Service-Learning Practices and Reflections in the Perspective of Nel Noddings’Theory of Caring Education:The“Care for the Elderly”Service-Learning Program as an Example

Nel Noddings’ethics of care is an important lineage of Western moral education thought,which contains deep humanistic values.Service-learning advocates the equal importance of service and learning,and emphasizes more on the discovery of educational connotations in practice.Based on the social background of aging,this paper takes the“Care for the Elderly”service-learning program as an example,attempts to take the care ethics as the entry point,adopts interviews,questionnaires,and other research methods,and opens-up the service-learning practice path under the threshold of Nel Noddings’care education theory.

Application of “Swanson’s Middle Range Caring Theory” in Sweden after miscarriage

Objective: The aim of this study was to apply Swanson’s Middle Range Caring Theory to the follow-up visit with a midwife for Swedish women who have suffered early miscarriage or received care for late missed miscarriage in preg-nancy week 18-20. Methods: Twenty-five tape recorded interviews with women four weeks after their early miscarriages and thirteen tape recorded semi-structured interviews with midwives and nurses who had the experience of caring for women who have been diagnosed with a missed miscarriage during a routine ultrasound scan. The interviews were transcribed verbatim and interpreted deductively from the text using the theory. Results: Each woman described her personal experience of miscarriage in the relative terms of a human experience. The midwives and nurses described their experiences with women who received care for missed miscarriage. The interviews included information about the treatment provided by the caregivers during the period afterward of the diagnosis. The caregiver attitude was formed from Swanson’s caring categories: “Maintaining belief”, “knowing”, “being with”, “doing for”, “enabling”. Conclusions: Swanson’s Middle Range Caring Theory as applied to the caregiver includes being emotionally present, giving support with respect for the woman’s dignity, being competent, meeting each woman’s own individual needs. Given the proper care after a miscarriage every woman has the power within herself to improve their wellbeing.

Theory Critique of Kristen Swanson’s Theory of Caring

Theory is considered essential for integral assessment, adopting its foundations and concepts is of great utility. The theory provides different templates to help nurses provide care that respects patients and improves outcomes. Through understanding the intersection of nursing, patients, health, and the environment, theories aim to simplify the complicated, ever-evolving relationship that nurses have with their profession. Nursing theory helps distinguish nursing as a separate discipline from medicine and related sciences, and assists nurses in understanding their patients and their needs. The behaviors of healthcare providers affect how patients participate in and experience care situations. In the nursing discipline, the theoretical structures of caring have been established as the core concept of guidance in all nurses’ work. The aim of this paper is to develop a critique of Kristen Swanson’s theory of caring—a theory structured around five caring principles (maintaining belief, knowing, being with, doing for, and enabling) by applying it to nursing practice. When applied to nursing practice, each of these five stages stimulates the caregiver’s attitude, which in turn improves the overall patient’s well-being. Implications to nursing practice are mentioned [1] [2].

Empirical Verification of Swanson’s Caring Processes Found in Nursing Actions: Systematic Review

Caring has long been recognized as central to nursing and is increasingly posited as a core concept although developing a theoretical description of caring which is adequate in the 21st. century continues to be a difficult task for nursing scholars. Consequently, verifying existing theoretical structures of caring remains an ongoing challenge. The aim of this article is to provide empirical verification of the caring processes of “knowing,” “being with,” “doing for,” “enabling” and “maintaining belief” from Swanson’s Middle Range Caring Theory based on the categorization of nursing actions from a systematic literature review on care. Methods: A systematic literature review was conducted in the fields of nursing sciences, medicine and psychology. Purposeful sampling was carried out covering a period from 2003-2013. The final sample included 25 articles. Results: Major themes of nursing actions included “knowing” which consisted of centering, nurturing, informed understanding, assessment skills, communication and respect for individual differences. “Being with” was characterized by intimate relationship, connecting, presencing, emotional adaptability awareness of self/other and decentering. “Doing for” included competence, knowledge, professional/technical skills, helping actions, anticipatory, multidisciplinary and preserving dignity. “Enabling” was characterized by self care, commitment, complexity of care, appropriate communication, information/education, sharing power, enabling choice and ongoing validation. Finally, “maintaining belief” was characterized by spiritual being, humanistic view, harmonious balance, hope, love, and compassion, meaning, and religious and spiritual orientation. Conclusion: Empirical verification was shown for the caring processes described in Swanson’s Caring Theory grounded in concrete nursing actions.

