中国护理学科发展面临的挑战与应对策略

Challenges and Countermeasures for the Development of Nursing Discipline in China

目的基于当前可得最佳证据,评价我国护理学科发展面临的挑战及应对策略,为促进护理学科、平台、梯队建设提供建议。方法系统检索CNKI(1979～2012.8)、VIP(1989～2012.8)、CBM(1981～2012.8),以及世界卫生组织、国际护士协会、世界银行、中国卫生部、教育部和全国大、中专院校官方网站,收集护理学科发展,人员培养和执业等相关资料,采用SPSS 13.0和Microso Excel软件进行统计分析。结果①截至2012年,全国共有855所护理院校,本科和独立学院招收护生38 212名,大专或职业中专招收护生130 837名。②2010年中国医护比例为1∶0.9,实际需求医生260万,护士短缺34.6万。③护理人员<35岁者占50%,低级职称占64%～69%,高级职称<2.5%。④中国培养1名医生和护士/助产士的费用仅为印度的2/5,撒哈拉沙漠以南的1/5～1/4。⑤截至目前,灾害护理文献中有科研数据者仅占30.1%,体会及综述类分别占30.6%和38.3%。结论中国医疗卫生和教育系统尚需深入改革,培养护生核心胜任能力和转化式学习方式,合理增加卫生投入,及时更新护理教材及教学方法。提倡护理学科与各学科间协作及循证护理,改善卫生服务质量和病人满意度。

Objective Based on the acquirable and optimized evidences at present, to explore the challenge and coun- termeasures for the development of nursing discipline in China, and to provide suggestions for promoting the construction of nursing discipline, platform, and talent team. Methods The study materials were searched in the following electronic da- tabases including PubMed, EMbase, Web of Science, CNKI, VIP and CBM, as well as in the official websites of World Health Organization （WHO）, International Council of Nurses （ICN）, World Bank, the Ministry of Health （MOH） and the Ministry of Education （MOE） of China, and the domestic universities, colleges or technical secondary schools. Then the statistical analysis was conducted using SPSS 13.0 and Microsoft Excel software. Results a） By 2012, there were 855 nursing schools, 38 212 nursing undergraduates enrolled in universities, and 130 837 nursing students enrolled in junior colleges and senior vocational schools; b） The doctor-to-nurse ratio was 1 to 0.9 in 2010. The actual demand for doctors was 2.6 million, and there were still lack of 346 000 nurses; c） The age of nurses younger than 35 years old accounted for 50%. Those with primary professional title accounted for 64% to 69%, while less than 2.5% with advanced professional title; d） The training cost for a doctor and nurse/midwife in China only accounted for 2/5 of that in India and 1/5 to 1/4 in the sub-Sahara Africa; and e） To date, only 30.1% of disaster nursing studies in China provided research data, 30.6% were clinical experience and 38.3% were review. Conclusion Education and health systems need to be extensively reformed. It is necessary to train nursing students with core competencies using transformative learning. It is necessary to update textbooks and teaching methods, and funding should be appropriately increased. Nursing should cooperate with other disciplines, and apply evidence-based nursing meth- ods to improve the quality of healthcare services and patient satisfaction.