Application and Promotion of Whole-Process Capacity Management Model for CHF Patients Led by Specialist Nurses in “Heart Failure Center Alliance Unit”

Objective: To implement the whole-process capacity management model led by specialist nurses, improve the capacity management behavior of medical staff, and build a standardized, standardized and operable CHF capacity management system. Methods: According to the evidence pyramid principle and search strategy, 2 evidence-based nursing backbone completed literature search in both Chinese and English, and finally included 7 literatures. Results: Around the three key links of capacity assessment, monitoring and management, stakeholders were invited to evaluate each evidence according to the FAME principle, that is, the feasibility, suitability, effectiveness and clinical significance of evidence. Finally, 11 best evidences were obtained and 5 clinical review indicators of the cost project were transformed. This study formulated the competence management plan for CHF patients based on the current situation, established competence load evaluation criteria for CHF patients, and determined the target “dry weight” value for CHF patients. Conclusion: The whole-course volume management model of CHF patients guided by specialist nurses should be established and applied and promoted in the “heart failure Center Alliance unit”, so as to improve the capacity management ability of medical staff for CHF patients, enhance the self-management ability of CHF patients, improve the capacity management behavior and health outcomes, and effectively reduce the hospitalization rate and mortality rate of CHF patients in the region.

Current status of clinical nursing specialists and the demands of osteoporosis specialized nurses in China's Mainland

The clinical nursing specialist(CNS)is an expert who applies an expanded range of practical,theoretical,and research-based competencies to the care of patients within in a specialty clinical area within the larger discipline of nursing.A large number of studies consistently conclude that the CNS is a valuable healthcare resource that provides highquality clinical and evidence-based nursing practice and improves patient outcome.The CNS has been involved in healthcare practices for many years,with an increasingly diverse role.However,the training for the CNS in China is only in a preliminary developmental stage.The aim of this article is to review the history and development of the CNS role.Furthermore,the epidemiologic status of osteoporosis,as well as the feasibility and necessity of developing training programs in China for the osteoporosis CNS,will be discussed.

Competence of clinical teachers:A survey on perception of masters of nursing specialist postgraduates, their clinical teachers, and head nurses

Objectives:To explore the current admittance situation of clinical teachers for masters of nursing specialist(MNS)postgraduates and to test the competence of clinical teachers in self-evaluation and other evaluations.Methods:In this cross-sectional study,using a random number table,we chose 80 MNS postgraduates under clinical practice,their clinical teachers,and head nurses each from six hospitals in Hunan and Guangdong.The participants were tested on the basis of the Clinical Teachers'Competence Inventory of MNS Postgraduates.The competences of clinical teachers were evaluated by the three groups of participants.Results:The aggregated scores of teacher competence as evaluated by the MNS postgraduates(181.33±24.95)were lower than those assigned by both clinical teachers(190.75±24.30)and their head nurses(198.53±18.90),with significant differences in all dimensions except for clinical managing ability.The five highest rated items from all participants focused on the teachers'clinical nursing ability,and the five lowest rated items were mainly about their clinical research ability.Conclusion:The evaluation from MNS postgraduates is obviously lower than the self-evaluation of clinical teachers,and all participants are aware of the deficiency in research ability of the teachers.Thus,the admittance and examination of clinical teachers should be controlled strictly.Training should be carried out immediately to strengthen their comprehensive abilities,especially their research ability.

Construction of the First Certification Evaluation Index System for Diabetes Specialist Nurses by Delphi Method

Objective: To establish an evaluation index system for the first-time certification of diabetes specialist nurses in line with the clinical nursing practice in China, and to provide a reference basis for government administrations and hospitals to formulate unified standards. Methods: After the research team has determined the theme, it will consult the development of A) specialist nursing through the library, Internet and electronic literature database;B) the history of the development of specialist nurses in diabetes and other fields;C) the selection criteria of specialist nurses;D) the training of specialist nurses system, assessment method;E) Specialist nurse certification body, evaluation standards and certification standards and other related documents, literature, books and report materials. The author established the preliminary index system through literature review, specialist interview and group discussion and used Delphi method to organize three rounds of 30 experts’ consultations. Results: A first certification evaluation index system including 8 fundamental indicators, 5 first-level indicators, 19 second-level indicators and 99 third-level indicators was constructed for diabetes nurses. Conclusion: The results of three rounds of expert consultation and demonstration are reliable, and the constructed index system is suitable for comprehensive evaluation of diabetes specialist nurses, which provides a basis for the effective management of nursing resources.

