【作者】 张艳；

【导师】 姜安丽；

【作者基本信息】 第二军医大学 ， 护理学， 2013， 博士

【摘要】 目的：1.构建既适合我国国情、又顺应护理学国际化、专科化趋势的护理学学科体系，以丰富和促进护理学元理论研究，并为我国护理学科的规范化、系统化建设提供理论依据。同时，为不同类型的护理学研究生培养、专科护士培训提供方向性指导。2.比较不同成熟阶段的护理学科的发展特征，揭示影响护理学科演进历程的关键因素，为促进我国护理学学科体系发展提供策略性建议。方法：1.应用文献研究法，把握护理学科体系研究趋势，探讨护理学科体系的概念及其内涵，确定学科体系构建策略。2.运用文献计量学方法、内容分析法，考察国内外护理学科体系的知识形态、组织建制现状，归纳出判断学科成熟程度的基本内容，形成护理学二级学科准入标准。3.运用历史研究法、个案分析法，进一步论证护理学二级学科准入标准的合理性，经专家小组会议法进一步修订和完善其条目内容。4.运用理论研究法，从分析护理学科概念内涵切入，确立护理学科体系的逻辑起点，逐步推演出护理实践的逻辑范畴及其涉及的学科知识群。5.运用比较研究法，揭示国内医学及部分人文社会科学的学科体系特点，形成构建护理学学科体系的本土化参考依据；结合逻辑起点推演结果，依据“护理学二级学科准入标准”，构建由二级学科群、二级学科、三级学科或研究方向组成的护理学学科体系。6.运用专家小组会议法，讨论、修订所构建的护理学学科体系，进一步辨析各层级学科的内涵差异，澄清模糊认识。7.运用理论研究法，通过与生态学概念交叉移植，结合“护理学二级学科准入标准”内容，提出生态学视域中的护理学学科体系发展框架及策略。结果：1.界定了护理学“学科”、学科层级划分、护理学科体系概念及其内涵，提出学科的四种形态特征（知识、组织、历史、文化信念形态），逐步确立护理学学科体系的逻辑起点为“人的健康反应”。由此推演护理实践过程的逻辑中介、核心、结果范畴及逻辑终点，提炼出人和环境这两个影响健康反应的关键因素，并沿着人、环境、照护主轴，以健康反应为结局变量，绘制出多维的、立体状的护理学科知识体系简图。2.从宏观角度描述了国内外护理学科知识创新、知识传播及组织建制状况，归纳整理出判断护理学科成熟度的基本维度：理论内涵、知识创新、知识传播、人才培养、社会需求，并通过分析中外护理学科发展现状的差距，提炼出各维度应涵盖的基本内容，初步形成“护理学二级学科准入标准”。3.纵向梳理了中美两国护理学科体系演进历程中的重要事件及文献内容，从中发现人才培养、知识创新、知识传播、社会需求是影响学科体系演进的关键因素，并通过社区护理学的个案演进历程分析得到进一步确证，由此验证了所提出的“护理学二级学科准入标准”的合理性，并经35位专家讨论，逐条修订并完善了条目内容。4.揭示国内学科体系设置具有内在逻辑主线多维性特点。从护理学学科体系的逻辑起点推演，沿着人、环境、照护三条逻辑主线，将护理学科知识划分为“人文护理知识体系”、“科学护理知识体系”。前者继续分为“护理学原理”、“跨学科护理知识”，后者分为“人的生命阶段的护理知识”、“护理诊疗知识”、“生存环境的护理知识”三个知识群，分别涵盖不同类属的护理学次级学科。按照“护理学二级学科准入标准”，结合前期的文献计量学研究及历史研究资料，筛选出10门备选二级学科，提请27位专家进行小组会议讨论。最后，专家对所构建的护理学学科体系的赞同程度均较高。5.从生态学视域提出我国护理学学科体系发展框架，涵盖了护理学学科体系发展的影响因素及发展趋势，并据此提出国内护理学学科体系建设的发展策略。结论：1.本研究通过总结国内外大量文献中对护理学科本质属性的认识，结合对护理学“学科”概念及其内涵的界定，确定“人的健康反应”是护理学科体系的逻辑起点。可按照人、环境、照护三条逻辑主线，通过科学性与人文性护理过程，描绘出复杂的、立体型的护理学科知识体系，为护理学理论研究提供了参考依据。2.本研究采用文献计量学方法考察国内外护理学科发展现状，揭示了护理学科重点研究领域及各学科发展前沿，提炼出影响学科发展的关键因素，归结出中外护理学科发展的异同点。研究中所收集到的中美护理学发展史料将对国内护理学历史研究提供一定参考。3.本研究确立的“护理学二级学科准入标准”将为今后的二级学科自主申报设立一定的指引方向，所构建的护理学科体系具有整体性、科学性、兼容性、现实性、扩延性特点，符合我国国情，具有现实可操作性。4.依据本研究提出的护理学学科体系生态发展框架，提出今后护理学科体系建设的策略：①巩固学科基本要素，奠定学科发展的深厚根基；②拓宽生态资源，加速护理国际化、制度化进程；③汲取跨学科知识营养，促进护理学科丛林繁荣发展。更多还原

