【作者】 李静；

【导师】 姜安丽； 沈宁； Julie Fairman；

【作者基本信息】 第二军医大学 ， 护理学， 2010， 博士

【摘要】 随着我国社会的迅速发展,护理学逐渐形成了自己的理论知识体系,护理教育也形成了从中专到博士研究生的全层次培养体系。但我国护理学还是临床医学下的二级学科,其学科定位问题一直没有得到很好的解决和广泛的认同,这就导致了在护理教学和护理实践中的一些乱象,如护理教育的培养目标定位不当、课程设置不能反映护理学科的人文属性等。将护理学定位在一级学科,可以按照护理学科的特点和临床对人才的需求制定适合护理学专业发展的人才培养计划,为护理学科培养高层次的科研队伍,这将为护理学科的发展提供更加广阔的发展空间。合理的学科划分是专业设置的指南,也是学科发展的基础,构建适合我国国情的护理学学科体系需要科学的理论指导与研究。对护理学科体系内部进行分类,是为了科学地反映护理学发展的实际及把握其发展趋势,以加强对护理学的规划和指导,提高护理研究和护理理论的水平,从而更有力地指导护理教育和护理实践。本研究主要采用文献研究法和历史研究法,确定学科成熟所需要的条件,论证护理学定位为一级学科的必要性和可行性；针对我国目前护理学科发展的现状和我国的国情,对我国的护理学科进行历史性分析,参照美国的护理学科发展历史及现状,探讨学科发展的动因和条件；根据护理学科的特点和学科构建的原则,提出我国护理学学科体系的基本框架及研究生专业设置展望,为我国护理学科的发展及护理学学科体系的构建提供具有指导意义的理论框架。本文共分五大部分第一部分：概论介绍了选题的背景、国内外相关研究现状、研究的意义、相关概念界定。阐述了课题的研究思路和方法,包括文献研究和历史研究,通过综合分析中西方护理学科的发展过程,结合中美两国护理学科发展的动因和条件,在此基础上提出可供我国护理学学科体系构建借鉴的理论框架。第二部分：我国护理学定位为一级学科的必要性和可行性护理学科定位为一级学科是高等护理教育发展的需要。护理学科定位于一级学科,有助于护理学科成员强化学科主体意识和主观能动性,推动学科体系的完善和学科理论的发展,形成护理学科的科学的哲学观、思想方法、专业精神,并应用于全面调整护理学各层次教育的培养目标和课程设置,形成具有学科特色的各层次人才的培养方案,以培养具有批判精神和人文精神的护理学科创新性人才,发展护理学科合理的高层次人才队伍。护理学定位为一级学科也是护理实践发展的需要。护理学在护理理念、工作性质和工作范畴方面已发生了重大的变化。同临床医学相比,护理学日益呈现出其重视人而不仅仅是重视疾病的本质,护士的工作已扩大到了医院以外的场所,护士的工作范畴已超出了临床医学一级学科的范畴。护理实践这些方面的变化,一方面使护理工作者深入进行新问题的研究,需要增加新的知识对问题做出解释和回答,这些知识已不是临床医学所能涵盖的；另一方面,从照护病人的角度,护理实践的独立性与自主性也大大提高,实现了与医生合作照护和负责病人,进一步提升护理质量。护理学科定位为一级学科也是护理研究的需要。目前护理学科的定位一方面影响了护理学科人才队伍的建设,另一方面不足以引起政府有关部门对护理学科的重视,严重限制了国家、地区和部门对护理学科的投入和资源的分配。就护理学本身的成熟程度而言,定位为一级学科也有其理论基础,护理学以人、环境、健康和护理作为学科的基本概念框架,已经形成了自己的理论和知识体系,并显现了与医学的区别。目前护理学的学科体系的雏形已经基本形成。随着学科的发展,一级学科逐渐增加,而二级学科逐渐减少,这是学科发展的自然生态。因此,护理学定位为一级学科也是护理学自身发展成熟水平所决定的。第三部分：美国护理学科发展历史对我国的启示美国护理学科是在南丁格尔的护理理念中逐渐发展起来的。在1850年以前,护理的重点是提供照护和促进舒适,注重于疾病本身而不是整体的病人。1900s后医学的快速发展对护理学的发展起到了极大的促进作用,医生与护士需要合作,在专业化的医疗环境中的护理实践促进了专科护理知识的发展,护理学科逐渐建立起来。在20世纪50到60年代,美国护理学者意识到了护理科研对学科发展的重要性,开始大力发展护理科学研究。学科的发展开始重视护理的概念和研究范围、学术气氛和学者的发展。70年代末期和80年代,护理学者开始反思有关护理概念、护理范围和发展知识的适当方法,他们借助哲学的探索方法探讨关于护理知识本质的问题,并且用适当的研究方法发展护理知识。在以后的护理学发展过程中,将教育、研究和实践进行整合,发展护理学独有的知识体系是护理学科的重点。研究的重点是护理结局、人和环境的作用及护理哲学,护理学科被充分接纳作为一门科学,护理实践是基于特定知识体系的实践,护理知识被承认作为卫生保健知识的一部分。至此,美国的护理学科已经得到了极大的发展,护理学科的知识体系也已经形成了多层次、多维度和多样性的卫生保健领域的独有的知识体系,包括从护理哲学到各科临床护理,以及个体的与护理有关的生理和心理知识。第四部分：我国护理学科发展历史借鉴我国护理学科的发展之初也深受南丁格尔护理理念的影响,19世纪后期,随着教会护理的发展而逐渐发展起来。西方教会人员在中国开办医院和创立护校,为我国护理学科的发展奠定了基础,尤以美国中华医学基金会的资助开办的中国协和医学院护校,开创我国高等护理教育先河,培养了一批优秀的高级护理人才和护理学科的领军人物。建国后,由于各种政治和经济原因,我国停办高等护理教育,将护理教育定位于中专教育,与美国等西方国家的学术交流中断,这使得我国护理学科的发展陷入了低谷。文革期间,护校停办,护士转行做医生,护理被认为是没有任何知识和技术含量,不需要训练就能做的工作,医院的许多护理工作由家属来完成。中华护理学会在文革期间也停止了所有的学术活动,正常的工作秩序被打乱,这严重阻碍了护理学科的发展。在文革结束后,市场经济和改革开放政策使得护理学科有机会发展新的教育项目和完善专业结构。我国高等护理教育自80年代中期恢复后逐步走上了正轨。在这个过程中,护理实践也开始改革,70年代末期和80年代引进的责任制护理代替了多年的功能制护理,把人看作不仅是生理的人,而且是心理和社会的人,注重与病人之间的沟通和护患关系。90年代中期,由美籍华人袁剑云博士来华讲学并引进了一种新型的护理工作形式——系统化整体护理,把人看作一个不可分割的整体,更加强调护理对象的生理-心理-社会的完好状态。在科研方面,不但实施了系统化的护理量性研究,还进行了大量的护理质性研究,为发展护理学科的知识体系提供了条件。第五部分：我国护理学学科体系构建的初步设想纵观我国和美国护理学科的发展历史可以看出,美国护理学科的发展过程是随着社会的发展和人们对健康的需求而逐渐发展的,由院办护校的建立、大学护理教育、护理研究生教育,到临床护理专业化的发展,护理学科体系逐步完善。我国护理教育已经形成了从中专到博士的多层次护理教育体系,但是学科体系不是很完整,有必要在相关理论指导下构建护理学的学科体系,以指导护理研究生的专业设置,促进护理学科的发展。对我国护理学科体系的构建,应该植根于我国护理实践,结合国内外护理学科的发展实际,遵循反思性、自主性、科学性、实践性和系统性原则,参考其他学科分类的方法,按照护理学的研究对象——护理活动进行学科分类,按照科学的一般理论,结合教育学科体系的构建方法,分为基础学科、技术和方法学科以及应用学科三大类,以科学地反映护理学发展的实际及预测其发展趋势,提高护理研究的水平,进一步发展护理学科。当然,护理学科体系的构建不是一成不变的,具有开放性,可以随着教育科学的发展而不断增加新的维度和新的层次。这一学科体系的结构只是探索性研究,是否妥当,还需要实践的检验。更多还原

【Abstract】 Along with the development of medicine, nursing has its body of knowledge. Nursing education in China has its full system from diploma to doctoral level. However, nursing is still a specialty of medicine, which impeded the development of nursing. The collegiate nursing education was resumed in 1985 after the foundation of China. Therefore, higher degree nurses were in need, especially the faculty of the schools of nursing. The specialties of the graduate nursing education were classified according to the function of nursing such as administration and education in the early time. The clinical and basic specialties were not embodied clearly. How to classify the body of nursing knowledge and set up the specialties of graduate nursing