PARIHS循证概念框架理论及应用现状分析与思考

将证据应用到临床实践具有复杂性与多变性,借助证据应用模式将有助于这一转化,健康服务领域研究成果应用的行动促进（promoting action on research implemrntation in health severice,PARIHS）循证概念框架,即证据应用模式的一种,其目前在我国鲜见报道与应用。笔者对 PARIHS循证概念框架的理论予以介绍,包括3大核心要素,即证据、证据应用组织环境及促进因素的协调;理论起源与发展的历程,突出 PARIHS框架内涵与思路不断清晰化的发展过程;还对目前应用于不同目的、不同领域临床实践与科研活动中的应用现状进行分析。最终得出 PARIHS框架研究与应用价值突出,最大化框架使用价值基础上清晰化理论内涵、促进框架应用方式与效果评价的标准化及研发恰当合适的应用工具是 PARIHS框架探索研究的重点。     

推动证据向临床转化 (二)如何选择知识转化理论模式

本文作为证据临床转化方法学系列文章的第二篇,旨在详细阐述如何选择合适的知识转化理论模式,以指导和促进证据向临床的转化。本文分析了理论、模式和概念框架的内涵,并介绍了5个知识转化领域最常用的理论模式,包括KTA知识转化框架、渥太华研究应用模式、PARIHS框架、复旦循证护理路径图和基于证据的持续质量改进模式图。在此基础上,分析了在推动证据临床转化的过程中,选择合适的知识转化理论模式的重要性、依据及应注意的问题。     

加拿大安大略注册护士协会临床实践指南应用方法解析

临床实践指南与临床实践之间的差距阻碍着最佳证据的有效实施。加拿大安大略注册护士协会发布的《工具书:如何实施最佳实践指南》一书,其以知识转化模型为框架,分别从确定问题、适应当地文化背景、评估知识使用过程中的促进和阻碍因素、选择和调整干预措施和策略、监测知识应用情况和评估实施结果以及知识的持续性应用等方面,为促进证据的临床转化提供了系统的策略指导。该文通过对书中以上6个方面进行解析,进一步介绍指南的应用方法,以促进我国对临床实践指南的高效运用。     

卫生系统知证政策指导:评估对研究证据的信心

本文是《PLoS Medicine》关于卫生系统知证政策指导三篇系列文章的第三篇,阐述了应如何将证据转化为指导,以形成卫生系统政策,并促进临床和公共卫生干预的实施。其要点如下:①评估不同类型研究证据是决定解决卫生系统问题的政策方案的关键;②鉴于许多卫生系统干预的复杂性,系统透明的评价方法尤为重要;③当前有不少好的工具可用于评价对支持政策制定各阶段不同类型的研究证据的信心,其中评价关于效果的证据最多;④我们需要制定工具来帮助评价其他关键因素的系统评价证据,如政策方案对于利益相关者的可接受性、实施可行性及公平性;⑤还需要进一步研究全球卫生系统指导政策方案的制定、构建及呈现方法。     

卫生系统知证政策指导:指导制定的基本原理和挑战

本文是《PLoS Medicine》关于卫生系统知证政策指导三篇系列文章的第一篇,阐述了应如何将证据转化为指导,以形成卫生系统政策,并促进临床和公共卫生干预的实施。其要点如下:①薄弱的卫生系统阻碍了有效干预的实施,加强此系统的政策需要基于当前可得的最佳证据;②卫生系统证据最好以政策制定过程参考的指导的形式呈现,但目前卫生系统指导制定质量较差;③将问题、干预及实施相关的研究转化为影响卫生系统组织方式的决策和政策是卫生系统指导制定面临的一个挑战;④制定及时且适用于广大卫生系统利益相关者的指导,并确定评价卫生系统指导质量的方法是另一个挑战;⑤改编现有方法(如用于临床指南的那些方法)制定有意义的建议来应对卫生系统、政策系统及背景的复杂性,尚需进一步研究。     

学术速递

1.推动证据临床转化系列目前,知识转化已经成为全球卫生保健关注的热点。但如何开展循证实践,促进高质量证据向临床的转化成为困扰护理人员的关键问题,尤其是关于证据实施的方法学,一直处于不断发展和完善中。复旦大学护理学院从2010年开始致力于推动证据向临床的转化与应用,开展了多项课题,推出了多个本土化证据实施模式,在多年教育、研究积累的基础上,梳理和分析了在证据实施方面的资源、理论与方法。     

概念构图教学法及其在护理教育中的应用

概念图是一种在国外特别是欧美国家广为盛行的教学策略,可以切实提高教师的教学效果,有效地改变学生的认知方式,促进学生的意义学习。现就概念图的定义、理论基础、特征、制作方法、作用及其在护理教育中的应用进行阐述,以期推动概念构图教学法在护理教育中的应用与研究。     

概念图及其在护理教学中的应用现状

阐述了概念图概念及特点、概念图分类及制作分类、概念图的理论基础,从概念图在护理教学中应用的必要性及护理师生的态度、概念图在护理教学中的应用现状、概念图在护理教学中应用的启示综述了概念图在护理教学中的应用现状。     

