【作者】 唐红梅；

【导师】 巴德年；

【作者基本信息】 浙江大学 ， 社会医学与卫生事业管理， 2012， 博士

【摘要】 护理是一门“以人的健康服务”为主的专业,随着医学模式转变、健康观念的更新、疾病谱的变化、卫生保健体制革新,特别是经济全球化发展,我国护士队伍从以中专为主体转向中专、大专、本科多层次教育的方向发展。然而,现存护理教育4个培养层次(即,中职、高职、本科、研究生)之间尚未实现无缝衔接的教育体系,由于培养目的、课程设置等原因,高职专科毕业生通过考试、职业资格准入等的学习上升路径被阻断,高职专科护理教育成为终结性教育。这不.仅阻碍了我国护理教育人才培养的效率,造成了重复性培养的资源浪费,也不利于集约行业及教育资源提高人才培养质量。《中国护理事业发展规划纲要(2011-2015年)》提出,到2015年,全国注册护士总数达到286万,每千人口注册护士数为2.07。全国护士队伍中,大专以上学历护士应当不低于60%。但是,护理人员职业流动性大、护理队伍结构层次参差不齐、护理教育培养目标单一课程设置不科学合理等问题的存在阻碍了护理教育可持续性发展。对已有的研究进行梳理发现,从护理教育体系角度进行实证研究,并给出策略指导的文章十分有限。为了科学合理地对护理教育发展给出政策性、策略性指导,并保证护理教育实施的质量和效率,需要认真调查、分析、研究和解决护理岗位人才需求和护理教育之间的矛盾,把他们转换成有力的支持力量。本研究以我国护理教育发展中存在的问题为基点进行系统研究,通过国内外护理教育制度和模式比较；了解典型区域护理队伍现状和人才培养需求；分析我国护理教育层次体系、规模与质量、教育教学改革中存在的差距和影响因素；在此基础上形成促进护理教育可持续发展和专业人才培养的策略思路。研究的内容主要包括：1、阐述健康的内涵和社会价值、界定护理的概念、护士角色定位和护理教育的起源、探讨了护理教育的特征。2、护理教育发展相关政策的出台是保证我国护理发展的制度基础。在一系列政策制度的保障下,学者开始关注护理教育的科学性发展,对现有护理教育研究进行了分类归纳。3、借鉴美、英、日、澳四国护理教育发展经验,从培养目标、教育制度、课程改革和质量监督四个环节出发,对护理教育发展进程进行剖析,并探讨了四国护理教育发展的共同趋势。4、选取全国东中西部20个省市37所开办高职护理专业的院校以及相对应300家教学医院,分别进行护理专业人才需求调研和护理专业教学现状调研,以便为我国护理教育改革提供事实依据。5、从护理教育层次体系、人才培养与需求适应机制和构建贯通课程体系等三个维度对我国护理教育的改革形成标本兼治之策。本研究主要取得了以下成果：1、生物-心理-社会的医学模式下,护理不再是单纯的疾病护理,而是转向“整体人”,涵盖人的生理、心理、社会等各方面的健康需求,护士的角色也相应地从护理的实施者,拓展为教育者、咨询者、健康生活方式的倡导者等。护理模式转变可以促进护理人员职业发展、实现护理教育自身发展、落实“健康中国2020”战略目标。2、医疗改革过程中,护理专业发展的相关政策、法律法规的进一步健全(涉及医疗机构管理、妇幼与社区、医院感染管理、突发卫生事件应急等),给护理教育发展提供了制度保障,同时从国家层面上指明了护理教育人才培养的目标以及发展方向。而有关护理教育的研究内容也有所拓宽,如护理法律、护理人才培养目标、师资培养,各热点领域的研究视角更加贴近教育教学改革的实际操作层面,更加有利促进护理教育体系的建立。3、尽管美、英、日、澳四个国家护理教育发展各具特色,但均形成了完善的护理人才培养体系,并且各层次之间的无缝衔接成为其发展的共同趋势。培养目标多元化、教育制度体系化、课程改革市场化和质量监督健全化等共同构筑了西方护理教育可持续发展模式。4、分析调研数据发现,我国护理教育与专业人才需求存在差距：护理教学尚无统一规范；培养规模大、质量不高；各层次护理教育的培养目标比较单一；课程设置偏重学科性质与岗位细化不符；教学过程中学生主体地位受到忽视；缺乏科学评价教学质量的标准和体系。5、为实现“三层多元”的护理教育体系,使护理教育真正成为一种职业类型教育,而非学历终结教育,论文提出了“建立以护理程序为主线、实施全面整体护理为教学标准、相互衔接可持续发展的护理教育层次结构体系。既有高端学术型教育、中间层次技术型教育,还有基础实用型教育,配合各种人文素质培养和在职继续教育,以培养护理行业的决策层、管理者和实施人”的策略思路,并列举了相应的措施：①治标之策：科学制定护理教育“十二五”规划,明确护理专业层次性培养目标,对接岗位任务设置护理课程,不断改进教学方法和手段,建立护理教育质量评价体系；②标本兼治之策：建立健全人才培养与需求的动态适应机制,完善体现终身教育理念的护理职业教育体系,优化院校有效衔接合作育人的管理体制,参照国际理念制定中国护理教育标准,积极营造促进护理教育持续发展的社会环境。更多还原

