The development of clinical competencies for use on a paediatric oncology nursing course using a nominal group technique

This paper outlines the development of a competency model to be used to assess clinical competence during a post-registration specialist course. A nominal group technique was used to gather data about the detailed practice of paediatric oncology nurses. The nominal group technique was chosen to achieve consultation and consensus with a professional group. The six steps from undertaking the nominal group technique to implementation are described in detail. Some reflections on the use of competency statements are offered.     

基于名义群体法的临床教学管理岗位胜任力框架构建及初步应用

目的研究临床教学管理岗位胜任力内涵,构建胜任力框架并观察初步应用效果。方法首先以北京协和医院临床教学秘书、临床教学对象、教学行政管理人员、教改实践与研究人员等关键群体为研究对象,通过两轮名义群体法(nominal group technique,NGT)形成临床教学管理岗位的胜任力框架。然后采用该胜任力框架以问卷调查的形式邀请临床教学秘书进行自评打分,自评采用李克特评分法(最高为5分,最低为1分),统计并分析自评结果。结果临床教学秘书、临床教学对象及教学行政管理人员通过首轮NGT讨论,对于临床教学管理岗位胜任力要素,如个人素养、组织协调能力、教学能力与教学创新能力等可基本形成共识,但对其内涵及重要性排序持有不同观点。教改实践与研究人员通过第二轮NGT讨论,在首轮讨论结果基础上形成了涵盖7个维度(医学知识与技能、以学习者为中心、沟通与合作、职业素养与榜样、反思与提升、教学理论与方法、教学协调与管理)的临床教学管理岗位胜任力框架。自评结果显示,除“教学协调与管理”“教学理论与方法”2个维度自评得分低于4分外,余5个维度自评得分均高于4分。结论本研究初步形成临床教学管理岗位胜任力框架并尝试应用,应用效果对引导胜任力提升及评价具有重要提示作用,但具体内涵描述尚待更多实践以进一步验证和优化。     

Respect for patient autonomy in forensic psychiatric nursing

A fundamental issue that forensic psychiatric nurses struggle with is respect for patient autonomy, as the two liberal prerequisites for autonomy, liberty and rationality, are either absent or compromised in forensic psychiatric settings. In this paper, a contemporary feminist perspective of autonomy, relational autonomy, will be advanced as an alternative approach to the traditional liberalist, Kantian, perspective of autonomy. The concepts of autonomy, paternalism, and justice will be discussed in relation to forensic psychiatric nursing.     

Forensic nursing educational development: an integrated review of the literature

The forensic area of practice has been a popular career choice and area of study for many of the health science disciplines. Forensic nursing is a nursing specialty with subspecialties that focus on nursing practice who care for victims and offenders, living and deceased at the clinical legal interface. This integrated review of the literature overviewed the historical development of each of the forensic nursing subspecialties and identified gaps in specialty nursing educational development. Although multiple studies for the last 30 years identified the need for forensic nursing education, recommendations did not soon translate into educational curriculum development. The literature showed that role development was not concurrent with educational development in all forensic nursing subspecialties.     

The meaning and significance of clinical group supervision and supervised individually planned nursing care as narrated by nurses on a general team psychiatric ward

By interviewing 22 psychiatric nurses, the present study aimed to reveal the meaning and significance of systematic clinical group supervision and supervised individually planned nursing care, using latent content analysis. The interpreted meaning was ‘confronting the complexity of ongoing life in daily nursing care’ and the interpreted significance was ‘strengthening the foundation for nursing care’. Reflection on action and confirmation seemed to be core components in the process of clinical supervision. Focusing on the relational and task aspects in nursing care within a group approach may have contributed to the positive experiences of development that occurred.     

Psychiatric nursing in prison: the state of the art?

Psychiatric nursing in prisons has received criticism from within and outside the profession in recent years. In England and Wales this amongst other issues has prompted a review of forensic health care by the United Kingdom Central Council for Nursing, Midwifery & Health Visiting (UKCC). The status of forensic psychiatric nursing as a specialty has also been disputed in the literature and the role of nurses working in this field is seen by some to be more about social control than caring. These arguments are set in the present situation of increasing numbers of mentally ill individuals in the prison system and a crisis in the availability of beds in secure units, a situation that is paralleled throughout the western world. The standard expected of health care services in prisons is equivalence with the service the public receives from the National Health Service (NHS). The number of prisoners needing transfer to hospital has increased during the last decade, resulting in competition for a limited number of suitable beds. The effect on health care centres (HCCs) in English prisons is that they now must provide long-term care for seriously mentally ill prisoners. This paper outlines the development of British psychiatric services in prisons. It then describes the HCC in Her Majesty's prison (HMP) Belmarsh and reports on recent radical changes in the management structure of this service. The aim of these changes is to produce a clinical environment in which psychiatric nurses can deliver high quality care in an area beset with difficulties for clinicians and managers and to further progress towards the goal of equivalence. These advances have been achieved through a shift of emphasis in management structure that increases the number of clinical posts and minimizes administrative and security-based responsibilities held by clinical grades. We conclude that although external contracts are necessary, much can be achieved through internal review and changes in policy.     