我国Clinical Nurse Specialist的培养及相关问题研究

[目的]探讨Clinical Nurse Spe-cialist(CNS)在我国的译称,及其在我国的培养规格、认证管理体系及相关问题等各个方面的具体要求。[方法]应用德尔菲(Delphi)技术对全国57名专家进行函询。[结果]经过两轮函询,回复率分别为96.5%、88.7%,在CNS的概念、培养和认证各方面形成良好的集中性趋势。[结论]经过两轮函询,明确了CSN的概念、培养及认证的具体要求。

A review of the development and current status of wound ostomy continence nurses in the mainland of China

Wound ostomy continence nurses(WOC nurses),developed as an important part of clinical nurse specialists play an indispensable role in the management of ostomy,all kinds of chronic wounds and incontinent dermatitis.However,there exists a gap compared with developed countries and regions.This paper provides an overview of WOC nurses in China including origin and development,training and accreditation system,roles,values and management,in order to provide references for the development of WOC nurses in China.

Core competence evaluation standards for emergency nurse specialist: Developing and testing psychometric properties

Introduction:Nurse specialists are being cultivated and trained in China to cope with the international development of nursing discipline.However,an empirical summary and reviews of literature have shown a lack of core competence evaluation standards for emergency nurse specialists(ENSs)in China.ENS training has been conducted in several regions without any effective competence evaluation standards.This paper describes the development and psychometric testing of the Core Competence Evaluation Standards for Emergency Nurse Specialists(CCESENS)in the Chinese context.Methods:Several rigorous research methods were applied.The proposed evaluation process consisted of two phases with seven steps.First,the Core Competence Framework Model for Emergency Nurse Specialist(CCFMENS)was established,and 118 items were generated through a review of literature,theoretical analysis,and expert interviews.Drafts of the dimensions and items were evaluated by two-round Delphi methods.Analysis hierarchy process was used to determine the weight of each dimension.Second,field testing was performed among 138 senior emergency nurses.Internal consistency and correlation analysis were applied to test the reliability and validity of the model.Results:The CCESENS consisted of five first-level dimensions,16 second-level dimensions,and 55 items.Cronbach's a coefficient of overall standards was 0.972,and each dimension ranged from 0.508 to 0.972.Expert content validity index was 0.818,and the correlation coefficients of the five first-level dimensions with the overall standards CCESENS ranged from 0.701 to 0.886(P<0.05).Discussion:The CCESENS demonstrated sound internal consistency reliability,content validity,and construct validity.The proposed standard provides an objective standard and reference for assessing,training,and evaluating core competence of ENS.

A systematic review of the effectiveness of clinical nurse specialist interventions in patients with chronic obstructive pulmonary disease(COPD)

Objective： This review aimed to examine the effectiveness of clinical nurse specialist （CNS） interventions in patients with chronic obstructive pulmonary disease （COPD）. COPD significantly affects people＇s health worldwide. With the development in nursing, CNSs are playing increasingly important roles in different departments. However, the studies on the effectiveness of CNSs in COPD are not as well organized as the studies on the effectiveness of CNSs in bronchiectasis and asthma. Therefore, this review aims to find some updated evidence on the CNS interventions for patients with COPD and on whether these interventions are effective.Methods： A narrative analysis of the data was performed for the eligible studies. Four databases were chosen： CINAHL, MEDLINE, British Nursing Index, and Cochrane Library. Other websites such as the National Institute for Health and Clinical Excellence, National Health Service Evidence, Association of Respiratory Nurse Specialists, and National Association of Clinical Nurse Specialist were searched as well. Two reviewers performed study identification independently, and all the retrieved articles were stored using the EndNote X7 software. The risk of bias in the included studies was assessed using the Cochrane Collaboration＇s risk of bias tool. Results： A total of nine studies were included in this review. There were five current interventions by CNSs for patients with COPD. These interventions were home nursing support, CNS]s supported discharge, multidisciplinary cooperation programs, nurse-led care programs, and self-care management education. The effectiveness of these five interventions was evaluated individually. There is low- to moderate-quality evidence indicating that home nursing support interventions may have a positive effect on mortality and quality of life. No significant difference in quality of life has been found between the CNS-supported discharge intervention and the usual service. The multidisciplinary cooperation program probably had a positive effect on quality ot life in patients with COPD. Both nurse-led care and self-care management education intervention had a positive effect on mortality of patients with COPD.Conclusions： The findings of this review provide updated evidence on the effectiveness of CNS interventions for patients with COPD. Although nine trials were included and five types of interventions were identified, there is still lack of high-quality evidence.

