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。

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.

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.

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.

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.

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.

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.

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。

Evidence-Based Practice among Critical Care Nurse’s/Midwives in Qatar

Background: Successful implementation of evidence-based research into clinical practice was determined by four core elements, self-belief, the nature and level of evidence, the conductive context into which the study is to be implemented, and organizational factors facilitating the process. Aim: The current study aimed to examine barriers influencing evidence-based practice among critical care nurses in QATAR. Methods: A cross-sectional survey was utilized for the study resulting in data collected from 278 nurses during the period of Feb-2021 to March 2021 using the Barriers to Research Utilization Scale (BTRUS). The BTRUS consisted of data on various information sources utilized by nurses for support in practice, potential barriers for evidence-based practice, and perceived skills on applying research-based evidence. Result: The most significant organizational barriers were lack of time, lack of empowerment to change practice, lack of support from colleagues in implementing research evidence, and lack of access to research articles. Self-perceived barriers were irrelevance of research evidence to current practice, studies having methodological flaws, skepticism about research findings, a large amount of research evidence, and inability to understand statistics. The Nurse’s age, years of nursing practice, academic attainment, and organizational position influenced self-reported barriers and utilization of sources of Evidence. Conclusion: Organizational support, improved self-belief, and evidence-based practice expertise may reduce barriers to implementing research evidence in clinical Practice.

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。

Reflection as a Skill-Clinical Supervision as a Prerequisite for Professional Development to Ensure Patient Safety

This study is set in the context of the final phase of nurse specialist students’ (NSS) postgraduate education in surgical, oncological, anaesthesia and intensive care nursing at the University College in June 2015. The aim was to explore NSSs’ experiences of clinical supervision (CS) during their postgraduate clinical education. 46 NSS answered open-ended questions and their responses were analysed by means of a qualitative content analysis. The response rate was 82%. One main theme emerged: CS as a prerequisite for professional development and two domains: A reflective way of growing and learning through CS and The meaning of being and acting in a reflective and professional manner to ensure patient safety (PS). The results indicate that reflection is a crucial part of the NSS’ experiences of CS during their postgraduate clinical education. The supervisor’s ability to confirm the students, mutual trust and feeling safe in the relationship with the supervisor are of great importance. The students highlighted the value of continuity in CS and being supported yet challenged. The supervisor has great responsibility for the NSS’ development of professional clinical competence. The supervisor’s personal and professional skills, in addition to her/his ability to provide CS are important for PS as well as for professional and interdisciplinary teamwork. Acting in a reflective and professional manner is of great importance for ensuring PS. Although most of the students reported being sufficiently competent to ensure PS and agreed that CS and reflection are of great importance for PS, they wanted more time to reflect on their actions together with their supervisor. In conclusion, CS has the potential to lead to quality improvement. However, in order to enhance reflective practice, which is a prerequisite for CS and PS, we recommend closer cooperation between the university college and clinical supervisors, as well as a formal master level education for clinical supervisors.

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。

精神心理方向护理硕士专业学位研究生临床实践培养方案的构建

目的 构建精神心理方向护理硕士专业学位研究生临床实践培养方案。方法 基于文献回顾和专家讨论,形成精神心理方向护理硕士专业学位研究生临床实践培养方案初稿。选取来自北京、长沙、武汉、南京、上海、广州、成都、合肥、南昌的13名专家作为函询对象,于2022年10月—12月采用专家函询法对其进行2轮函询。结果 2轮专家函询的专家积极系数均为100%;专家权威系数分别为0.94、0.96;肯德尔协调系数分别为0.251和0.418(P<0.001)。最终构建的精神心理方向护理硕士专业学位研究生临床实践培养方案由7个模块(培养目标、培养内容、培养方式、培养时间、考核内容及占比、带教师资、实践基地)、36个一级条目、67个二级条目、103个三级条目构成。结论 本研究构建的精神心理方向护理硕士专业学位研究生临床实践培养方案科学、可信,可为我国精神心理方向护理硕士专业学位研究生临床实践能力的培养提供参考。

ICU专科护士临床实践教学服务质量评价指标体系的构建

目的基于SERVQUAL模型构建ICU专科护士临床实践教学服务质量评价指标体系。方法2023年9-12月,采用小组访谈、文献分析及德尔菲专家函询法,通过2轮对15名专家的函询,确定ICU专科护士临床实践教学服务质量评价指标体系的内容。结果2轮专家函询中,问卷的回收率均为100%,专家权威系数为0.92和0.91,变异系数为0.05~0.28和0.05~0.22,整体肯德尔协调系数分别为0.38和0.57,最终构建的ICU专科护士临床实践教学服务质量评价指标体系包含一级指标5项、二级指标10项和三级指标34项。结论构建的ICU专科护士临床实践教学服务质量评价指标体系结果科学可靠,专家意见集中,兼具教学评价和指导功能,可为ICU专科护士培训认证工作提供系统、客观的教学服务质量评价依据。

