现代护理的科学意识和护理理论

为帮助广大读者了解西方的护理理念和护理模式,本刊于2011年,隆重推出美国的《当代护理学》的中文译本,旨在为广大护理工作者介绍当今世界发达国家的护理专家的思维和理念,从而使我国的护理事业在取百家之长、舍众家之短之中,百花争妍、春之盎然。如果读者在阅读《当代护理学》的过程中,能充分了解到了东西方文化的差异、现代医疗系统的目的,以及在应对突发事件之中变得更加从容,对自身的职业更加认可与自信,对著作者、翻译者以及杂志所开设的栏目及编辑而言,都将是一份欣喜!     

Workplace learning through collaboration in primary healthcare: A BEME realist review of what works,for whom and in what circumstances: BEME Guide No. 46

Background: Changes in healthcare practice toward more proactive clinical, organizational and interprofessional working require primary healthcare professionals to learn continuously from each other through collaboration. This systematic review uses realist methodology to consolidate knowledge on the characteristics of workplace learning (WPL) through collaboration by primary healthcare professionals.

Methods: Following several scoping searches, five electronic bibliographic databases were searched from January 1990 to December 2015 for relevant gray and published literature written in English, French, German and Dutch. Reviewers worked in pairs to identify relevant articles. A set of statements, based on the findings of our scoping searches, was used as a coding tree to analyze the papers. Interpretation of the results was done in alternating pairs, discussed within the author group and triangulated with stakeholders’ views.

Results: Out of 6930 references, we included 42 publications that elucidated who, when, how and what primary healthcare professionals learn through collaboration. Papers were both qualitative and quantitative in design, and focused largely on WPL of collaborating general practitioners and nurses. No striking differences between different professionals within primary healthcare were noted. Professionals were often unaware of the learning that occurs through collaboration. WPL happened predominantly through informal discussions about patient cases and modeling for other professionals. Any professionals could both learn and facilitate others’ learning. Outcomes were diverse, but contextualized knowledge seemed to be important.

Discussion/conclusions: Primary care professionals’ WPL is multifaceted. Existing social constructivist and social cognitivist learning theories form a framework from which to interpret these findings. Primary care policy makers and managers should ensure that professionals have access to protected time, earmarked for learning. Time is required for reflection, to learn new ways of interaction and to develop new habits within clinical practice.     

Concurrent validity of the MAE visual naming test.

Deficient confrontation naming has been observed in a number of neurological illnesses, as well as in aphasia and normal aging. The Visual Naming Test (VNT) of the Multilingual Aphasia Examination (MAE) is a standardized measure of confrontation naming. One hundred patients, consecutively referred for neuropsychological evaluation, were administered the VNT, Boston Naming Test (BNT), and WAIS-R. Concurrent validity of the two confrontation naming measures was demonstrated by their high intertest agreement. Performance on the VNT was found to be related to a unique ability separate from general intellectual functioning. Suggestions regarding the clinical use of the VNT are discussed.     

CT colonography: interpretative performance in a non-academic environment

AIM: To investigate interpretative accuracy and reporting time for radiologists performing computed tomography (CT) colonography in day-to-day non-academic clinical practice. MATERIALS AND METHODS: Thirteen radiologists from seven centres, who were reporting CT colonography in non-academic daily clinical practice, interpreted a dataset of 15 colonoscopically validated cases in a controlled environment. Ten cases had either a cancer or polyp >10mm; one case had a medium polyp and four were normal. Correct case categorization and interpretation times were compared using analysis of variance to aggregated results obtained from both experienced observers and observers recently trained using 50 cases, working in an academic environment. The effect of experience was determined using Spearman's rank correlation. RESULTS: Individual accuracy was highly variable, range 53% (95% CI 27-79%) to 93% (95% CI 68-100%). Mean accuracy overall was significantly inferior to experienced radiologists (mean 75 versus 88%, p=0.04) but not significantly different from recently trained radiologists (p=0.48). Interpretation time was not significantly different to experienced readers (mean 12.4 min versus 11.7, p=0.74), but shorter than recently trained radiologists (p=0.05). There was a significant, positive, linear correlation between prior experience and accuracy (p<0.001) with no plateau. CONCLUSION: Accuracy for sub-specialist radiologists working in a non-academic environment is, on average, equivalent to radiologists trained using 50 cases. However, there is wide variability in individual performance, which generally falls short of the average performance suggested by meta-analysis of published data. Experience improves accuracy, but alone is insufficient to determine competence.