护理质性研究对循证护理的影响探讨

本文从3个方面探讨护理质性研究对循证护理的影响.(1)质性研究有助于架起循证护理证据与循征护理实践之间的一座桥梁.(2)护理学科专业性特点,护理质性研究是护理研究中切合护理科学性、人文性、实际性的一种科学研究方法,质性研究结果同样是真实、可靠的科学证据,有助于更好地在循证实践中应用循证结果.(3)护理质性研究为循证护理研究提供另一种形式的证据,为实施循证护理系统评价创造了契机.提示护理研究者应对质性研究在护理研究中的实用价值重新加以思考,应用现有标准评价护理证据的科学性,才能推动循证护理实践与护理学科的深入发展.     

Toward Clinical Scholarship: Promoting Evidence-Based Practice in the Clinical Setting

Organizational interventions are being suggested to increase the rate of quality research dissemination and uptake. This article describes how one tertiary institution is using an evidence-based nursing (EBN) committee as an organizational strategy to shift its nursing culture toward clinical scholarship. A number of approaches and activities that have stimulated the movement toward evidence-based practice (EBP) are examined: organizational commitment to EBP, strategic positioning of the EBN committee within nursing's administrative structure, articulation of a mission, conceptualization of a model for EBN practice, learning on the job, selection and adoption of an evidence-based model for implementing change, marketing for a change in culture toward clinical scholarship, and other selected examples of projects undertaken by the committee. Action-oriented principles associated with committee experiences are related to the approaches and activities.     

Implications of evidence‐based practice for mental health nursing

The introduction of evidence‐based practice (EBP) and the hierarchical approach to evidence it engenders within research and evaluation has aroused controversy in the mental health professions. The aim of this paper is to present a critique of EBP with a specific relationship to mental health nursing. It will be argued that in its current form, EBP presents a potential impediment to the facilitation of consumer participation in mental health services and to the recovery model. The need for the consumer voice and the importance of the lived experience of mental illness are not readily reconciled with a strong scientific paradigm that promotes detachment and objectivity. The importance of evidence in contemporary mental health care will also be acknowledged and discussed in light of the current climate of increased consumer knowledge, fiscal constraint, and extensive social criticism of mental health‐care services. The current approach to EBP requires reconstruction to support the consumer‐focused nature of mental health nursing, and to facilitate the implementation of a recovery model for mental health care.     

上海地区循证护理教育培训内容和形式的调查

目的 探讨上海地区开展循证护理教育的培训内容和形式.方法 2008年4-6月我们采用自行设计的问卷对上海市已开展研究生教育的护理院校60名护理专业课教师进行调查,其内容包括:开设循证护理教育的教学条件、内容、重点难点、方法、学时及考核方式.结果 90%以上的护理专业课教师认为,开设循证护理课程的学院应拥有良好的图书馆资...     

Making evidence based practice a reality for mental health nursing

In recent years, efforts have been directed towards making mental health nursing more evidence-based. Making evidence based practice (EBP) a reality in modern health services requires due attention to service planning and management. It is acknowledged that there are many challenges and barriers to implementing EBP as outlined in this article. However, by using an example from our mental health service and drawing upon the literature, we show that a variety of techniques can be used to incorporate EBP into everyday practice. A combination of approaches is recommended, including education and training, leadership programs, research units, dissemination of research findings and structural changes to draw upon the expertise of key clinical, education, management and research staff.     

大专及以上实习护生循证护理知信行现状及其影响因素的调查

目的了解临床实习护生循证知信行的整体水平及其影响因素。方法采用自行设计的问卷对192名大专及以上学历的护生进行调查。循证知信行自评问卷包括循证护理基础知识部分（8项）、循证态度和信念部分（14项）和循证实践行为部分（8项）,采用3级评分法,每项赋分1—3分。该调查问卷的Cronbach’s α系数为0．910,知识、态度和信念及实践行为各维度的Cronbach’s α系数分别为0．850,0．897,0．893。结果共发放问卷192份,回收有效问卷180份,问卷的有效回收率为93．75％。护生的自评得分中知识、态度和信念、行为得分分别是（10．85±2．83）,（34．34±4．94）,（10．84±3．24）分。学习形式、循证护理培训、循证实践经历是影响循证知信行整体水平的主要因素（P〈0．05）。结论护生对循证实践的态度较为积极,但缺乏相关的循证护理基本知识,且较少开展循证实践行为。护生的循证护理培训应该加强,且越早越好。     