Critical reflection on the role of theater nurses in a multidisciplinary team for perioperative care in China

Objective: The aim of this article is to reflect on the role of theater nurses in a multidisciplinary team, understand the factors that have influenced theater nurses' practice, and improve the authors' clinical practice ultimately.Methods: The author used Smyth's model to guide the process of reflection on the practice issue. Critical reflection, critical emancipatory theory, reflexivity, and critical social theory were used to help the author analyze the factors that have affected theater nurses' practice in the organization.Results: There are gaps between the espoused and enacted theories. A theater nurse's practice is determined by multiple factors, such as political, structural, social, historical, cultural issues, and so on. The hierarchy of the health context could hinder possible changes in theater nurses' practice. To better understand our practice and implement transformation, we should shape a supportive environment,bear in mind the practice motto of "patient-centered" care, and improve our knowledge and reflection skills.Conclusions: Reflection plays a significant role in the advancing of practice among theater nurses and needs to be combined with clinical practice. To provide the best service of care to perioperative patients, a theater nurse should have an insightful understanding of the factors that have influenced her/his behaviors historically, socially, and culturally. By improving their critical reflection skills,practitioners could gain knowledge from experience.

基于Swanson关怀理论的护理干预在早产儿母亲中的应用

目的:探讨以Swanson关怀理论为框架的护理干预在早产儿母亲中的应用效果。方法:采取便利抽样法选取2022年1月-5月入住百色市某三级甲等医院新生儿重症监护室(NICU)治愈出院的40例早产儿母亲作为对照组,选取2022年6月-10月入住百色市某三级甲等医院NICU治愈出院的40例早产儿母亲作为试验组。对照组实施NICU常规护理,试验组在对照组干预的基础上实施基于Swanson关怀理论的护理干预,比较两组早产儿母亲干预前后疾病不确定感、希望水平、育儿胜任感得分情况。结果:干预后试验组早产儿母亲疾病不确定感得分明显低于对照组(P<0.001),希望水平得分明显高于对照组(P<0.001);出院时及出院1个月后试验组早产儿母亲育儿胜任感得分明显高于对照组(P<0.001)。结论:基于Swanson关怀理论的护理干预可有效降低早产儿母亲疾病不确定感水平,提高其希望水平,增强其育儿胜任感,有利于早产儿顺利从医院过渡至家庭。

老年慢性阻塞性肺疾病患者应用Swanson关怀理论的健康教育实践研究

目的观察基于Swanson关怀理论的健康教育对老年慢阻肺患者治疗依从性和生活质量的影响。方法回顾性选取2021年6月—2023年6月间在亳州市人民医院接受治疗的老年COPD稳定期患者104例,依据不同干预措施将患者分为对照组和观察组,每组52例。对照组患者行常规健康教育,观察组采用基于Swanson关怀理论的健康教育。观察并比较2组干预前后患者治疗依从性、生活质量和肺功能指标值变化情况。结果干预后,观察组和对照组患者吸入药物治疗依从性量表(TAI)评分均较同组干预前升高,且观察组TAI评分高于对照组(均P<0.05);观察组和对照组患者活动能力、胸闷、精力和日常活动能力评分较同组干预前降低,且观察组上述评分均低于对照组(均P<0.05)。干预后,观察组和对照组患者FVC、FEV 1/FVC较干预前升高,且观察组高于对照组(P<0.05)。结论应用基于Swanson关怀理论的健康教育可显著改善老年慢阻肺患者的治疗依从性,提高患者的生活质量和肺功能。

观察基于Watson人性照顾理论的干预对重症肺炎合并呼吸衰竭患者的应用效果

目的:观察基于Watson人性照顾理论的干预对重症肺炎合并呼吸衰竭患者的应用效果。方法:选取2021年6月至2023年6月泉州市第一医院呼吸与危重症医学科收治的重症肺炎合并呼吸衰竭患者94例作为研究对象,按照随机数字表法分为对照组和观察组,每组47例。对照组给予常规护理干预,观察组在对照组基础上给予Watson人性照顾理论的干预。采用匹兹堡睡眠质量指数量表(PSQI)比较2组患者干预前后睡眠质量的变化,采用阿森斯失眠量表(AIS)评估2组患者干预前后失眠的改善效果,并通过2组患者护理后的呼吸困难缓解时间、机械通气时间、重症监护室住院时间,以判断恢复情况。结果:干预后,观察组患者PSQI评分、AIS评分均显著低于对照组,观察组呼吸困难缓解时间、机械通气时间及重症监护室住院时间均显著短于对照组,差异均有统计学意义(均P<0.05)。结论:对重症肺炎合并呼吸衰竭患者应用基于Watson人性照顾理论的护理干预可有效改善其睡眠质量,促进病情恢复,值得临床推广应用。