Training indicators and quantitative criteria for emergency nurse specialists

Objective： By constructing a training system of quality evaluation standards for emergency nurse specialist（ENS）, we can ensure smooth operations and quality training for ENS.Methods： First, the frame structure of indicators was designed on the basis of system theory and the balanced scorecard method. Meanwhile, corresponding quantitative standard indicators were compiled through literature analysis and a review of training characteristics. Next, screening indicators were collected through consultation with experts and statistical calculations. The indicators weight coefficient was calculated using the analytic hierarchy process（AHP）. Finally, indicators were validated in two groups of nurses in two different training courses.Results：（1） We created a three-level indicator system： level-Ⅰ dimensions have 4 indicators, while level-Ⅱ dimensions and level-Ⅲ dimensions have 13 and 34 indicators, respectively;（2） The coefficient of expert＇s judgment is 0.840, familiarity is 0.914 and authority is 0.877, and the three rounds of coordination coefficient are 0.456, 0.553 and 0.715, respectively;（3） There are at least 56 indicators in alternative quantitative standards; and（4） The alpha reliability value of the indicator system in the two training course had no significant difference（P 〉 0.05）. The same result was observed when examining two groups of nurses in one training course（P 〉 0.05）.Conclusions： This study established a training system of quality evaluation standards for emergency nurse specialists that is objective, reliable, easy to operate and representative according to scientific selection and verification. This system can therefore provide a basis for quality evaluation and targeted improvement for ENS training in addition to promoting health.

Development of the Diabetes Oral Health Assessment Tool ©for Nurses

Although some studies had suggested a bidirectional relationship between diabetes and periodontal disease, there were no appropriate tools for nurses to evaluate oral status and oral health behaviors in patients with diabetes. Therefore, the Diabetes Oral Health Assessment Tool (DiO-HAT ?) was developed with items contributed by health care professionals (diabetologists, periodontal specialists, a preventive dentist, a Certified Nurse in Diabetes Nursing, a national registered dietitian, registered nurses, a dental hygienist, and nursing researchers) who were involved in the medical care of patients with diabetes. Subsequently, a survey of 700 Diabetes Nurse Specialists (DNS) was conducted to determine their score of recognition and implementation of the DiOHAT ?, however, 304 participants (43.4%) responded. Constructive concept validation and the Cronbach’s alpha coefficient for all assessment items were 0.931, indicating high reliability: Factor 1, Patient’s oral health status (α = 0.831);Factor 2, Implementation of oral health behaviors (α = 0.890);Factor 3, Information transmission regarding dental visits (α = 0.862);and Factor 4, Perceptions and knowledge of oral health behaviors (α = 0.793). Although the mean score of recognition of DiOHAT ? was 3.5 ± 0.4 points, the mean value of the implementation score was 1.5 ± 0.5 points (obtained using a 4-grade scale). The implementation scores were significantly lower than the recognition scores for all items (p < 0.001). The findings suggested that the DNS were not inclined to implement all items of DiOHAT ?, despite recognizing their importance.

Emotional Support and Well-Being of Adults with Congenital Heart Disease (ACHD): Contributions of a Specialist Nursing Service

Living with a congenital heart condition can require a daunting and uncertain patient journey during which the support of a specialist nursing service is vital. A descriptive, cross-sectional evaluation completed over two years, utilised a postal questionnaire to investigate patient’s satisfaction with aspects of service. Qualitative responses to open questions on satisfaction with emotional support (n = 103) and contributions to well-being (n = 90) were analysed using a framework approach which identified eight themes. Professional knowledge and expertise, service accessibility, caring attributes, enabling patients to cope with anxiety, depression and meeting changing needs contributed positively to both patient well-being and emotional support. Family support was influential on emotional support alone, whilst mediating medical liaison exerted an impact on well-being by enhancing feelings of security. In conclusion, the specialist nursing service contributed positively to well-being and emotional support of patients and thereby to selective aspects of continuity of care.