基于网络智能的任务驱动式小组工作坊学习在专科护士临床带教中的应用

目的观察基于网络智能的任务驱动式小组工作坊学习在专科护士临床带教中的应用效果。方法选取2020年1月至2022年12月专科护生107人,按照抽签法随机分成两组,对照组(53人)采取传统带教,观察组(54人)接受基于网络智能的任务驱动式小组工作坊学习模式。观察两组理论和操作技能成绩及干预前后学习兴趣、学业自我效能感、护患沟通能力。结果观察组理论与操作技能成绩评分高于对照组(P<0.05);干预后观察组学业自我效能感高于对照组(P<0.05);干预后观察组学习兴趣高于对照组(P<0.05);干预后观察组护患沟通能力高于对照组(P<0.05)。结论在专科护士临床带教中,基于网络智能的任务驱动式小组工作坊学习模式可激发护生学习兴趣,增强自我效能,提升教学效果。

以科技提升口腔专科护理质量——“口腔专科护理”专栏第二期导读

2022年“口腔专科护理”专栏第一期受到了广大口腔专科护理人员的关注,为进一步提高口腔专科护理质量,提升口腔专科护理人员科研能力,《中西医结合护理》组织第二期“口腔专科护理”专栏,在广泛征稿的基础上,针对性地在多个口腔专科护士培训、口腔护理会议等高规格专科护理平台中推广宣传,以扩大专栏的知名度,吸引更多专科护理人员积极投稿。

专科护士参与的住院患者脑卒中风险筛查及随访管理

目的探讨专科护士参与的住院患者脑卒中风险筛查及随访管理效果,为全面落实脑卒中一级预防提供借鉴。方法构建住院患者脑卒中风险筛查模式,对内外科≥40岁的住院患者进行脑卒中风险筛查。由病区责任护士对患者进行初筛、专科护士对高危风险患者进行卒中一级预防管理,进行1年的随访。结果2021年9月从内外科36个病区中筛查出脑卒中风险患者3416例,其中高危513例(15.02%),中危1926例(56.38%),低危977例(28.60%);对3类患者实施分级管理,其中高危患者由神经内科进一步诊疗;完成1年随访的197例高危患者,随访后血压、血脂、运动等达标率显著高于随访前(均P<0.05),健康自我管理能力得分显著提高(均P<0.05)。结论专科护士参与的住院患者脑卒中风险筛查模式有利于早期发现脑卒中风险患者,落实一级预防,从而降低脑卒中发生率。

基于能力本位专科护士培养衔接模式在护理专硕临床实践中的效果研究

目的:探讨基于能力本位专科护士培养衔接模式在护理专硕临床实践能力中的影响。方法:采用整群便利抽样法抽取新疆某三级甲等医院2020级专业型护理研究生为对照组,2021级专业型护理研究生为干预组,其中干预组采用基于能力本位专科护士培养衔接模式,对照组采用传统的培养模式。两组均在临床轮转结束后对学生的理论成绩、操作成绩、专科知识成绩、护理病例书写、个案和教学查房以及临床小讲课能力进行考核,并让学生填写护理问题对应行动自我评价量表(OPSN)、护士行为目标达成度评价量表(NPGA)和护理科研能力量表,将两组学生临床实践能力和科研能力进行评价。结果:两组学生的理论成绩、专科知识成绩、操作成绩、病例讨论成绩、个案和教学查房及临床小讲课得分比较,干预组均高于对照组,差异具有统计学意义(P<0.05);两组中文版OPSN得分、NPGA得分和护理科研能力量表得分比较,干预组均高于对照组,差异有统计学意义(P<0.05)。结论:将基于能力本位专科护士培养衔接模式应用于护理学专业型研究生教育,可提高其护理实践能力和科研能力水平,有助于对护理专业型硕士研究生的培养。

北京市属医院门诊专科护理工作室建设与运行现况调查

目的:调查北京市属医院门诊专科护理工作室的建设与运行现状,为进一步完善管理提供参考。方法:采用目的抽样法,于2021年5月—6月自制调查问卷对北京市第一、二批40个门诊专科护理工作室的建设及运行情况进行调查。结果:专业类别上,护理工作室主要分为护理治疗类、健康咨询类及康复护理类,其领军人硕士学历占比15.0%,全职工作的占22.5%;有35个护理工作室与其他学科有交叉合作,在合作学科中,营养科、心理科、药学科位居前三。截至调查时,有75.0%的领军人及出诊护士没有相应绩效分配,但70.0%的领军人呼吁收取相应医事服务费。此外,护理工作室在工作量、人才培养、教学成果与科研产出方面均有明显成效。结论:护理工作室专业类别丰富、特色特出,运行机制优势显著,发展前景良好,但在绩效考核、人员准入、效益评价、服务延伸等方面亟待进一步完善与提升。

护理硕士专业学位研究生临床能力现状及影响因素研究

目的了解护理硕士专业学位研究生临床能力现状,分析其影响因素,探讨对策和建议。方法采用自制的一般资料调查问卷和护理硕士专业学位研究生临床能力自评问卷进行调查。结果年龄、医院的管理及是否喜欢本专业是护理硕士专业学位研究生临床能力的主要影响因素(P<0.05)。结论护理硕士专业学位研究生临床能力整体水平一般,护理教育者和管理者可根据其影响因素制定规范的管理制度和考核制度来保证培养方案的落实,实现学校和医院有效合作共同培养出优秀护理硕士专业学位研究生的目标。