基于SERVQUAL模型的零售药店药学服务质量评价体系构建

目的:为进一步提高零售药店的药学服务质量提供参考。方法:基于SERVQUAL理论构建零售药店药学服务质量评价体系,并以此体系为依据对206例顾客进行问卷调查,分析零售药店的药学服务质量对顾客满意度的影响。结果:结合SERVQUAL量表的有形性、可靠性、响应性、安全性、移情性等5个维度的内涵,可构建出药学服务质量的上述5个一级指标,以及与之分别对应的药店布局、服务环境、服务人员资格、履行承诺、服务及时性、投诉服务、药师审核处方、工作人员专业能力、建立药历档案、售后服务等27个二级指标。经过对206份问卷中的166份有效问卷进行回归分析表明,各维度对零售药店药学服务质量满意度的影响大小依次为可靠性、有形性、安全性、移情性(权重分别为0.359、0.338、0.230、0.159)。结论:应重点确保服务质量的可靠性,从保障服务人员的资格、履行对顾客的承诺等方面入手,以提高顾客的满意度。

Swanson关怀理论对母婴分离产妇乳汁分泌情况的影响

目的分析Swanson关怀理论对母婴分离产妇乳汁分泌情况的影响。方法将2017年1月~2018年12月重庆市妇幼保健院产科分娩的327例母婴分离产妇,根据随机数字表法分为Swanson组(163例)及对照组(164例),对照组产后予常规护理,Swanson组根据Swanson关怀理论进行照拂。对两组产妇的一般资料、乳汁分泌情况及产后72 h内的泌乳量进行比较,并根据产妇72 h内乳汁分泌量分为≥50 mL及<50 mL两组,对影响乳汁分泌的因素进行比较及Logistic回归分析。结果两组产妇一般资料比较,差异均无统计学意义(均P>0.05);Swanson组的乳汁始动时间、产后3 d乳房肿痛人数、状态-特质焦虑问卷(STAI)及爱丁堡产后抑郁量表(EPDS)评分均明显低于对照组,产后24 h、>24~48 h及>48~72 h泌乳量及产后42 d母乳喂养率均明显多于对照组(均P<0.05),分娩方式、产后24 h睡眠时间、产后2 h乳头刺激、24 h内挤奶次数、夜间挤奶次数、每次挤奶时间及EPDS评分、Swanson关怀理论均对乳汁分泌有显著影响(均P<0.05)。且logistic回归分析示Swanson关怀理论是促进产妇乳汁分泌的独立保护因素(OR=0.454,95%CI:0.221~0.932,P=0.031)。结论Swanson关怀理论能有效增加母婴分离产妇的乳汁分泌量,提高其产后母乳喂养率,有效改善产妇焦虑、紧张情绪。

基于Swanson关怀理论的肺康复训练对肺癌患者的影响

目的 探讨基于Swanson关怀理论的肺康复训练在肺癌根治术患者中的应用效果。方法 将104例肺癌根治术患者按住院时间分成对照组和干预组各52例,分别实施常规肺康复训练和基于Swanson关怀理论的肺康复训练。比较两组干预后肺功能指标及护患关系信任度改善情况。结果 93例患者完成研究,干预后两组6 min步行试验评分、护患关系信任度评分比较,差异有统计学意义(均P<0.05)。结论 基于Swanson关怀理论的肺康复训练,可提升患者对护士的信任度,有利于患者术后康复。

Snyder希望理论指导的健康行为互动模式干预对肝硬化患者心理弹性及自理能力的影响

目的探讨Snyder希望理论指导的健康行为互动模式干预对肝硬化患者心理弹性以及自理能力的影响。方法选择2021年2月至2022年10月在我院接受治疗的78例肝硬化患者,按照随机数字表法分成常规组与研究组各39例,常规组给予基础护理,研究组在常规组的基础上给予Snyder希望理论指导的健康行为互动模式干预,比较两组的Herth希望量表(HHI)、Frank依从量表(FCS)、心理弹性量表(CD-RISC10)及自理能力(肝硬化自我管理行为量表)评分。结果护理后,两组患者HHI、FCS、CD-RISC10评分均升高,研究组各评分高于对照组(P<0.05);日常生活管理、病情监测管理、用药管理及饮食管理评分均较护理前升高,且研究组自理能力各评分高于对照组(P<0.05)。结论Snyder希望理论指导的健康行为互动模式干预能提高患者的希望水平和治疗依从性,改善其心理弹性,提升自理能力。