The Role of Study Nurses in Clinical Trials of IBD Drugs

Objective: To explore the establishment and roles of study nurses in IBD drug clinical trials. Methods: The management experience of this department’s study nurses in IBD drug clinical trials was retrospectively analyzed. Results: The study nurses played very important roles at all links during the preliminary preparation of IBD drug clinical trials, the whole-process management after project initiation, and the later work of project conclusion. Conclusions: As direct participants in drug clinical trials, study nurses play a very important role in ensuring standardization of the trial process, safeguarding patient’s rights and safety, and assisting investigators in carrying out study works smoothly.

Clinical Supervision and Non-Technical Professional Development Skills in the Context of Patient Safety—The Views of Nurse Specialist Students

The aim of the study was to evaluate nurse specialist students’ views of clinical supervision (CS) and its influence on their professional competence development. An additional aim was to interpret the results and link them to non-technical skills and Patient Safety (PS) topics. The research question was: What are the benefits of clinical supervision focusing on non-technical skills in the area of PS? A cross-sectional study of 46 nurse specialist students was conducted by means of questionnaires and exploratory factor analysis. Factors that influenced the nurse specialist students’ competencies were: interpersonal, professional and communication skills in addition to awareness of ethical skills, the importance of teamwork and the benefit of involving patients and their family members in safe care. The results were linked to non-technical skills and PS competencies. Clinical supervision is crucial for the development of non-technical skills and PS competencies among nurse specialist students. However, finding time to reflect and learn from the supervision was reported to be a problem. Over half of the students stated they did not have enough time for supervision. Thus, there is a potential for quality improvement. We recommend that universities should provide formal educational programmes for supervisors focusing on the professional development of students, especially in the area of non-technical skills. In conclusion, CS should be prioritised by management and clinical leaders as it enhances PS.

慢性伤口处理中的临床伦理困境探析——以1例产后脂肪液化合并线结反应的慢性伤口患者护理为例

专科护士在临床中发挥越来越重要的作用,同时他们在独立面对患者时(尤其是造口治疗师/伤口造口专科护士)也常常为伦理难题所困扰。在前期构建的“临床护理伦理结构化分析表格”基础上,采用案例陈述法,以1例产后脂肪液化合并线结反应的慢性伤口患者的护理为例,分析造口治疗师在解决治疗冲突时的伦理思考。进而建议专科护士在解决患者疑难复杂问题时,需要充分考虑患者的意愿与背景特征,可采用“伦理分析四盒子模型”,以达到分析及解决伦理冲突问题的目的。

互联网+专科护士区域联动护理在基层老年永久性肠造口早期病人中的应用

目的:探讨互联网+专科护士区域联动护理在基层老年永久性肠造口早期病人中的应用。方法:选取2019年1月1日—2021年12月31日就诊于某医院胃肠外科行永久性肠造口的70例基层老年病人为研究对象,根据就诊时间将其分为对照组和干预组,对照组给予常规护理,干预组在常规护理的基础上给予互联网+专科护士区域联动护理。采用中文版造口病人社会心理适应量表(OAI-20)和中文版造口病人生活质量量表(Stoma-QOL)分别于病人出院前1 d、出院后1个月、3个月、6个月后评估两组病人社会心理适应和病人生活质量,并比较两组6个月内造口及造口周围皮肤并发症的发生率。结果:70例病人均完成各阶段护理及评估,经重复测量方差分析显示,两组病人在社会心理适应方面和生活质量评估方面存在时间效应、组间效应及交互效应,干预组OAI-20总分、Stoma-QOL总分均高于对照组,差异有统计学意义(P<0.05);6个月内干预组并发症发生率低于对照组(P<0.05)。结论:互联网+专科护士区域联动护理能够提高基层地区老年永久性肠造口病人早期社会及心理适应能力,提高病人生活质量,降低造口并发症发生率,有利于在有限的医疗资源下给予病人同质化的护理。

