多专业学生案例讨论在护理本科生临床思维能力培养中的应用

Application of case discussion of multi-professional students in cultivating clinical thinking abilities of nursing undergraduates

目的探讨基于Tanner模式的案例教学对护理本科生临床判断及推理能力的影响。方法招募80名护理本科生分为2个网络班,每班分为8个小组,进行老年多病共存病人护理案例的学习,基于Tanner模式进行讨论和思考,引导学生从察觉、诠释、反应、反思对案例进行判断。教学前后应用中文版Lasater临床判断评分细则、临床推理与反思自评量表对护理本科生进行测评,课程结束后应用教学反馈问卷了解学生对本次辅助教学活动的评价以及学习后的自身变化和建议。结果教学结束后,护理专业学生的临床判断能力在察觉、诠释、反应、反思4个维度及总得分上均有所提高(P<0.001),临床推理与反思自评得分较教学前增加(P<0.001)。大部分学生表示未来从事老年护理的自信心增强,对整体教学较为满意,认为课程设置的学习目标符合自身能力发展需要。结论基于Tanner模式的案例教学提升了护理本科生的临床判断及推理能力。课程以老年多病共存病人护理案例为媒介,增进了学生对老年人的理解,增强了学生从事老年护理的自信心。

Objective To explore the effects of the case teaching based on Tanner model on clinical judgment and reasoning abilities of nursing undergraduates.Methods Eighty nursing undergraduates were recruited and divided into 2 online classes,and each class was divided into 8 groups.The online teaching focusing on geriatric cases was provided to these students.Students were guided to carry out inter-professional discussions based on the Tanner model and to do clinical judgement from the following dimensions of noticing,interpreting,responding,and reflecting.Before and after the course,students were asked to complete the questionnaires of the Chinese version of the Lasater Clinical Judgment Rubric(C-LCTR)and Self-Assessment of Clinical Reflection and Reasoning.The teaching feedback questionnaires were used to understand nursing students'evaluation on the teaching activities.Besides,students'changes and their suggestions for the teaching were also collected.Results After the course,the scores of clinical judgment of the nursing undergraduates were higher than those before the course in noticing,interpreting,responding and reflecting dimensions and the total C-LCJR score(P<0.001).The scores of Self-Assessment of Clinical Reflection and Reasoning of nursing undergraduates were also higher compared to those before the course(P<0.001).A majority of nursing undergraduates agreed that they would be more confident to be engaged in geriatric health care in the future.They were satisfied with the teaching activities as a whole,and thought that the learning objectives of the curriculum were in line with the needs of ability development.Conclusion The multidisciplinary online case teaching based on Tanner model can improve the clinical judgment ability and clinical reasoning of nursing undergraduates.The course is based on the cases of the older adults with multiple diseases and it can enhance students'confidence to be involved in geriatric nursing.