【Abstract】 Objective：1. To develop the nursing discipline system for academic standardization andsystematization based on the situation of China and the international trends ofnursing education. It would be applied as the theoretical guideline in education ofpostgraduate nursing students and clinical nursing specialists, furthermore,promote nursing meta-theory research.2. To explore key factors influencing the progress of nursing disciplinethrough comparing features in different stages, in order to put forward suggestionsfor the development of nursing system in China.Methods:1. The domestic constructional strategy of related disciplines andstructures of nursing knowledge body in foreign countries were reviewed tofind out the current trends in the research of discipline system. The concepts ofnursing discipline system and its connotation were explored and defined usingtheoretical and literature research.2. Indicator system of entry conditions of secondary nursing disciplinewas formed by examining the current situation of nursing knowledge body andorganizational system in domestic and foreign countries, and inducing the basiccomponents of judging the maturity level of a discipline through bibliometric andcontent analysis.3. Indicator system of entry conditions of secondary nursing discipline werefurther supported using historical approach and case analysis, some items wererevised in the panel meeting.4. Logic starting point of nursing discipline system by taking the concept ofnursing as the entry point were established, then nursing domains and the involvedknowledge were gradually deduced using theoretical approach.5. A comparative method was used to explore characteristics of clinicalmedicine, preventive medicine and some humanities, social disciplines, and toprovide reference points for the construction of nursing discipline system.Combining the result of logic deduce with entry conditions of secondary nursingdiscipline, nursing discipline system composed of secondary nursing discipline and third-level nursing disciplines or research directions were constructed.6.The nursing discipline system were discussed and revised in the expertpanel meeting to discriminate differences between connotations of varioussub-disciplines as to clarify some blur understandings on such nursingsub-disciplines.7. Through theoretical approach, development framework and strategies ofnursing discipline system were put forward from ecological perspective by usingthe interdisciplinary mechanism as concepts transplant, combining entry conditionsof secondary nursing discipline.Results:1.The concepts of nursing discipline, level division method in discipline,nursing discipline system and related connotation were defined, four forms ofnursing discipline including knowledge, organizations, history, cultural beliefswere proposed,thus “health responds in human” as the logic starting point ofnursing discipline were established,from which the logic domains of medium,core,result and destination were deduced in the process of nursing practice.Themulti-dimensional, stereo sketch of body of nursing knowledge were described andtwo key factors, human and environment affecting health responds in human arerefined, with human and environment,caring were principal axis and healthresponds as outcome variable through nursing process.2. The present situation of knowledge innovation, knowledge disseminationand organization framework of nursing discipline were analyzed from macro views,thus the basic dimensions of maturity on nursing discipline were induced: theoryconnotation, knowledge innovation, knowledge dissemination, personnel trainingand social needs of health. Indicator system of entry conditions of secondarynursing discipline was formed through analyzing the distance between currentstatus of nursing discipline at home and abroad, refining contents in different basicdimensions above mentioned.3. Knowledge innovation, knowledge dissemination, personnel training andsocial needs of health were found to be the key factors affecting the evolution ofnursing discipline by vertically combing important events and documentsoccurred in the nursing history of China and the United States, The finding wasconformed by the case analyzing of community health nursing. Thus the indicator system of entry conditions of secondary nursing discipline were proved to bereasonable and discussed by35nursing experts to revise those details.4. Some related disciplines showed that internal logic dividing lines weremultiple dimensions, which provide evidences to divide nursing knowledge withmultiple logic lines. Humanistic nursing knowledge and scientific nursingknowledge system were divided through logic deducing from logic starting point,the former then include nursing principles and interdisciplinary nursing knowledge,the latter then include three knowledge clusters, namely nursing knowledge aboutlife cycle, caring technology and living environment, containing relevantsub-disciplines respectively. According to the entry conditions of secondarynursing discipline, integrating the results of bibliometric and history research,10alternative secondary nursing disciplines were filtered and discussed by27expertsin the panel meeting, and finally got relatively high approval from those experts.5. A development framework of nursing discipline system containing maininfluencing factors and future trends were put forward from ecological perspective,which provided the foundation for development strategies in the process of nursingdiscipline construction.Conclusion：1.In this study, we summarized various understandings about the nature ofnursing discipline in literatures at home and abroad, integrated the defined conceptof nursing and its connotation, established “health responds in human” as the logicstarting point for the nursing discipline system. Thus we described thecomplicated, stereo knowledge body of nursing along with such three keyfactors,namely human，environment and caring. These three logic principle lineslay the foundation of nursing meta-theory research.2. In this study, we analyzed the status quo of nursing discipline at home andabroad,explored key research areas and advanced studies in nursing subdisciplines,refined key influencing factors and touched the same and different points in thedevelopment of nursing discipline in China and foreign countries. The history dataabout the evolution of nursing discipline in China and the United States collectedduring this study could be reference for future history research.3. In this study, we established entry conditions of secondary nursingdiscipline in China, which would guide autonomously secondary disciplineapplication in future. We also constructed a nursing discipline system with integrity, scientificity, compatibility, reality, expansibility which was based on thecurrent situation and could be linked up with related medical disciplines.4. According to the developmen framework for nursing discipline system, weproposed such strategies for construction of nursing discipline:①consolidatebasic key elements, which lays a profound foundation for promoting developmentof nursing discipline;②Broaden the ecological resources to accelerate theinternationalization and standardization of nursing process in China;③absorbmore interdisciplinary knowledge to promote the prosperity of nursing science.更多还原