我国性治疗护士工作范畴和核心能力的质性研究

目的探究我国性治疗护士的工作范畴及核心能力。方法通过文献回顾制定访谈提纲,对学习对象、学科专家、社会人群共23人进行半结构访谈,利用NVivO12软件对访谈资料进行编码。采用主题分析法进行资料分析,遵循Braun和Clarke六阶段法则,归纳分析并提炼主题。结果性治疗护士主要工作内容是以性功能障碍人群为主,辅以性心理障碍、性少数群体进行性教育、性咨询、性治疗。核心能力可归纳为5大主题包括专业临床实践能力、评判性思维能力、专业发展能力、管理与协调能力、法律与伦理道德践行能力。结论性治疗护士的工作范畴为处理各种有性问题的人群。性治疗护士应具备多方面的核心能力,以专业临床实践为中心能力,其他能力基于此相辅相成。未来仍需通过量性研究构建具有实用性、科学性的核心能力评价指标体系,为性医学护理领域应用型人才的培养与管理提供参考。

校院联合、医教一体开展专科护理人才培养的探索

在国家政策的支持和引导下,我国专科护士培养取得长足进步。但总体来说,仍存在专科护士教育体系不完善、培训内容不规范、师资力量薄弱、缺乏统一的资格认证、培养形式单一等问题。文章在分析我国专科护士培养的现状和存在问题的基础上,提出了高职院校联合临床教学基地“医教一体”开展专科护士人才培养的新路径。从专科护士“医教一体”培养合作模式与运行机制的建立、培养对象的选择和专科护理“医教一体”人才培养模式的创新、课程结构的重塑、临床教学基地的建设和专科护理师资队伍的建设等方面开展积极探索与实践,取得较好的成效,相关探索与实践是对专科护理人才培养新机制、新途径的有益探索,有利于充分发挥学校教育和高质量医疗资源两方面的优势,共同促进我国专科护士人才的培养,也为完善专科护士学历教育体系提供实践参考。

护理硕士专业学位研究生双导师制管理方案的构建

为建立护理硕士专业学位双导师制管理方案,对42名教育专家、临床护理专家、研究生导师进行两轮德尔菲专家咨询,最终确立一、二级指标。两轮德尔菲专家咨询的专家积极系数分别为100%(n=42)和90%(n=38),专家权威系数为0.965(>0.70),重要性赋值均数>3.5,第二轮问卷函询所有指标的变异系数为0.11~0.24(<0.25)。最终双导师制管理方案分为5个一级指标、34个二级指标。构建的指标代表性和可信度较高,可为护理硕士专业学位双导师制管理提供标准。

泌尿外科专科护士核心能力特征要素的质性研究

目的探究泌尿外科专科护士应具备的核心能力特征要素,为泌尿外科专科护士人才培养提供依据。方法采用描述性质性研究法,目的抽样选取河南省二级甲等以上11家医院的12名泌尿外科医生、20名护士和18名患者进行半结构式访谈,并收集典型个案信息作为补充资料,采用内容分析法对资料进行统计、分析。结果泌尿外科专科护士的核心能力特征要素可归纳为6大主题:临床岗位胜任力、沟通协调能力、专业发展能力、延续护理能力、法律素养、管理能力。结论泌尿外科专科护士需具备多元核心能力,应重视和加强以上6项核心能力的培养,以适应泌尿外科专科护理发展的需求。

湖南省47个伤口造口专科护理门诊成本效益现状研究

目的了解伤口造口专科护理门诊成本效益情况,为提升伤口造口专科护理门诊成本效益管理水平提供依据。方法采用自行设计的伤口造口专科护理门诊成本效益调查问卷对湖南省47个伤口造口专科护理门诊进行伤口造口专科护理门诊和护理单个患者的可货币化成本效益及患者满意度调查。结果湖南省47个伤口造口专科护理门诊可货币化成本均高于效益(效益/成本<1.0)。伤口造口专科门诊护理的466例患者可货币化成本高于效益(效益/成本<1.0)。伤口造口专科护理门诊的整体满意度评价≥8分者有492例,占92.66%。结论伤口造口专科护理门诊可货币化成本效益处于倒置状态,说明伤口造口专科护理门诊需科学控制成本、适当增设伤口造口专科护理门诊护士、优化伤口造口专科护理流程及争取伤口造口专科护理相关政策,从而提升伤口造口专科护理门诊成本效益管理。