效果-实施双轨设计的分类和应用

将证据转化为卫生保健服务,需要经过3个转化过程“临床前研究-临床研究-实施性研究”,耗时漫长且常常出现转化不足。为加快证据转化为日常医疗实践和卫生政策的进程,融合了临床有效性研究和实施性研究的“效果-实施双轨设计”应运而生。本文介绍效果-实施双轨设计的概念、分类及其应用,为研究人员应用此方法开展研究提供参考。     

知识转化的概念及理论框架

知识转化是将临床研究证据或以研究证据为依据的临床实践指南运用于临床实践当中,改善临床实践,促进执行者行为改变,提高患者服务质量。知识转化在国外发展迅速,而国内对知识转化的认识刚起步。为了促进知识转化在我国的发展,本文将重点阐述知识转化的概念及理论框架等内容,探讨其对临床实践的重要价值。     

"Getting through"--a difficult nursing concept

This analysis of the research literature related to the nursing concept "enduring" was carried out on the background of the demand for evidence based nursing. The aim was to test with an exemplary concept to what extent this request is feasible and meaningful, if related to a concept describing patients' subjective experience. The state of the art of research literature on enduring contains a variety of problematic aspects: conceptual, theoretical, linguistic as well as problems originating in nursing's moral tradition. These have important implications for the application of the concept in nursing practice.     

Bridging the Gap between Clinical Research and Knowledge Translation in Pediatric Emergency Medicine

In 2006, a multidisciplinary group of researchers from across Canada submitted a successful application to the Canadian Institutes for Health Research for a Canadian Institutes for Health Research Team in Pediatric Emergency Medicine. The conceptual foundation for the proposal was to bring together two areas deemed critical for optimizing health outcomes: clinical research and knowledge translation (KT). The framework for the proposed work is an iterative figure-eight model that provides logical steps for research and a seamless flow between the development and evaluation of therapeutic interventions (clinical research) and the implementation and uptake of those interventions that prove to be effective (KT). Under the team grant, we will conduct seven distinct projects relating to the two most common medical problems affecting children in the emergency department: respiratory illness and injury. The projects span the research continuum, with some projects targeting problems for which there is little evidence, while other projects involve problems with a strong evidence base but require further work in the KT realm. In this article, we describe the history of the research team, the research framework, the individual research projects, and the structure of the team, including coordination and administration. We also highlight some of the many advantages of bringing this research program together under the umbrella of a team grant, including opportunities for cross-fertilization of ideas, collaboration among multiple disciplines and centers, training of students and junior researchers, and advancing a methodological research agenda.     

Fast-Tracking Health Data Standards Development and Adoption in Real-World Settings: A Pilot Approach

Background  Pilot-testing is important in standards development because it facilitates agile navigation of the gap between needs for and use of standards in real-world settings and can reveal the practicalities of implementation. As the implementation and use of health data standards are usually more complicated than anticipated, the Office of the National Coordinator for Health Information Technology (ONC) routinely oversees and organizes relevant pilot projects. Objectives  This article provides an in-depth look into a sample of ONC''s standards-focused pilot projects to (1) inform readers of the complexities of developing, implementing, and advancing standards and (2) guide those seeking to evaluate new standards through pilot projects. Methods  The ONC''s approach to conducting pilot projects begins with identifying a clinical care need, research requirement, or policy outcome that is not well supported by existing standards through a landscape review. ONC then selects a testing approach based on the identified need and maturity of relevant standards. Next, ONC identifies use cases and sites to pilot-test the relevant standard. Once complete, ONC publishes a report that informs subsequent projects and standards development. Results  Pilot projects presented here are organized into three categories related to their demonstrated focus and related approach: (1) improving standards for presenting and sharing clinical genetic data, (2) accelerating the development and implementation of new standards, and (3) facilitating clinical data reuse. Each project illustrates the pilot approach from inception to next steps, capturing the role of collaboration among standards development organizations, stakeholders, and end-users to ensure standards are practical and fit for purpose. Conclusion  The ONC approach identifies implementation difficulties prior to broader adoption and use of standards, and provides insight into the steps needed to scale use of standards. The ONC''s organization of pilot projects serves as a natural accelerator for building communities of practice, often providing a well-connected beneficiary of lessons learned.     

健康服务领域研究成果应用的行动促进框架应用性研究的文献范畴分析

目的探讨健康服务领域研究成果应用的行动促进框架(the promoting action on researchimplementation in health services framework,PARIHS)的应用现况,以期为后续的发展提供理论依据。方法 2016年3月,检索PubMed、Embase(Excerpt Medica Database)、EBSCO、JBI循证护理数据库、中国知网、万方、维普等数据库;中文检索词为"健康服务领域研究成果应用的行动促进框架"、"循证实践理论框架/模式"、"证据应用"、"组织变革";英文检索词为"PARIHS"/"parihs"、"evidence-basedpractice"、"implementation"、"evidenceutilization"。检索时限为建库以来至2015年12月31日。采用文献范畴分析的方法,重点分析PARIHS的应用性文献,即运用PARIHS指导循证实践活动。双人进行文献筛选和数据提取。结果共有33篇应用性文献纳入分析。根据PARIHS在不同研究中的作用分为两部分,即以PARIHS为理论框架的应用研究和以PARIHS指导研究设计的应用.研究。前者主要包括对循证实践中的影响因素的探讨、研究应用效果和循证实践实施的准备度/可行性的评估;后者包括基于PARIHS量表/问卷的构建及应用、以PARIHS指导实践策略的制定和以PARIHS为指导的结局资料的分析。结论 PARIHS全面阐释影响循证实践过程的多个元素,并分析了各元素相互作用、相互依存的关系。它可以直接地用于不同的实践项目、不同的环境及证据应用不同的阶段,对医疗机构循证实践的开展有较好的指导作用。     