【Abstract】 Nursing is a patient-centered profession of health service. As the transformation of medical model, the updating of health concepts, the alteration of diseases spectrum, and the reform of healthcare system especially the globalization of the economy, the education of the nurse troop in China pluralized. Nowadays nurses graduate from technical secondary schools, junior colleges or universities rather than purely from technical secondary schools in the past. However, the four tiers (technical secondary schools, junior colleges, universities, and graduate schools) co-existing in the current nursing education system are not seamlessly compatible because of either culturing purpose or curriculum provision. Junior colleges become the actual end-point of some graduates who tend to receive higher level education through either examinations or certifications, which not only lowers the efficiency but also harms the quality of nursing education in China, along with a waste of education resources."The outline of China’s Nursing Care Development Plan (2011-2015)" proposes that by2015the number of the total registered nurses reaches2.86million (or2.07nurses for every1thousand people), among whom60%or above should finish their training from junior colleges. However, the current nursing education development is encumbered by the excessive fluidity of the job positions, uneven capabilities of the nursing troop, inflexible culturing purpose as well as the unscientific course settings.The current literatures give limited guidance to strategy research from the perspective of the whole nursing education system. To compromise the conflict between the nursing job market and the nursing education, we need to carefully investigate and analyze to give out scientifically appropriate policy and strategically feasible support for the sake of nursing education’s efficiency and quality.This research is a systematic study based on the current problems appeared in China’s nursing education development. We compared different nursing education systems and modes of both in and abroad. We explored the status quo of the nursing troop and the demand of nursing job market in representative areas. We analyzed the hierarchical system, scale, quality and the short-comings in nursing educational reform and associated factors. Thereafter, the ideas and strategies promoting sustainable development and professional training for nursing education were constructed.The research content mainly includes:1. Elucidate the content and the social value of health; define the concept of nursing and the role of nurse; explore the origin of nursing education; analyze the characteristics of nursing education.2. The enactment of relevant policies is the constitutional base for nursing education development. Under these policies we began to pay close attention to the scientific development of nursing education. Current research on nursing education has been classified.3. Based on the experience of nursing education development from four countries including U.S.A, UK, Japan and Australia, we insightfully explore the process of nursing education development on four elements:culturing target; education constitution; course reform and quality surveillance. Finally, their common development trend was also discussed.4. We picked37junior colleges offering nursing education and300affiliated teaching hospitals from20provinces and municipalities nationwide. The investigations of the demand from nursing job market and the status quo of nursing education were performed to collect firsthand information as the foundation for China’s nursing education reform.5. A three-dimensional approach was formed for China’s nursing education reform. It consists of nursing education’s hierarchical system, adaptation of talents culturing according to market’s need, and construction of a compatible course settings.The research got the achievements as follows:1. Under the bio-psy-soci model, nursing burdens the responsibility of meeting the health needs under physiology, psychology and sociology rather than purely care for the diseases. The role of a nurse is more than an implementer of care. Nurses are also patients’educators, consultants as well as advocates of how to lead a healthy live. This transformation of nursing model conduces to the career development of the nurses, thus promoting the nursing education and heading toward the strategic goal "Healthy China2020".2. As the medical reform goes further, relevant policies, laws and regulation would be more complete (healthcare organization management, maternal’ and child care, community medicine, hospital-infection management, emergency healthcare incidence responding, etc.), which offer the constitutional support and the training goal for the nursing education. Meanwhile, the research of nursing education will be expanded as well. Fields like nursing law, nursing professional culturing target, and nursing education teaching team build-up will gain more attention. The research focuses will go closer to the practice, conducing to the establishment of nursing education system.3. Though USA, UK, Japan and Australia have distinct features on nursing education, all of them have complete nursing education system within which there is seamless connection among different levels. The western nursing education has formed a sustainable development model featured in pluralization of education goals, systemization of education institution, marketization of course reform and complete quality control&surveillance. 4. Based on analysis, in China there is disparity between nursing education and demand for professionals. For example:So far there is no uniform teaching standard; The education scale is large but with unsatisfied quality; The culturing target is monotonous and inflexible; Course setting does not perfectly match the practical work; The teaching activity is not student-centered; There is lack of systematic standard as the scientific evaluation tool for teaching quality.5. In order to build up a nursing education system with "Three Tiers and Multiple Supplements", the author argues that China needs a sustainable and stratified structure with nursing practice as the main line and integration concept as the education standard. Nursing education should be a professional training rather than an end-point. Within the system, we have advanced academic education, technical education as well as practical basic education, corresponding respectively to the executive, manager, and practitioner level of the nursing troop. Besides, humanities and continuing educations are indispensible supplements of the system. To fulfill the goal we have stipulate the following measures:①Temporary solution:Enact "twelfth five years" plan for nursing education; Clarify stratified culturing goals for nursing professionals; Set up courses according to the practical work; Improve teaching methods; Establish quality evaluation system for nursing education.②Fundamental solution:Establish an adaptation mechanism so that the talents culturing matches the demand; Construct a professional educational system with a commitment of life-long learning; Optimize the management of schools offering nursing education; Construct China’s own nursing education standard while referring to international concepts; Encourage to build up an amiable social atmosphere for the sake of a sustainable nursing education.更多还原