【作者】 张琪；

【导师】 曾铁英；

【作者基本信息】 华中科技大学 ， 护理学， 2011， 硕士

【摘要】 目的:探讨临床实习期间培养护理本科生循证护理基本知识和技能的有效教学策略。方法:第一阶段通过自行设计的循证知信行问卷调查不同层次护理专业学生的循证基本知识、态度和信念以及循证实践行为水平,并分析其可能的影响因素。第二阶段将其中的80名护理本科临床实习学生以学校为整体组成15个学习小组,首先通过研究组编写的学习资料包和学习目标的提示,借助网络图书馆等资源,与同伴合作,对循证护理的基本知识和实践方法进行自主学习。之后借鉴文献评价的方法指南和实例,对指定科研文献开展评价,重点培养证据评鉴能力,并在WORKSHOP讨论会中汇报交流。通过问卷比较学生学习前后循证知信行水平差别,并反馈学习效果。结果:1.在理论分值为8-24,14-42,8-24范围内,目前临床实习护生循证护理相关知识、态度和信念、行为各维度的平均得分分别为10.85、34.34、10.84。2.普通本科护生循证知识水平高于大专护生,其态度信念水平高于中专自考本科护生。既往的循证护理培训经历是现阶段循证知识和行为水平的积极因素,而既往的循证护理实践经历也是循证知识水平的积极影响因素。3.循证学习项目开展后,本科护生的循证护理知识、循证态度和信念、循证实践行为自评得分均有显著提高(t=-11.64, -4.24, -8.95, P<0.01)。4. 72名(97.3%)学生对学习过程持满意或基本满意态度。对开展文献评价活动的WORKSHOP满意度高于自我导向学习策略(χ2=4.5709, P<0.05)。学习者报告在分析解决问题能力、自主学习能力、团队合作能力、实证观念和科研能力方面达到提高的人数分别都超过了90%;而有显著提高的比率则分别达到31.1%,45.9%,44.6%,27.0%和24.3%。5.超过半数的学习者(n=43, 58.1%)认为最佳学习途径应该是在临床实践中学习,而在学习过程中遇到的主要障碍是缺乏文献检索、评价等学习技巧(n=37, 50%)。结论:1.现阶段我国护理专业学生的循证基本知识技能和循证实践行为缺乏,但循证态度信念较积极。2.普通本科护生循证基础知识水平最高,态度信念最积极,是开展循证学习的最适宜人群。应根据其能力基础确定适合的循证学习方案,重点开展循证培训。同时通过持续学习循证知识和开展循证护理实践来逐步建立临床工作中以实证为依据的护理行为习惯。3.采用自我导向学习和WORKSHOP策略有利于帮助学生培养循证护理的基本能力,并在学习过程中促进自主学习能力、交流沟通技巧和团队合作精神等综合素质的提高,应加以借鉴推广。4.建议在加强本科护生循证基本知识和能力培养的基础上,继续拓展循证学习内容,深入了解证据的内涵和等级系统,并通过加强临床护理师资人员的循证素质和能力培养,积极引导学生,师生配合促进证据在临床实践中的应用。更多还原

【Abstract】 Objective To explore appropriate learning strategies to equip undergraduate nursing students with basic knowledge and skills and foster positive attitudes toward evidence-based practice (EBP) during their clinical practicum.Methods During the first stage, the perceived EBP basic knowledge, attitude and behavior levels of all the nursing students practicing in the same hospital were investigated through a self-designed questionnaire and possible influencing factors were analyzed as well. In the second stage, a total of 80 undergraduate nursing students were recruited and divided into 15 groups to learn the basic knowledge of Evidence-Based Nursing (EBN) at first through a self-directed learning (SDL) approach with the help of a package of learning materials. Clinical preceptors and peer students played roles of facilitators and internet and library resources were utilized. Then students in the same group cooperate together for the purpose of learning how to critically evaluate research evidence with a research report evaluation guideline and literature appraisal examples as reference. They also made a presentation and had an in-depth discussion of their research evaluation report by means of workshop. The outcomes were evaluated through questionnaires to compare EBP competencies before and after the learning process and satisfaction and feedback were surveyed as well.Results1. The theoretical score range of EBP related knowledge, attitude and belief, and behavior were 8-24, 14-42, 8-24 and the mean scores clinical nursing students achieved were 10.85、34.34、10.84 respectively.2. Multivariate analysis showed that educational background was the influencing factors of evidence-based knowledge level as well as attitude and belief of nursing students. The undergraduate nursing students had the highest level of EBN related knowledge and attitude. Previous experience of EBN training was a positive factor of the level of evidence-based knowledge and behavior at this stage, while previous experience of evidence-based practice was a positive influencing factor of current EBN related knowledge.3. Statistically significant differences in the mean scores of EBP knowledge, attitude and belief, and behavior (t=-11.64, t=-4.24, t=-8.95, P<0.001) levels were found after students participated in the learning program.4. A total of 72 participants (97.3%) showed some or complete satisfaction with the learning strategies and statistical difference (χ2=4.5709, P<0.05) and more satisfaction with workshop were shown in addition. More than 90% of the participants found improvement in analytical and problem-solving ability, independent learning ability, cooperative and communication ability, evidence-based conception and scientific research ability, among which the proportions for obvious improvement were 31.1%, 45.9%, 44.6%, 27.0% and 24.3% respectively.5. More than half of the students (n=43, 58.1%) thought learn EBP in clinical practice as the best way to learn, while the primary barrier during learning process was a lack of literature retrieval and evaluation skills (n=37, 50%).Conclusions1. Although nursing students have positive attitudes and confidence about EBP, there remains a substantial gap in knowledge and practice level.2. The undergraduate nursing students are the most appropriate people for EBP training. The evidence-based learning plan should be based on their competencies and we need provide more opportunities for their EBP training. Meanwhile, through continuous learning of EBN knowledge and implementing evidence-based practice they can gradually base nursing care on evidence in clinical work.3. This study provides evidence that a learning program through the SDL and workshop strategies can effectively equip undergraduate nursing students with beginning competencies in EBP. Meanwhile, their independent learning abilities, cooperative and communicative skills were improved as well. 4. It is implicated the learning program may be extended to assist students gain an insight into the essence and hierarchy of evidence for EBP and more opportunities should be provided for clinical utilization of evidence in the future through strengthening and improving the evidence-based qualities and competencies of clinical preceptors.更多还原