威系数分别为0.92、0.89、0.91。死亡教育方案终稿包括4个主题、8种教育方法、22个条目:听见死亡(讲授+主题讨论)7个条目,看见死亡(观影体验+经验分享)5个条目,触碰死亡(情境模拟+价值澄清)5个条目,超越死亡(人生回顾+濒死体验)5个条目。各条目重要性评分均>3.5分,变异系数为0.04～0.18,两轮专家咨询肯德尔和谐系数(W)分别为0.174和0.465(均P<0.001)。结论该研究以建构主义学习理论为视角构建的护士的死亡教育方案具有较好的科学性、实用性和可行性,培训主题及目标层层递进,教学方法灵活开放,易于被护士接受,能够为死亡教育在护士中的实施提供参考依据。     

心脏康复护理专家共识

目的形成《心脏康复护理专家共识》（以下简称《共识》）,规范医疗机构心脏康复护理相关工作。方法 在全面回顾国内外心脏康复相关指南、专家共识、系统评价、原始研究等文献及相关疾病诊疗方案、管理共识等相关文献的基础上,形成《共识》初稿,并邀请心血管领域的临床护理、医疗以及护理管理等相关领域专家开展专家论证。结果 共邀请37名专家开展了3轮专家论证,对初稿进行修改和完善,形成终版《共识》,包括心脏康复护理工作目标,心脏康复护士资质、培训、核心能力与职责,心脏康复护理工作内容,心脏康复护理质量管理,心脏康复患者安全管理5个方面。结论 《共识》是在综合专家意见及心脏康复相关指南、共识及临床研究基础上形成,可为医疗机构开展心脏康复护理工作提供参考。     

基于临床护理分类系统的患儿体温过高护理程序知识库的构建

目的 基于临床护理分类（clinical care classification,CCC）系统2.5版,构建患儿体温过高护理程序知识库。 方法 以患儿常见症状“腋下温度≥37.5 ℃”为研究内容,采用循证护理法,研究小组结合临床护理常规及医院管理制度,汇总与“腋下温度≥37.5 ℃”相关的所有护理措施。基于CCC系统2.5版“腋下温度≥37.5 ℃”相关护理诊断、核心护理干预措施、护理活动类型修饰语及护理结局修饰语,构建患儿体温过高护理程序知识库初稿。按照CCC系统2.5版中“具体护理措施编码=核心护理干预编码+护理活动类型修饰语编码”“护理结局编码=护理诊断编码+护理结局修饰语编码”的编码规则,对知识库初稿内容进行编码,然后通过专家咨询对知识库初稿内容及编码进行评价、讨论与修改,确定知识库终稿。 结果 患儿体温过高护理程序知识库终稿包括1项护理诊断、19项具体护理措施和4种护理结局。 结论 患儿体温过高护理程序知识库具有专业性、科学性与实用性,标准化了护理语言,有利于信息共享。     

老年患者出院准备服务专家共识（2019版）

目的 形成老年患者出院准备服务临床实践专家共识,规范老年患者出院准备服务的相关内容。方法 运用循证方法,按照证据级别高低,检索、评价和汇总该领域的证据,提取与老年患者出院准备服务相关的推荐建议和研究结论,形成共识初稿,通过2轮专家函询和2次专家论证会,结合专家意见,对初稿进行调整、修改和完善,形成共识终稿。结果 2轮函询专家积极系数均为100%,专家权威程度均为0.83,各指标重要性赋值均数均>3.5,且变异系数均<0.25,专家肯德尔和谐系数分别为0.234和0.253（均P<0.001）。最终对老年患者出院准备服务的概念、主要原则、意义、内容及实施过程5个部分的推荐意见达成一致。 结论 该共识为老年患者出院准备服务在中国的实施提供了指导依据,促进出院准备服务在中国的实施和发展。     

Integrating Climate Change in the Curriculum: Using Instructional Design Methods to Create an Educational Innovation for Nurse Practitioners in a Doctor of Nursing Practice Program

An applied epidemiology course for doctor of nursing practice students was revised to include a module on the impact of climate change on population health. The Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model of instructional design is a gold standard framework for creating course content and guided the module development. A nurse content expert discussed the environmental impacts of climate change on health using literature, actual clinical scenarios, and the application of epidemiologic data. Topics included safeguarding workers and vulnerable populations within the context of the coronavirus disease 2019 pandemic. Students posted reflections on their understanding of module content in response to structured prompts electronically in the learning management system for review by the faculty. Faculty evaluation of responses identified the need to further develop and integrate environmental epidemiology and climate change content more fully within the doctor of nursing practice curriculum.     