Measuring the quality of judgement and decision-making in nursing

AIM: This paper discusses measurement of the quality of judgement and decision-making in nursing research. It examines theoretical and research issues surrounding how to measure judgement accuracy as a component of evaluating decision-making in nursing practice. DISCUSSION: Judgement accuracy is discussed with reference to different methods of measurement, including comparing judgements with independent criteria and inter-judge approaches. Existing research on how judgement accuracy has been measured in nursing practice is examined. Evaluation of decisions is then discussed, including consideration of the process of decision-making and evaluating decision outcomes. Finally, existing research on decision-making in nursing is assessed and the strengths and limitations of different types of measurement discussed. CONCLUSION: We suggests that researchers examining the quality of judgement and decision-making in nursing need to be aware of both the strengths and limitations of existing methods of measurement. We also suggest that researchers need to use a number of different methods, including normative approaches such as Bayes' Theorem and Subjective Expected Utility Theory.     

特护小组在医院开展新技术、新业务中的作用

为了实现既不浪费人力资源又能高质量地保证医院新技术、新业务开展护理配合,成立了由护理部直接领导的特护小组,其管理机制灵活,业务培训起点高,责、权、利明确,工资待遇到位,较好地发挥了特护小组的作用,这种管理体制既符合目前军队医院聘用护士多的现状,又能随机变通、快速高效、保质保量,实现了护理人力成本效益的最大化。     

团体训练对护理专业新生学业自我效能感及专业认同的影响

目的 探讨团体训练对护理专业新生学业自我效能感及专业认同的影响,为护理专业新生入学教育提供新方法、新思路.方法 对140名护理专业新生分3个阶段共6次进行综合团体训练,并通过学业自我效能问卷和专业认同问卷评估新生训练前后学业自我效能感和专业认同得分以及两者的相关性.结果 团体训练后,护理专业新生学习能力自我效能、学习行为自我效能及总得分较训练前均有显著提高(P＜0.01);除专业技能,护理专业新生在专业认识、专业情感、专业意志、专业价值观、专业期望及总分值上均有显著提高(P＜0.01);护生学业自我效能感同专业认同中专业意志和专业期望维度存在正相关(P＜0.05).结论 综合团体训练可以有效提升护理专业新生学业自我效能感和专业认同,因此可以作为今后高校护理专业新生入学教育的主要内容和方式.     

Something special: forensic psychiatric nursing

In this paper the claims that forensic psychiatric nursing has achieved the status of a specialist area of nursing are refuted. An examination of the literature demonstrates that specialist knowledge and skills have not been documented. It is suggested that three requirements are necessary if forensic psychiatric nurses wish to achieve specialty status. Forensic nurses have to consolidate their role in the containment and care of patients, they have to return to the nurse-patient relationship as the foundation of psychiatric nursing practice, then, within that relationship, nurses must expand their practice to include dealing with offence issues.     

护理工作环境在临床护士职业认同与工作满意度之间的中介效应分析

目的探讨护理工作环境在临床护士职业认同感与工作满意度之间的中介作用,为临床护士管理提供依据。方法采用护理工作环境量表、护士职业认同问卷和护士工作满意度评定量表对378名临床护士进行调查,并构建结构方程模型。结果护理工作环境量表总分为(191.60±25.42)分,低于常模(P0.01)。护士职业认同感总分为(90.05±11.42)分。护士工作满意度量表总均分为(2.82±0.36)分,低于常模(P0.01)。相关分析显示工作环境、职业认同感与工作满意度之间均存在不同程度的正相关(P0.01)。结构方程模型显示,职业认同对护理工作满意度有直接效应(λ=0.638,P0.01);职业认同对护理工作环境有直接效应(λ=0.443,P0.01);护理工作环境对护理工作满意度有直接效应(λ=0.516,P0.01),职业认同通过护理工作环境对护理工作满意度有间接效应(λ=0.228,P0.01);护理工作环境、职业认同分别解释护理工作满意度16.24%与13.82%的变异量。结论护理工作环境能影响护理工作满意度,提示医院护理管理者应加强护理工作环境建设,改善工作环境,从而增强临床护士职业认同感,提高护理工作满意度。     

高年级护理本科生专业认同感现况调查

目的了解高年级护理本科生专业认同程度及其影响因素,为改善专业认同感教育模式提供依据。方法采用胡忠华编制"护理本科生专业认同调查问卷",对某大学护理学院4年级、3年级护理本科生进行问卷测评。结果高年级专业认同感总分为(76.83±8.51),性别、年级对专业认同感无显著性差异;第一志愿录取高于其他两个录取方式,有显著性差异(P0.01);因自己喜欢而就读者高于其他原因就读者,有显著性差异(P0.01);回归分析显示,对专业认同感总分有影响的因素是录取方式和就读原因。结论高年级护理本科生专业认同感处于一般水平,因此要重视学生态度形成的培养问题,利用青年学生可塑性强和在校期间的有利条件,探讨有效的教育教学模式,加强护生专业认同感的教育。