研究与实践合作促进模式用于提高护士循证护理水平的实践

Application of Advancing Research and Clinical Practice through Close Collaboration(ARCC)model to improve evidence-based nursing

目的探讨研究与实践合作促进（ARCC）模式提高护士循证护理水平的效果。方法借鉴ARCC模式,分3个阶段在全院推行循证护理实践理念：准备阶段成立循证护理委员会成员,翻译修订ARCC模式专用量表;培训发展阶段,编写循证学习资料,培训循证实践导师,建立循证网络资源平台,引导临床护士自我导向学习,举办循证学习培训班;循证实践阶段,成立循证护理杂志俱乐部,建立循证问题及推进循证护理实践,举办新知讨论会。结果实施ARCC模式后,护士循证实践能力维度、循证护理实施量表以及医院循证组织文化建设量表得分显著高于实施前（P〈0.05,P〈0.01）。护理部共收集护理问题40个,形成循证研究问题10个,循证实践导师主导的循证项目9项,其中3项研究已制定出标准方案,分别在手术室、ICU、肿瘤科试行6～12个月,无一起因用证导致医疗纠纷、护理投诉事件,以及患者人身安全受损事件发生。结论实施ARCC模式有利于形成护理部-院级循证实践专家团队-科室循证实践指导者的三级架构,提高临床护士循证护理实践水平,促进医院护理循证实践组织文化建设,也在一定程度上提升了用证的安全性。

Objective To explore the effect of the evidence-based practice model of Advancing Research and Clinical Practice through Close Collaboration（ARCC）on clinical nurses′evidence-based nursing（EBN）levels.Methods Based on ARCC model,we pushed forward the philosophy of EBN through the following stages：at pilot stage,we formed an EBN committee and revised several instruments regarding ARCC;at development stage,we compiled EBN materials,trained evidence-based practice mentors（EBP）,built up a web platform,encouraged self-directed learning of EBN by nurses,and provided EBN training programs;at practice stage,we formed EBN Journal Club,located several clinical questions,and asked the EBPs to solve the questions through the approach of EBN;we also held new knowledge discussion meeting several times.Results After activity of ARCC,the scores of EBN belief,EBN implementation,and organizational culture readiness of EBP,were significantly higher than before（P〈0.05,P〈0.01）.Department of nursing collected 40 clinical questions,and formed 10 EBN practice programs,among which,9were led by EBPs;from 3of the programs,we had formulated standard protocols,which were later put into practice in the operating room,ICU,and department of oncology for 6-12 months,without resulting in any cases of medical disputes,nursing complaints,or injuries to patients.Conclusion ARCC model helps to form a three-tier architecture comprising the department of nursing,hospital EBN committee,and EBPs,which is in favor of promoting the level of EBN in nurses,and improving evidence-based practice culture of hospital.The structure also improves the safety of using evidence to a certain extent.