education are important tasks because they are related to the development of nursing discipline and graduate nursing education.Reasonable classification of the knowledge body of nursing is the guideline for setting up the specialties for the graduate education. The construction of nursing discipline in China needs scientific theory as a guideline. The development of nursing education should adapt to the economic and people’s needs. Nursing is a practical discipline. We should put it in the social environment for the classification. The classification of the knowledge body of nursing will guide the knowledge development and theory construction, which will guide the clinical practice. This paper is a historical and literature research, which explored the development of nursing both in China and America. It is expected to have a significant meaning for the construction of nursing discipline in China.This paper consists of five parts, which are shown as follows:Part One:IntroductionFirst, the background, the meaning, the purpose of the study and related study in this area were reviewed and discussed. Second, the scheme and approaches applied in this study were described, which include literature analysis, survey, and historical research.Part Two:The necessity and possibility of nursing being set as an independent disciplineNursing has its theoretical basis to be an independent discipline. It has its own concepts frame:human being, environment, health, and nursing as well as its own body of knowledge, which indicates the difference between nursing and medicine. The frame of nursing discipline has been formed. The sub disciplines of them have their own text book and research area such as medical-surgical nursing. Nursing is changing in nursing philosophy, properties of nursing, and working arena. Nursing pays more attention to human rather than disease compared with medicine. The working arenas for nursing include others besides hospitals. The research area outreaches the scope of medicine. The increase of independent disciplines and the decrease of dependent disciplines are a natural process of the development of all the disciplines. If nursing being set as an independent discipline, higher nursing education will be developed quickly as well as the nursing discipline.Part Three The development of nursing discipline in the United StatesNursing in the United States has been developed under the notion of Nightingale in the 20th century. Before 1850, the focus of clinical nursing was caring. Nursing research came from the intuition and observation on the environment through trial and error without any systematic research. Nursing focused on diseases, which was the same as medicine. Nursing was developed quickly during World War II. But nurses were in great shortage. Clinical nursing specialization promoted graduate nursing education. Physicians needed cooperation with nurses. The nursing practice in the specialized environment of medicine stimulated the specialized nursing knowledge development. During 1950s-1960s, the focus of of nursing research was nursing education, nursing leadership, and nursing management. The first journal of nursing research in the United States was "Nursing Research" that published in 1952. Nursing research promoted the development of nursing theory. This was the theory period. Nursing was separated from medicine and paid attention to both disease and human being. During late 1970s and 1980s, nurses began to reflect on nursing concepts, scope of nursing, and proper strategies for developing nursing knowledge. Therefore, they relied on nursing philosophy to explore what nursing was. Since then, they integrated nursing education, nursing research, and clinical nursing to develop nursing knowledge. Nursing was accepted as a science, clinical practice based on certain body of knowledge, and health care knowledge. The nursing discipline was fully developed.Part Four Nursing in China after 1949Nursing in