Nursing students in clinical practice--developing a model for clinical supervision

The aim of this study was to develop a model for clinical supervision to promote the clinical practice of nursing students. The study was implemented in Finland and it was carried out in three phases. Firstly, data were collected by means of a literature review and focus group interviews. Secondly, the data were analysed and described in expert groups, and finally the model itself was evaluated by 23 nursing experts. The data of literature review and focus group interviews consisted of 27 studies and four groups from three organisations: nurses (n = 7), managers (n = 6), teachers (n = 8) and students (n = 6). The data were analysed by qualitative content analysis. The model devolved from the study includes the concepts describing prerequisites, content and influence of clinical supervision. The prerequisites are nursing skills, a holistic view of the nursing curriculum, pedagogical, organisational, development, cooperation and interaction competence and decision-making skills. The content of clinical supervision includes support of professional development, pedagogical competence, research and development activities and collaborative working. Clinical supervision has influence on students’ professional and personal development and conception of the future of nursing profession, students’ preparedness for career planning and the teacher’s and preceptor’s professional development. The model could unify the notions of all parties concerned of the prerequisites, content and influence of clinical supervision. Furthermore, the entire supervision process and its control could be clarified. The model may be utilised in selecting and educating preceptors and evaluating the quality of clinical supervision.     

Clinical leadership and pre-registration nursing programmes: A model for clinical leadership and a prospective curriculum implementation and evaluation research strategy

AimTo present for wider debate a conceptual model for clinical leadership development in pre-registration nursing programmes and a proposed implementation plan.BackgroundGlobally, leadership in nursing has become a significant issue. Whilst there is continued support for leadership preparation in pre-registration nursing programmes, there have been very few published accounts of curriculum content and/or pedagogical approaches that foster clinical leadership development in pre-registration nursing. A doctoral research study has resulted in the creation of an overarching model for clinical leadership.DesignA multi-method research study using theoretical and empirical literature 1974–2015, a focus group, expert opinion and a national on-line survey.DiscussionA conceptual model of clinical leadership development in pre-registration nursing programme is presented, including the infinity loop of clinical leadership, an integral curriculum thread and a conceptual model: a curriculum-pedagogy nexus for clinical leadership. In order to test out usability and evaluate effectiveness, a multi method programme of research in one school of nursing in Australia is outlined.ConclusionImplementation of the proposed conceptual model for clinical leadership development in pre-registration nursing programmes and a programme of (post-doctoral) research will contribute to what is known about curriculum content and pedagogy for nurse academics. Importantly, for nursing students and the profession as a whole, there is a clearer expectation of what clinical leadership might look like in the novice registered nurse. For nurse academics a model is offered for consideration in curriculum design and implementation with an evaluation strategy that could be replicated.     

以患者为中心的临床护理干预创新质量评价指标体系的构建

目的 构建以患者为中心的临床护理干预创新质量评价指标体系,旨在为评价临床护理干预创新质量提供参考。方法 以“结构-过程-结果”三维质量评价模型为框架,通过文献回顾、半结构访谈制定评价指标初稿,形成专家函询问卷,采用德尔菲专家咨询对19名专家进行2轮函询,并通过层次分析法确定各级指标权重。结果 2轮函询中专家权威系数分别为0.885、0.889,肯德尔和谐系数分别为0.174、0.192（均P<0.001）。最终构建的临床护理干预创新质量评价指标体系包括3项一级指标、13项二级指标和55项三级指标。结论 构建的临床护理干预创新质量评价指标基本符合以患者为中心的理念,具有较好的科学性和实用性,对评价临床护理干预创新质量具有指导意义。     

客观结构化临床考试在护理本科生毕业考核中的应用

目的探讨客观结构化临床考试（objective structured clinical examination,OSCE）在护理专业本科生毕业考核中的可行性及效果。方法 采用OSCE模式对2009届320名护理专业本科生进行毕业考核,考试分3站进行,时间40~50min,由各站主考老师或标准化患者对考生进行评价,各站分数之和即为总分。考试结束后,采用自行设计的问卷调查护生和教师对OSCE模式的评价。结果 320名护理专业本科生毕业考核的总成绩为（77.37±10.98）分,一次通过率为99.0%;分别有88.44%、80.94%和58.43%的学生认为OSCE模式有利于培养学生的整体护理理念、提高沟通能力和专业素质;教师普遍反映新型的考试模式全面改革了对于学生临床能力的评价方式,更能激发学生学习和实习的积极性,充分发挥考试的功能。结论护理专业本科生毕业考核中采用OSCE模式,能体现护生对知识应用的灵活性和处理问题的应变能力,能对护生的临床实践能力进行全面、客观、公正的评价,护理专业教师和学生普遍反映较好。     

住院患者自杀防范培训体系的构建

目的 构建住院患者自杀防范培训体系,为对临床护士开展住院患者自杀防范培训提供参考。方法 基于文献回顾,调查护士对住院患者自杀防范培训知识的需求状况,初步拟订专家函询问卷。2020年1月—3月,采用德尔菲法对25名从事自杀防范研究、护理安全管理、护理人文关怀等领域的专家进行2轮函询。结果 2轮专家函询问卷的有效回收率分别为96.0%、91.7%;专家权威系数分别为0.88、0.83;肯德尔和谐系数分别为0.29、0.17（P<0.001）。最终形成的住院患者自杀防范培训体系包含4个一级指标、26个二级指标。结论 住院患者自杀防范培训体系的可靠性和实用性较高,可为开展临床护士防范住院患者自杀培训提供依据。     

