以病例为导向的客观结构化临床考试在卒中急救护士培训中的应用

Application of case-oriented objective structured clinical examination in training stroke emergency nurses

目的探讨以病例为导向的客观结构化临床考试(OSCE)在卒中急救护士培训考核中的应用效果。方法 2018年6月至2019年6月,选择我院符合卒中急救护士岗位要求的71名护士作为研究对象。应用以病例为基础、以脑卒中急救过程为主线、以卒中急救护士急诊室岗位能力要求为本位的OSCE对卒中急救护士的急性缺血性脑卒中急诊绿色通道能力进行考核,考核共设6个站点,考核内容分别为预检初判评估、护理技术操作、患者从急诊预检台至CT室的转运、CT和多模态CT检查前后护士与影像科技师的配合、静脉溶栓药物的使用情况、静脉溶栓过程中对患者的病情观察与宣教。考试结束后计算各站点得分率和考试的难度系数、区分度系数,并通过调查问卷了解考生对本次考核的反馈。结果 71名卒中急救护士的考试成绩为78.6~95.8分,平均考试成绩为(82.9±3.2)分。考试的难度系数为0.17,区分度系数为0.36。6个站点的平均得分率为86.1%,其中第2站点的得分率最高(92.2%),第5站点的得分率最低(74.3%)。大部分考生认为这种考试模式符合临床实际(97.2%,69/71),能够反映急性缺血性脑卒中急救思维能力(95.8%,68/71)和综合急救护理能力(95.8%,68/71),且应进行临床推广(98.6%,70/71)。结论以病例为导向的OSCE模式能客观地反映卒中急救护士的急性缺血性脑卒中综合急救能力,并得到了考生认可。

Objective To explore the application of case-oriented objective structured clinical examination(OSCE) in the training and assessment of stroke emergency nurses.Methods From Jun.2018 to Jun.2019,71 stroke emergency nurses were enrolled in this study.The rescue ability of stroke emergency nurses in the stroke green channel was evaluated by OSCE based on practical cases,stroke emergency process and occupation ability requirements in the emergency rooms.Six stations were set up for the evaluation,including preliminary assessment of acute ischemic stroke (AIS),nursing operation,patient transfer from emergency inquiries to computed tomography (CT) room,cooperation between nurses and imaging technicians before and after CT and multi-mode CT examination,use of intravenous thrombolytic drugs,and disease observation and education in the process of intravenous thrombolysis.The score rate in each station,coefficient of difficulty and degree of distinction were calculated after the examination,and the student feedback on the examination was assessed by a questionnaire.Results The examination score of 71 stroke emergency nurses was 78.6-95.8,with an average of 82.9±3.2.The coefficient of difficulty was 0.17 and the degree of distinction was 0.36.The average score rate of the 6 stations was86.1%,and the second station had the highest score rate (92.2%) and the fifth station had the lowest score rate (74.3%).Most examinees believed that this examination mode was in line with clinical practice (97.2%,69/71),could reflect the clinical thinking ability (95.8%,68/71) and the comprehensive ability (95.8%,68/71) in AIS first aid,and was worthy of clinical promotion (98.6%,70/71).Conclusion The case-oriented OSCE mode can objectively reflect the comprehensive ability of stroke emergency nurses in AIS first aid,and has been recognized by examinees.