"循证"冠名的中国护理文献发表现状分析

目的通过对中国近年来发表的循证护理文献进行回顾调查,探析“循证”冠名的中国护理文献发表现状及中国护理人员开展循证护理时存在的问题和难点。方法检索中国科技期刊数据库2000～2006年初6种中文护理期刊,对其以“循证”冠名的中国护理文献进行分类和分析。结果①循证护理研究类型正从理论探讨向临床应用转化。②90.9%的临床研究文献没有说明检索证据的路径与策略,63.6%没有说明所遵循的研究证据的来源途径。③93.9%未说明研究证据的质量等级,运用SR及RCT研究结果指导临床实践的仅占6.1%。④72.7%缺乏有效方法评价循证护理的实际效果。结论“循证”冠名的中国护理文献的内涵质量有待提高,中国护士需要学习更多的有关循证实践的知识与技能,以促进临床护理实践,并提高循证相关的护理研究文献的质量。     

护理硕士专业学位研究生循证护理课程的效果评价

目的评估护理硕士专业学位研究生循证护理(evidence-based nursing,EBN)课程的教学效果。方法便利抽样法选取本校护理学院2013、2014级护理硕士专业学位研究生62名为研究对象。采用中文版循证实践知识、态度、行为问卷(evidence-based practice questionnaire,EBPQ)和EBN课程反馈问卷在EBN课程教学前、后对学生进行教学评价。结果在接受EBN课程后,护理硕士专业学位研究生的循证实践行为、态度、知识技能3个维度的得分及总分较课程前均有很大提升(均P0.01)。学生对EBN课程的反馈评价良好,对教学内容、教学方法、考核方式、总体评价的满意度分别为91.9%、85.5%、85.5%、90.3%。结论在护理硕士专业学位研究生教育中开展循证护理课程,能提升学生的循证实践知信行水平,其对课程满意度较高。     

Constructivism applied to psychiatric-mental health nursing: an alternative to supplement traditional clinical education

With the popularity of accelerated pre-licensure nursing programmes and the growth in nursing student enrolments, traditional clinical education continues to be a challenge to deliver. Nursing faculty members are required to develop and implement educational innovations that achieve effective learning outcomes, while using fewer resources. The purpose of this qualitative study was to explore the effectiveness of a constructivism-based learning project to achieve specific learning outcomes and to supplement approximately 30 clinical hours in a psychiatric-mental health nursing course. Students participated in a 10-week, multistage project that examined life histories, treatment resources, and evidence-based practice, as applied to a single individual with a mental illness. Students reported increased understanding of mental health and illness, developed personal relevance associated with the knowledge gained, and learned to problem solve with regard to nursing care of individuals diagnosed with mental illness. For many students, there also appeared to be a reduction in stigmatized attitudes towards mental illness. Constructivism-based learning is a promising alternative to supplement clinical hours, while effectively achieving learning outcomes. Future research is needed to further validate the use of this method for the learning of course content, as well as the reduction of stigma.     

The Australian experience of nurses' preparedness for evidence-based practice

Aim  This study aimed to determine current knowledge and attitudes towards evidence-based practice (EBP) among pre- and post-registration nurses in New South Wales (NSW), Australia.
Background  Educational and clinical strategies for EBP in nursing assume a readiness to interpret and integrate evidence into clinical care despite continued reports of low levels of understanding and skill in this area.
Method  Perceptions of EBP were examined through a self-complete, anonymous postal survey distributed to 677 (post-registration) clinical nurses and to 1134 final year (pre-registration) nursing students during 2002 and 2003.
Results  A completed survey was returned by 126 post-registration and 257 final year nursing students (combined 21% response rate). Both pre- and post-registration nurses had a welcoming attitude towards EBP. Pre-registration nurses expressed more confidence in their EBP skills but self-rated knowledge and skill were low to moderate in both groups.
Conclusion  Nurses in Australia are clearly supportive of EBP but it is incorrect to assume that even recent graduates have a level of knowledge and skill that is sufficient to permit direct engagement in evidence implementation.
Implications for nursing management  Among a range of clinical supports, nurse managers and leaders can contribute to evidence-based health care by understanding the EBP knowledge and skills of their workforce and demanding a more practical approach in nursing education towards evidence-based guidelines and summaries appropriate to the clinical context.     

