危机处置情景模拟法结合Mini-CEX在急性心肌梗死护理教学中的应用

Application of Mini-CEX Combined With Scenario Simulation for Crisis Management in Teaching of Nursing for Acute Myocardial Infarction

目的探讨应用危机处置情景模拟训练后采用迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)评估实习护士对冠心病及其危急并发症处理的能力的效果。方法选取2018年1月—2019年12月于大连医科大学附属第二医院心脏病重症监护病房(cardiovascular care unit,CCU)实习的护理学本科生110名作为研究对象,分为观察组(55名)与对照组(55名),对照组采用常规的教学查房、幻灯片(powerpoint,PPT)讲解及临床实习的教学方法;观察组除与对照组相同的教学方法外,加用危机处置情景模拟教学法,采用Mini-CEX等方式进行考核。比较两组实习护士出科时理论考试、Mini-CEX及其单项技巧得分、课程满意度评价。结果观察组学生的出科理论考试、Mini-CEX评分均高于对照组学生,差异有统计学意义(P<0.05)。两组学生合格率较高的是体格检查技巧、人文关怀能力、交流沟通能力,而临床判断能力、组织能力和效率合格率较低。在教学满意度评价中,观察组满意率明显高于对照组,差异有统计学意义(P<0.05)。结论危机处置情景模拟教学法对提高护生急性心肌梗死的急救综合能力有一定帮助。而Mini-CEX评分法可多方位的评估不同教学方法对学生能力提升的情况。

Objective To explore the application of Mini-CEX(mini-clinical evaluation exercise)combined with scenario simulation for crisis management in clinical teaching of nursing for acute myocardial infarction.Methods A total of 110 undergraduate nursing students who interned in the cardiovascular care unit(CCU)of the Second Affiliated Hospital of Dalian Medical University from January 2018 to December 2019 were selected as the research subjects,and were divided into an observation group(55 students)and a control group(55 students).The control group was used conventional teaching methods such as ward rounds,PPT presentations,and clinical internships.In addition to using the same teaching method as the control group,the observation group also was used crisis management scenario simulation teaching method and Mini-CEX and other methods for assessment.Two groups of intern nurses were compared in terms of theoretical exam scores,Mini-CEX and its individual skill scores,and course satisfaction evaluations upon graduation.Results The scores of examination and Mini-CEX and each individual skill,including medical history collection,physical examination,humanistic care,clinical judgment,communication,organizational ability and efficiency in the observation group were higher than those in the control group(P<0.05).The two groups of students have higher pass rates in terms of physical examination skills,humanistic care skills,and communication skills,while clinical judgment skills,organizational skills,and efficiency pass rates are lower.In the evaluation of teaching satisfaction,the satisfaction rate of the observation group was significantly higher than that of the control group,with a statistically significant difference(P<0.05).Conclusion The situation simulation teaching method of crisis management is helpful to improve the comprehensive first-aid ability of nursing students with acute myocardial infarction.The Mini-CEX can comprehensively evaluate the improvement of students'ability by different teaching methods,which is worthy of further exploration and promotion.