“四主题法”分阶段培训在提升新入职护士伦理实践能力中的应用

doi:10.3761/j.issn.1672-9234.2021.02.012

摘要/Abstract

摘要：

目的探讨新入职护士“四主题法”分阶段培训的方法及效果。方法将2016年入职的97名护士作为研究对象,运用“四主题法”分阶段进行护理伦理培训。制订护理伦理四主题表,包括医疗适应性、患者选择、生活质量、情景特征4个主题38个方面。第1阶段采用理论授课的方式,讲解护理伦理学基础理论知识和护理伦理四主题的基本概念;第2阶段采用翻转课堂与PBL教学结合,运用四主题表以小组讨论形式进行案例分析讨论;第3阶段采用床边教学,运用四主题表分析临床案例和护理问题。比较培训前后新入职护士的护理伦理学基础知识理论成绩和护士核心能力中伦理实践能力。结果培训后,护士的护理伦理学基础知识成绩为（77.14±22.26）分,高于培训前的（38.47±20.51）分,差异有统计学意义（t=15.89,P<0.001）。培训第2阶段和第1阶段的护士伦理实践能力得分差异没有统计学意义（P=0.146）,第3阶段高于第1、2阶段和培训前（均P<0.001）。结论运用“四主题法”分阶段进行护理伦理学培训能帮助新入职护士掌握护理伦理学知识,提升伦理实践能力。

关键词: 在职培训, 护士, 伦理学, 护理, 四主题法, 分阶段培训

Abstract:

Objective To explore the effects of a phased training with four topics approach on practically ethical ability of new nurses. Methods A total of 97 new nurses who joined in the hospital in 2016 for standardized training were recruited and four topics approach was used for the ethical training.A table was developed with four themes of nursing ethics,including medical adaptability,patient selection,quality of life,and situational characteristics. In the first stage,the basic theoretical knowledge of nursing ethics and concepts of four topics were taught. In the second stage,group discussion was conducted guided by the table with flipped classroom and PBL method. In the third stage,clinical cases and nursing problems were analyzed using the table. The changes of the theoretical knowledge scores and practically ethical ability were compared pre-training and post-training. Results The theoretical score of post-training（77.14±22.26） was significantly higher than that of the pre-training（38.47±20.51）（t=15.89,P<0.001）. There were no significant differences regarding the practically ethical ability scores in phases 2 and phase 1（P=0.146）. However,the score of phase 3 was significantly higher than those of phase 1 and 2（P<0.001）.Conclusion The approach of four topics can improve the ethical awareness,ethical decision-making ability and practical nursing service ability of new nurses.

Key words: Inservice Training, Nurses, Ethics, Nursing, Four topics approach, Phased training

卢晓莉,徐静,金艳艳,吴海英,崔飞飞,杜金刊. “四主题法”分阶段培训在提升新入职护士伦理实践能力中的应用[J]. 中华护理教育, 2021, 18(2): 154-158.

LU Xiao-li,XU Jing,JIN Yan-yan,Wu Hai-ying,CUI Fei-fei,DU Jin-kan. The effects of a phased training with four topics approach on practically ethical ability of new nurses[J]. Chinese Journal of Nursing Education, 2021, 18(2): 154-158.