Transformative change of self: The unique focus of (adolescent) mental health nursing?

In mental health nursing, inadequate nursing practice research has resulted in a deficit of knowledge concerning the nurse–client relationship; an area seen as the heart of practice. In turn, the specialty has experienced difficulty in identifying its unique domain of practice. Findings from a hermeneutic study into adolescent mental health nursing explicated its practice knowledge. These findings include (i) 'engaging in therapeutic relationships'; (ii) 'guiding the potential for change'; and (iii) 'facilitating positive outcomes'. A higher order finding was named 'fostering a functional self'. These findings are discussed. Findings point to the nature, purpose and processes of the nurse–client relationship, and to outcomes from that relationship. It is suggested they also represent a beginning understanding of the specialty's unique contribution to nursing; that mental health nursing fosters transformative change of self .     

低年资临床护士循证护理知信行现状及影响因素分析与实践障碍研究

目的:探讨低年资(护龄≤5年)临床护士循证护理(EBN)知信行与循证实践(EBP)障碍现状及相关性,分析影响EBN知信行的因素,为EBN实践的有效开展提供依据。方法:2020年4月1日~6月1日采用方便抽样法,选择济南市3所三甲医院407名低年资(护龄≤5年)临床护士作为研究对象,采用一般资料问卷、循证护理知信行量表(EBPQ)、循证实践障碍量表进行问卷调查。结果:407名低年资临床护士EBPQ问卷均分为(4.61±1.10)分,循证实践障碍问卷各维度得分为开展循证护理的资源条件(29.15±6.82)分、科研报道的质量(25.28±6.51)分、护士对循证护理的主观态度及能力(23.81±5.45)分、研究报道的时效性与系统性(18.69±4.66)分;经单因素分析显示,性别、人事关系、职称、是否为带教老师、工作中感受到的压力、是否有过护理科研经历、阅读文献情况、对学习循证护理是否感兴趣、在临床工作中是否有必要开展循证护理方面EBN知信行得分比较差异有统计学意义(P<0.01,P<0.05);多元线性回归分析显示,性别、对待护理的职业态度、对学习循证护理是否感兴趣为EBN知信行的影响因素。结论:低年资护士EBN知信行水平仍有待提高,造成实践障碍的因素包含各个方面,需要进一步进行针对性的措施加以改进。     

Embedding evidence-based practice in a nursing curriculum: a benchmarking project

The development of a new nursing curriculum in one Australian university provided the opportunity for academic staff to consider the best ways to integrate the requirements of evidence-based practice (EBP) into nursing education and culminated in the development and conduct of a specific benchmarking project. Data collection for the project included the use of university documents, observations and informal discussions with staff. An analysis of this information resulted in the emergence of five categories that were grouped into two major categories, namely infrastructure and processes. Within the major category of infrastructure, two minor categories, namely evidence-based nursing (EBN) Unit and EBN champions emerged. The major category of processes included three minor categories, namely integrating a research thread, immediate introduction to EBP and planning with local services. The outcome of the benchmarking project also offers a template for other health disciplines to adopt when trying to embed and value EBP in their department and curricula.     

The role of qualitative research within an evidence-based context: can metasynthesis be the answer?

The increasing emphasis on evidence in the health care planning and policy context has fuelled considerable discussion and debate in nursing circles on the appropriate place of the less favourably placed knowledge forms within the conventional evidentiary hierarchy. In this paper, nursing's affinity for qualitative methods, and the species of knowledge they generate, are considered within the context of this evolving evidence-based practice movement. Noting conceptual and terminological confusions around the notion of evidence such as have arisen within the nursing literature, the author argues for clarity in our collective thinking about the role of research in a nursing or any other applied practice discipline. Toward this end, she points to some of the newer approaches to research synthesis and integration that may hold particular promise for enhancing our confidence about what might properly constitute a qualitatively-derived evidentiary knowledge claim. Such approaches may assist nurses to work more comfortably within the evidence-based movement, assured that reliance upon scientifically sound reference points need not compromise the complexity, richness and diversity they recognize as inherent in practice context excellence.     