干预图在护理领域的应用进展

该文介绍干预图的概念、实施步骤及其在院前预防、院内护理和院后康复方面的应用,其中院前预防包括传染病防控和疾病早期筛查、妇幼健康促进、控制风险因素和改善不良生活方式,院内护理包括促进护理新技术在临床的应用和人才培养、医患沟通和信息交流、健康教育和风险评估,院后康复包括慢性病患者自我管理和健康行为改变、术后患者和癌症幸存者的康复护理,并总结了干预图的优点和局限性,以期促进干预图在中国的推广和应用,提高临床护理干预质量。     

Seeking evidence from medical research consumers as part of the medical research process could improve the uptake of research evidence

Concerns have been expressed about gaps between available medical research evidence and current medical practice. These gaps have been attributed to process problems with the implementation of evidence previously judged to be appropriate, rather than to problems with the appropriateness of the evidence provided for implementation. Two such 'appropriateness' problems are the applicability of research evidence to an individual patient, and the acceptability to an individual patient of a proposed treatment. Part of both these problems is due to the pre-eminence of the scientific paradigm within the medical research domain, and of the randomized controlled clinical trial within that domain. However, there is an opportunity beneficially to address both these problems by supporting reciprocal communication between medical research 'producers' and medical research 'consumers'– both practising clinicians and patients' representatives – in the setting of research priorities, selection of topics for research, development of research questions and study designs, in-progress reviewing, and final reporting of medical research projects. Such communication could allow researchers to understand, and respond to, clinicians' and patients' inputs concerning the applicability, utility and acceptability issues that will ultimately affect whether, and how, medical research findings can be applied. Such communication could also assist with some post-research implementation issues: integration of appropriate evidence into everyday practice; access to appropriate information sources; and a critical lack of necessary time.     

Problem-based learning,critical thinking and concept mapping in speech-language pathology education: A review

Despite speech-language pathology (SLP) education undergoing many innovative changes over the years, there has been little research about learning or outcomes in SLP programs. Critical thinking in clinical decision-making, however, has been identified as a critical skill in SLP. Several recent studies have shown that concept mapping can be used to assess, and perhaps enhance, critical thinking. Problem-based learning (PBL) is reported to be one way to encourage critical thinking and life-long learning. Here we review the literature in PBL, concept mapping, and critical thinking, focusing on the education of SLP students. The review illustrates the close and complex interactions amongst problem-based learning, critical thinking and concept mapping. The aim of the review is to provide a better understanding of the mechanism of PBL, and to increase understanding regarding why the employment of PBL in SLP programs may facilitate critically-thinking graduate clinicians. The evidence indicates that PBL allows more meaningful learning that promotes better integration between theory and clinical practice.     

急性缺血性脑卒中溶栓术后患者延续性护理实施现状

延续性护理旨在将以患者为中心的理念延续到患者出院后,以提高患者的生存质量。本文就急性缺血性脑卒中溶栓术后患者延续性护理的内涵及意义、应用现状、实施形式、测量工具及实施效果进行综述,旨在为临床护理工作提供参考借鉴。     

思维导图在护理教育中应用效果的研究进展

概述了思维导图的概念、理论依据、绘制要点及主要特征,主要从提高备课效率与教学质量、提高护生批判性思维能力、提高护生理论成绩与实践能力、丰富护理查房的形式内容、促进护理科研的发展,有利于专科知识的学习记忆、有助于培养高层次护理人才方面综述了思维导图在护理教育中的应用效果。同时,分析了思维导图在护理教育应用中存在的问题,提出进行规范思维导图客观评价体系的研究。     

Named nursing: in whose best interest?

This paper explores certain influences and issues surrounding the implementation and application of the named nurse concept. The author critically examines the proposals that primary nursing increases job satisfaction, cost effectiveness and quality of care, and suggests that as primary nursing appears to be the template for named nursing, these are factors which may have influenced the former British government's decision to implement the concept of named nursing. Owing to problems regarding the reliability and validity of much of the research, the author draws the conclusion that the direct extrapolation from one concept (such as primary nursing) to another (such as named nursing) is perhaps open to question. The author also analyses other issues related to the implementation and use of the named nurse concept including advocacy and accountability, and proposes that the introduction of individualized care, and in particular named nursing, perhaps serves the drive towards the professionalization of nursing first, and the patient second, and if so questions whether there is a need to reconsider the aim of nursing.