基于“S-O-R”模式联合“Heider平衡理论”的健康教育在妇科肿瘤患者术后延续护理中的应用

目的:探讨以“S-O-R”模式联合“Heider平衡理论”移动医疗为基础的健康教育在妇科肿瘤患者术后延续护理中的应用效果。方法:将94例接受化疗的妇科肿瘤患者随机分为实验组和对照组各47例;对照组给予常规护理干预,实验组实施以“S-O-R”模式联合“Heider平衡理论”移动医疗为基础的健康教育;比较两组癌因性疲乏程度[采用Piper疲乏修订量表(R-PFS)评分]、疾病不确定感[采用Mishel中文版疾病不确定感量表(MUIS)评分]、生活质量[采用癌症患者核心问卷调查表(QLQ-C30)评分]。结果:实验组R-PFS各维度评分均低于对照组(P<0.05);两组出院后MUIS评分均低于出院前(P<0.05),且实验组低于对照组(P<0.05);实验组QLQ-C30各维度评分均高于对照组(P<0.05)。结论:将基于“S-O-R”模式联合“Heider平衡理论”的移动医疗健康教育应用于妇科肿瘤患者术后延续护理中,可有效降低患者癌因性疲乏程度和疾病不确定评分,改善患者生活质量。

Building Knowledge: The Concept of Care

Aim and Objectives: The aim of this article is to explore whether the specific levels of caring described in Swanson’s Middle Range Caring Theory which include characteristics of caring, people’s concerns and commitments underlying caring, conditions that enhance/inhibit caring and consequences of caring and non-caring could be used in categorizing findings from two literature reviews investigating the concept of care. Background: Nursing has a long legacy as a caring/healing profession where caring is increasingly posited as one of the core concepts in modern nursing science. However, the meanings given to the concept of care remain elusive, ambiguous and unclear. Design: Two systematic literature reviews. Method: Twenty-nine articles based on strategic inclusion and exclusion criteria were synthesized. Data was retrieved from CINAHL, Medline, Embase and PsycInfo covering the period 2003-2016. The literature search used the key words care, concept analysis, systematic review, meta-synthesis, meta-analysis and narrative review. Results: Major themes found were related to the following characteristics of caring persons: compassionate, knowledgeable, positive and reflective. Concerns and commitments underlying caring were doing the right thing, connecting, focusing on the others’ experience, acknowledging individual dignity and worth and being present. Conditions that enhanced/inhibited caring were situational constraints, personality traits, communication skills, health problems and organizational features. Consequences of caring and non-caring actions included both positive and negative emotional, spiritual, physical, and social outcomes for patients, families and nurses. Conclusion: The specific levels of caring described in Swanson’s Middle Range Caring Theory are highly suitable for categorizing the findings from three literature reviews on the concept of care. Relevance to Clinical Practice: Swanson’s Middle Range Caring Theory can be used to guide clinical practice and encourage an individual approach to care. It has been shown to contain clear, comprehensible language in its theoretical basis;this encourages use in clinical practice.

基于King达标理论的培训方案对临床护士叙事能力及人文关怀能力的影响

目的:探讨基于King达标理论构建临床护士叙事护理培训方案对临床护士叙事护理能力、人文关怀能力及共情能力的影响。方法:2023年3月—5月选取淄博市某三级甲等医院138名护士,采用随机数字表法分为试验组和对照组。对照组实施常规叙事护理培训,试验组在对照组的基础上实施基于King达标理论指导下的叙事护理方案。采用医学叙事能力量表(NCS)、关怀能力评价量表(CAI)、杰弗逊共情量表(JSE-HP)进行效果评价。结果:干预后,试验组护士NCS、CAI及JSE-HP得分均高于对照组,差异均有统计学意义(P<0.05)。结论:基于King达标理论构建的临床护士叙事培训方案可有效提高临床护士叙事护理能力、促进人文关怀能力并提升护士共情能力。