China was influenced by the notion of Florence Nightingale and developed along with the coming of missionaries. The missionaries set up hospitals and nursing schools, which laid the foundation for nursing. The foundation of the School of Nursing, Peking Union Medical College funded by the Chinese medical foundation of the United States was the beginning of the higher nursing education. Many elites graduated from it.In 1950, the first National Health Conference was held by the Ministry of Health, at which nursing education was designated as a secondary nursing education program (Zhongzhuan) at the high school level without collegiate education. During these nearly thirty years, nursing was placed subordinate to medicine, which dramatically impeded its development. The working form of nursing was functional nursing in order to finish the order of the physicians without any systematic research. During the Great Cultural Revolution, schools of nursing were suspended and nurses became physicians. Everybody could do nursing work without any training. Everything was in a chaos at that time.After the Great Cultural Revolution, market economy and open-door policies gave nurses opportunities for developing new academic programs and professional structures. Higher nursing education was resumed in 1984. In 1985, there were 11 universities setting up baccalaureate nursing programs. Master degree program and doctor degree program began in 1992 and 2004 respectively. But most of them were academic degree rather than specialty degree. Changes were made in clinical practice during the late 1970s and 1980s. Primary nursing was put forward which focused on mental health and the interrelationship between nurses and patients. Holistic nursing was another work form focused on the whole of the human being that was put forward in the 1990s. Not only was systematic quantitative research implemented, but also qualitative research, which laid the foundation for the development of nursing. During this time period, scholar development was the focus. Nursing should be put as an independent discipline that was the wish of all. At the beginning of the 21st century, the government released a document about the practice and education for clinical nursing specialization. This laid the foundation for the scientific development of nursing.Part Five Construction of nursing disciplineNursing history of China and America gave us a hand on the construction of nursing discipline in China. America relied on nursing philosophy that stands for the trend of nursing. The construction of nursing discipline could draw lessons from both China and America. However, we should consider the difference between the two countries and construct nursing discipline with Chinese characteristics.Nursing education system has been fully developed. Until 2008, there were 63 nursing schools had master degree programs,9 of them had doctoral degree programs. Most of the specialties of graduate education were nursing education, nursing administration, and clinical nursing. These were all academic degree rather than specialty degree. The names of the specialties were not formal and could not reflect the whole discipline. It is necessary to construct the nursing discipline in order to set up the specialties for the graduate education and promote the development of nursing.We should take root in nursing practice to construct nursing discipline combining the history of nursing. The construction should abide by rules of reflection, science, practice, and systemetic. Classification of nursing discipline should be made according to the object of nursing—nursing practice as well as other disciplines’methods for classification. This way would reflect the development trends of nursing and improve nursing research.The construction of nursing discipline is not a stable one. It is an open system and can be developed over time. This study is just a pilot one which will be tested by the practice.更多还原