图/表 2

参考文献 13

[1]	Jonsen AR, Siegler M, Winslade WJ. Clinical ethics:a practical approach to ethical decisions in clinical medicine[M]. 6th ed. New York: McGraw-Hill, 2006.
[2]	朱娅鸽, 杜芬静, 杨慧玲, 等. 关于医院护士伦理决策能力的相关影响因素研究[J]. 中国医学伦理学, 2016,29(1):167-170.
	Zhu YG, Du FJ, Yang HL, et al. Study on the relevant factors of hospital nurses’ ethical decision-making ability[J]. Chinese Medical Ethics, 2016,29(1):167-170.
[3]	高静, 吴晨曦, 杨翔宇, 等. 临床护士护理伦理决策能力现状及影响因素研究[J]. 中华护理杂志, 2013,48(6):488-491.
	Gao J, Wu CX, Yang XY, et al. The level and influencing factors of nurses’ ethical decision-making competence[J]. Chin J Nurs, 2013,48(6):488-491.
[4]	曹志平. 护理伦理学[M]. 2版. 北京: 人民卫生出版社, 2011:150-162.
	Cao ZP. Nursing Ethics[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2011:150-162.
[5]	唐淑美, 陈晓静, 宋立业, 等. 临床护士护理伦理决策能力与情绪控制水平的相关性分析[J]. 中华现代护理杂志, 2018,24(29):3518-3522.
	Tang SM, Chen XJ, Song LY, et al. Correlation between ethical decision-making ability and the levels of emotion control in clinical nurses[J]. Chin J Mod Nurs, 2018,24(29):3518-3522.
[6]	Schumann JH, Alfandre D. Clinical ethical decision making:the four topics approach[J]. Semin Med Pract, 2008(11):36-42.
[7]	刘明, 殷磊, 马敏燕, 等. 注册护士核心能力测评量表结构效度验证性因子分析[J]. 中华护理杂志, 2008,43(3):204-206.
	Liu M, Yin L, Estela M, et al. Confirmatory factor analysis of competency inventory for registered nurse[J]. Chin J Nurs, 2008,43(3):204-206.
[8]	唐沛妍. 新入职护士的伦理素养培育探析[D]. 大连:大连医科大学, 2018.
	Tang PY. Analysis of cultivation of ethical qualities of new nurses[D]. Dalian:Dalian Medical University, 2018.
[9]	胡菁, 刘晓虹. “护士职业获益感”概念框架内容的质性研究[J]. 护士进修杂志, 2014,29(8):732-735.
	Hu J, Liu XH. Qualitative research on conceptual framework of“Nurses’ perceived professional benefits”[J]. J Nurses Train, 2014,29(8):732-735.
[10]	卢晓莉, 崔飞飞, 吴海英, 等. 新入职护士规范化“护照”培训模式的探索[J]. 中国高等医学教育, 2018(2):28-29.
	Lu XL, Cui FF, Wu HY, et al. Exploration of using standardized “passport” training model for new nurses[J]. China High Med Educ, 2018(2):28-29.
[11]	高娅娅, 朱国栋. PBL联合翻转课堂在泌尿外科临床实习教学中的应用研究[J]. 中国医学教育技术, 2019,33(3):361-365.
	Gao YY, Zhu GD. Exploration of teaching strategy of problem-based learning(PBL) combined with flipped classroom in internship teaching in department of urology[J]. China Medical Education Technology, 2019,33(3):361-365.
[12]	陈艳晓, 应争先, 杜金刊, 等. 临床伦理学教育在五位一体住院医师规范化培训中的探索[J]. 中国医院, 2016,20(10):12-14.
	Chen YX, Ying ZX, Du JK, et al. Exploration of clinical ethics education in five-in-one resident standardized training[J]. Chin Hosp, 2016,20(10):12-14.
[13]	王云岭. 对医学伦理学教育的反思[J]. 中国高等医学教育, 2011(4):23-24.
	Wang YL. Reflection on medical ethics education[J]. China High Med Educ, 2011(4):23-24.

[1]	李津, 张婧珺, 杨磊, 李小妹. 护理学导论线上线下混合式 “金课”建设[J]. 中华护理教育, 2021, 18(9): 773-776.
[2]	李欣, 庞冬, 陆宇晗, 马晓晓, 候晓婷. 临终护理培训课程的研究进展[J]. 中华护理教育, 2021, 18(9): 860-864.
[3]	张磊. 护理高职生亲社会行为与共情能力的相关性研究[J]. 中华护理教育, 2021, 18(9): 823-826.
[4]	黄婷,丁梅,洪晓彤,黄蓉. 国外老年痴呆症照护在线开放课程介绍及启示[J]. 中华护理教育, 2021, 18(9): 799-802.
[5]	刘燕,白阳娟,卢玉林,李莹霞,李铭. 多专业学生案例讨论在护理本科生临床思维能力培养中的应用[J]. 中华护理教育, 2021, 18(9): 803-808.
[6]	王润珠, 刘烨, 朱米娜, 黄丽华. 肝硬化腹水患者肠内营养管理的证据总结[J]. 中华护理教育, 2021, 18(9): 784-788.
[7]	杨园园, 陈华, 郭立涛. 护理本科生新生儿护理临床见习线上教学的设计与实践[J]. 中华护理教育, 2021, 18(9): 809-813.
[8]	吕菲, 薛梅. OSCE在高职涉外护理方向学生核心能力评价中的应用[J]. 中华护理教育, 2021, 18(9): 814-818.
[9]	李敏, 李彩福. 护理实践专业性量表的汉化及信效度检验[J]. 中华护理教育, 2021, 18(9): 844-848.
[10]	闫德修, 包玲, 章雅青. 工作控制在变革型领导和护士创新行为间的中介作用[J]. 中华护理教育, 2021, 18(9): 849-854.
[11]	王滢茹, 周乐山. 护理本科生人文关怀能力与关怀氛围的相关性研究[J]. 中华护理教育, 2021, 18(9): 819-822.
[12]	胡细玲, 陈晓萍, 张苍, 黄婉婷, 陈妙霞, 李琨. 体验式教学法在内分泌科护理本科实习教学中的应用[J]. 中华护理教育, 2021, 18(9): 831-834.
[13]	高岩, 范玲, 杨瑞玲, 孙婧, 姜李, 王彤, 赵霞. 工作坊在康复科护士压力性损伤培训中的应用[J]. 中华护理教育, 2021, 18(9): 835-839.
[14]	侯梦晓,王飞杰,黄丽洁,越丽霞,赵天云,王志霞. 护士压力性损伤管理自我效能感量表的汉化及信效度检验[J]. 中华护理教育, 2021, 18(9): 840-843.
[15]	侯锦,郭爱敏. 英国诺丁汉大学跨专业教育与学习中心见闻与启示[J]. 中华护理教育, 2021, 18(8): 765-768.