诺丁斯关怀理论指导下的护理干预对支气管哮喘儿童心理健康、生活质量的影响

目的探讨诺丁斯关怀理论指导下的护理干预对支气管哮喘儿童心理健康、生活质量的影响。方法方便选取2022年3月—2023年3月福建省儿童医院收治的98例支气管哮喘患儿作为研究对象,按照随机数表法分为对照组和观察组,各49例。对照组接受临床支气管哮喘常规护理,观察组在常规护理基础上加入诺丁斯关怀理论指导下的护理干预。对比两组患儿的服药依从性、心理健康、生活质量的差异。结果入院当日,两组患儿的服药依从率、儿童抑郁障碍自评量表(Depression Self-rating Scale for Children,DSRSC)、儿童焦虑性情绪障碍筛查表(Screen for Child Anxiety Related Emotional Disorders,SCARED)、儿童哮喘生活质量问卷(Pediatric Rhinoconjunctivitis Quality of Life Questionnaire,PAQLQ)评分对比,差异无统计学意义(P均>0.05)。出院当日,观察组的服药依从率93.88%优于对照组,差异有统计学意义(P<0.05);观察组的DSRSC(8.19±0.97)分、SCARED(13.11±1.76)分低于对照组,差异有统计学意义(t=8.077、9.730,P均<0.05);观察组的PAQLQ中症状、活动、情感功能等评分均高于对照组,差异有统计学意义(P均<0.05)。结论诺丁斯关怀理论指导下的护理干预应用于支气管哮喘儿童中,可有效强化服药依从性、优化心理健康、提升生活质量,是一种优质的护理模式。

诺丁斯关怀理论对先天性并指畸形患儿心理健康及生活质量的影响

目的探讨诺丁斯关怀理论护理对先天性并指畸形患儿心理健康、生活质量的影响。方法选取136例先天性并指畸形患儿作为研究对象,采用随机数字表法分为对照组和干预组,每组68例。对照组采用常规护理,干预组采用诺丁斯关怀理论护理。观察2组患儿并发症发生情况,比较2组患儿干预前后生活质量[世界卫生组织生活质量测定量表简表(QOL-BREF)评分]、心理健康状况[少儿心理健康量表(MHS-CA)评分]。结果干预组并发症发生率(2.94%)低于对照组(13.24%),差异有统计学意义(P<0.05)。干预后,2组QOL-BREF各维度(心理、生理、生活环境、社会关系)评分均高于干预前,且干预组评分高于对照组,差异有统计学意义(P<0.05);干预后,2组MHS-CA各维度(思维语言、认知功能、意志行为、个性特征、情绪体验)评分均高于干预前,且干预组评分高于对照组,差异有统计学意义(P<0.05)。结论诺丁斯关怀理论护理可改善先天性并指畸形患儿心理健康状况,提高生活质量,并减少并发症。

基于希望理论的肺康复训练对COPD患者希望水平及自我护理能力的影响

目的探讨基于Snyder希望理论的肺康复训练对慢性阻塞性肺疾病患者希望水平、自我护理能力及生存状况的影响。方法将132例慢性阻塞性肺疾病患者随机分为试验组和对照组各66例。对照组实施呼吸科常规护理,试验组在对照组基础上实施基于Snyder希望理论的肺康复训练。干预前及干预4、12周后采用Herth希望量表、自我护理能力量表及BODE指数对两组进行测评。结果干预后,试验组希望水平、自我护理能力评分显著高于对照组,BODE指数评分显著低于对照组(均P<0.05)。结论基于Snyder希望理论的肺康复训练能有效提升慢性阻塞性肺疾病患者的希望水平及自我护理能力,改善患者生存状况。

患者对预检分诊服务满意度理论框架的扎根理论研究

目的 通过扎根理论研究构建患者视角的预检分诊服务满意度理论框架,为评估和量化患者对预检分诊服务的满意度提供参考。方法 采用目的抽样和理论抽样的方法,选择27例接受过预检分诊服务的患者进行半结构式深度访谈;运用程序化扎根理论的研究方法,采用NVIVO12.0软件辅助对原始数据进行开放式编码、主轴编码及选择性编码,并进行理论饱和度检验。结果 析出患者期望、服务质量、信息供给、人本关怀、持续改进5个主范畴。结论 5个主范畴分别构成预检分诊服务满意度的主体因素、核心因素、关键因素、基本因素和保障因素。该理论框架可为改善预检分诊服务、评估患者满意度提供参考。

健康教育图文册的构建及在食管癌患者术后康复护理的应用

目的基于知识可视化构建健康教育图文册,并探讨其用于食管癌患者术后康复护理的效果。方法将116例食管癌手术患者按照入院时间顺序分组,试验组58例,采用由研究团队基于知识可视化构建的健康教育图文册进行术后健康教育;对照组58例,实施常规健康教育。出院时评价两组自我护理能力、恐惧疾病进展、术后康复指标及患者满意度。结果试验组自我护理能力总分显著高于对照组,疾病进展恐惧总分显著低于对照组,术后胸腔引流管留置时间、胃管留置时间显著短于对照组,患者满意度得分显著高于对照组(均P<0.05)。结论将健康教育图文册应用于食管癌术后患者,可提升患者自我护理能力及满意度,改善疾病恐惧水平,促进食管癌术后患者术后康复。