改良版OSCE在神经外科规范化培训新护士核心胜任力评价中的应用研究

Application of modified OSCE in evaluating core competencies of new nurses in neurosurgery standardized training

目的探讨改良版客观结构化临床考试(objective structured clinical examination,OSCE)用于神经外科规范化培训新护士核心胜任力评价的效果。方法对37名在神经外科进行规培的新护士实施考核和评价。以核心胜任力评价为核心,临床护理工作为主线,临床案例库为依托,构建改良版OSCE方案:即①入科时实施OSCE诊断性考核评价;②培训过程中实施OSCE引导下的过程性教学评价;③出科时实施OSCE结果性考核评价。OSCE考核包括护理评估、技能操作、临床思维、健康教育、人文关怀5个考站。采用SPSS 26.0进行t检验和秩和检验。结果在考评体验方面,护士对改良版OSCE的实施评价和教学满意度较高。在改良版OSCE方案的质量评价方面,出科时OSCE考核平均成绩与入科时比较差异有统计学意义(t=24.21,P<0.001);在自主学习能力评价方面,实施改良版OSCE后,护士的自主学习能力与入科时比较差异有统计学意义(t=10.29,P<0.001)。在核心胜任力评价方面,出科与入科时相比,其核心胜任力分维度良好个人特质(Z=5.24,P<0.001)、临床护理能力(Z=5.07,P<0.001)、支持和人际沟通能力(Z=5.12,P<0.001)、评判性临床思维能力(Z=5.17,P<0.001)、专业建设与自我发展(Z=5.05,P<0.001)与总分(Z=5.27,P<0.001)得分的差异有统计学意义。结论改良版OSCE能够较为全面地评价神经外科规培新护士核心胜任力,具有较好的可行性和有效性,为规培轮转科室的教学管理提供了参考依据。

Objective To explore the effectiveness of modified objective structured clinical examination(OSCE)for evaluating the core competencies of new nurses on standardized training in neurosurgery.Methods Thirty-seven new nurses on standardized training in neurosurgery were evaluated using a modified OSCE protocol that was focused on core competencies required for clinical nursing practice on the basis of a clinical case library,which consisted of diagnostic assessment upon entrance,process teaching evaluation during training,and outcome assessment upon exit,at five OSCE stations(nursing assessment,skill practice,clinical thinking,health education,and humanistic care).SPSS 26.0 was used to perform the t-test and rank sum test.Results The nurses highly recognized the effectiveness of modified OSCE and were largely satisfied with teaching.There were significant differences at entrance and exit in terms of the mean OSCE score(t=24.21,P<0.001),independent learning ability(t=10.29,P<0.001),and the scores of core competencies—good personal traits(Z=5.24,P<0.001),clinical nursing ability(Z=5.07,P<0.001),support and interpersonal communication ability(Z=5.12,P<0.001),critical clinical thinking ability(Z=5.17,P<0.001),professional construction and self-development(Z=5.05,P<0.001),and the total score(Z=5.27,P<0.001).Conclusions The modified OSCE can comprehensively evaluate the core competencies of new nurses in neurosurgery standardized training,with good feasibility and effectiveness,which provides a reference for teaching management of standardized training programs.