循证护理在我院的临床实践和发展策略

为促进循证护理实践在我院以及全国的发展 ,从循证护理最佳证据的提供者和应用者两个方面 ,概述了我院循证护理实践的状况 ,并提出了促进循证护理实践的发展策略 ,包括 :循证护理强调证据和护理的科学性和有效性 ,是推行循证护理的前提 ;临床护理是循证护理研究的基础 ,循证护理实践必须促进临床护理的发展 ;需要建立一支具有循证护理观念的稳定队伍 ;并且需要成立循证护理研究机构 ,从而加强护理教育和继续教育 ,促进护理的可持续性发展。     

护理人员循证护理实践基本素质构成及现况调查

目的：探讨护理人员循证护理实践基本素质构成及现状调查。方法选择24名护理专家对护理人员开展循证护理实践应具备的基本素质进行访谈,对结果进行分析,明确循证护理实践基本素质的构成。随后对重庆市4所三级甲等医院936名护理人员进行循证护理实践基本素质现况的问卷调查,了解护理人员在循证态度、循证知识、循证技能等方面的状况。结果专家访谈结果的协调系数为0．601～0．783（均P＜0．01）,变异系数均小于0．2,说明专家的意见比较集中,一致性较好。50．5％的护理人员初步具备循证护理素质,循证实践态度积极,但循证知识和循证技能两方面较弱,且不同职称、学历、年龄的护理人员之间循证护理实践基本素质的差异均具有统计学意义（P＜0．01）。结论循证护理实践基本素质包括循证态度、循证知识、循证技能;护理人员均具备积极的循证护理态度,但在循证知识和循证技能两方面较弱。护师及以上职称、本科及以上学历及30～39岁的护理人员循证护理实践基本素质较好。     

循证护理在儿科临床护理教学查房中的应用

目的探讨将循证护理引入临床护理教学查房中的效果。方法按循证护理实践方法进行临床护理教学查房。结果92.8%以上的学生和老师认为,将循证护理运用于临床护理教学查房中,可增强学生循证护理实践意识、主动参与能力、获取信息能力、评判性思维能力和启发学生护理科研意识。结论将循证护理引入临床护理教学查房中,开拓了新的教学查房形式,培养了学生的综合能力。     

Evidence-based nursing--the missing link between research and practice

Evidence-based nursing (EBN) is being introduced promising to professionalize and emancipate nursing. Three questions are discussed as to whether this can be accomplished. The analysis comes to the following conclusions: Evidence-based nursing (EBN) as a problem solving process will become part of the German health care service by means of social legislation. The concept joins clinical experience and best evidence under the principle of patient adapted intervention. This complies with the demand for rationally justified, transparent, and economically comparable performance. One specific trait of research in nursing is the importance of qualitative methods that make the dimension of subjective meaning comprehensible. Only under a normative paradigm can the concept of evidence-based intervention be applied immediately. This leads to problems of adaptation that have to be solved when introducing EBN. Evidence-based nursing practice fits into modern concepts of professional nursing as well as into current visions regarding the reform of German nursing education. However, some peculiarities that characterize German nursing practice in particular must be taken into consideration. This includes the professional ideology of nursing staff as well as applied nursing science, which is still in its beginnings. CONCLUSION: With careful implementation the concept of evidence-based intervention can develop its potential to improve nursing practice. Further, EBN offers Germany an opportunity to catch up with international standards.     

Single case study and evidence-based practice

Single case study and evidence-based practice With the current emphasis upon evidence-based medicine in statutory health care provision in the UK, mental health nursing is challenged to justify its approaches. Psychological theories, once taken for granted in mental health nursing, are now being challenged by new definitions of evidence. In this paper the authors focus upon the use of individual case study. The discussion questions the validity of applying the hierarchies of evidence proposed by evidence-based medicine to mental health nursing theory and practice. The role of case study as the prime source of evidence is argued and is justified in mental health nursing research and practice.     

循证护理在护理专业教学中实践探索

综述了循证护理产生的历史背景和循证护理引入护理教学的必要性及循证护理在护理教学中的应用现状,指出护理教育要想适应循证护理的发展,必须加强院校投资,进行专业教师培训,培养学生循证思维和循证实践能力,提高护理质量。