慢性呼吸疾病肺康复护理专家共识

目的 编写《慢性呼吸疾病肺康复护理专家共识》（以下简称《共识》）,以期推动我国肺康复护理的规范化发展。方法 在大量文献回顾的基础上,通过对5名专家进行访谈、对19名专家进行函询确立《共识》的一级、二级主题,邀请10名该领域护理专家对形成的《共识》初稿进行同行评议,对《共识》内容进行修改及完善。 结果 通过专家函询,确立了14个一级主题和40个二级主题,函询问卷的有效回收率为100%,专家的判断系数为0.895,熟悉程度为0.839,权威系数为0.867;2轮专家函询一级、二级主题的肯德尔和谐系数分别为0.121、0.151和0.205、0.149,均具有统计学意义（P<0.05）;第1轮专家函询一级、二级主题变异系数为0.197、0.200,第2轮专家函询一级、二级主题变异系数为0.202、0.237,均<0.25,表明专家的判断结果相对一致。 结论 《共识》融合了19名临床护理专家的建议,结果具有科学性、严谨性和权威性。该《共识》不仅能够为临床护理实践提供指引,还为该领域指南、标准的制订奠定了基础,但仍需要进一步的理论和实证研究验证。     

Development of an undergraduate nursing Clinical Evaluation Form (CEF)

A clinical placement evaluation form for undergraduate nursing students was developed to address the need for evaluating success in clinical teaching support and provide a feedback loop to the University, clinical educators and clinical venues. A 21-item, with five domains, (orientation, clinical educator/teacher, ward staff and environment, clinical hurdles, and university) Clinical Evaluation Form (CEF) was developed. The form was live tested with 178 year 1 and 2 undergraduate nursing students. The CEF scale was reliable (alpha=0.90) and has good face and content validity approved by an expert panel. Further research is recommended to validate the CEF for use multi-professionally and across all year levels.     

Universal to standard precautions in disease prevention: preliminary development of compliance scale for clinical nursing

Background

The Center for Disease Control and Prevention revised the infection control practice from Universal Precautions to Standard Precautions in 1996. Although the practice of Standard Precautions has been implemented for almost 15 years in clinical settings, recent local research still adopts the Universal Precautions Scale to measure the compliance with the current infection control practice of general frontline nursing staff and students. Despite the scale's sound psychometric properties, that its items may not be sensitive and comprehensive enough to reflect the current compliance of frontline staff to Standard Precautions is questionable.

Aim

The present study aims to develop a Compliance with Standard Precautions Scale (CSPS) for use by the general frontline nurses and nursing students in clinical settings.

Methods

The current study employed a recognized instrumentation design. In addition, a preliminary assessment of reliability and validity was described. The CSPS was developed through the modification of the Universal Precautions Scale through five steps: reviewing the infection control guidelines, modifying the items of the Universal Precautions Scale, examining the relevance and adequacy of new items by an expert panel, verifying the linguistic and grammatical issues, and examining the understandability of the items and acceptability of the entire instrument by stakeholders. Internal consistency was examined using Cronbach's alpha statistic.

Results

The original 15-item Universal Precautions Scale was revised to the 20-item CSPS, in which 13 items were revised in wording and concept, 2 items were deleted, and 7 items were added. The 20-item new scale obtained the overall content validity index of 0.90, and 100% understandability and acceptability in face validity, and Cronbach's alpha of 0.73.

Conclusion

With the explicit justification on each generated item and the satisfactory results of the psychometric testing, the CSPS is a preliminary reliable and valid instrument in measuring the compliance with Standard Precautions of frontline nurses and nursing students in clinical settings.     

严重腹部创伤患者损伤控制复苏护理方案的构建

目的基于损伤控制复苏理念,构建严重腹部创伤患者损伤控制复苏护理方案。方法通过文献回顾、临床观察及头脑风暴等方法,整合腹部创伤相关指南和文献,制订护理方案初稿,经德尔菲法专家函询,确定严重腹部创伤患者损伤控制复苏护理方案。结果2轮专家函询中,专家积极系数分别为88.89%、100%,专家权威系数均为0.88,2轮函询条目的肯德尔和谐系数分别为0.29、0.32,最终形成的护理方案包括2项一级条目,15项二级条目,50项三级条目。结论本研究构建的护理方案具有科学性、可靠性及适用性,可为临床创伤护理提供指导。     

我国本科护理学专业教育标准构建的研究

目的 构建既符合我国国情,又顺应国际环境的本科护理学专业教育标准,为开展本科护理学专业认证提供依据和科学的评价工兵.方法 考察我国护理本科教育现状,并组织专家小组会议构建本科护理学专业教育标准草案.运用德尔菲法,从全国开办护理本科护理教育的院校中选择98所进行两轮函询,根据专家意见修订草案,同时对标准进行验证.结果 确立的本科护理学专业教育标准包括本科护理学毕业生应达到的基本要求(32项)和本科护理学专业教育办学标准(10个领域40项).专家意见的集中程度和对各级指标评价的一致性程度均较高.结论 形成的本科护理学专业教育标准科学、全面地规定了我国护理本科教育的人才培养和办学条件要求,符合我国本科护理教育的发展现状,并融入了我国护理专业发展特色,体现了当前护理教育发展的国际趋势.