三级医院心血管科护士置信职业行为指标的构建及应用研究

doi:10.3761/j.issn.1672-9234.2025.11.011

摘要/Abstract

摘要： 目的构建三级医院心血管科护士置信职业行为（entrustable professional activities，EPAs）指标体系，为评价其岗位胜任力提供科学工具。方法采用文献分析、半结构式访谈及德尔菲法，初步建立三级医院心血管科护士EPAs指标、描述说明及基于工作年限的分层预期置信级别；通过对56名护士的EPAs评价，检验指标可行性。结果对12个省级行政区16所医院的22名心血管护理专家发放了2轮函询问卷，2轮问卷有效回收率均为100%，2轮专家权威系数为0.842、0.856，Kendall协调系数为0.289、0.309（P<0.001）。形成10项EPAs指标（含29条描述说明）及预期置信级别。临床初步应用显示：多数EPAs项目达标率随工作年限增长呈上升趋势，但EPA8（一站式杂交手术整合护理）与EPA10（专业实践发展）的达标率（第5年末分别为59%、53%）相对较低。结论构建的三级医院心血管科护士EPAs指标融合了5C能力框架和心血管护理实践要求，包括职业素养、审辨思维、沟通能力、团队合作、创新思维5个能力维度，10项EPAs指标，聚焦29条可观察、可量化的临床任务。该EPAs指标可有效识别能力缺口并促进专业成长，可为三级医院心血管内外科融合发展和急危重症救治背景下心血管科护士岗位胜任力评估和临床教学培训方向提供参考。

关键词: 心血管科, 护士, 胜任力, 置信职业行为

Abstract:

Objective To construct an indicator system for entrustable professional activities（EPAs） of nurses in the cardiology department of tertiary hospitals，providing a scientific tool for evaluating their job competency. MethodsUsing literature analysis，semi-structured interviews，and the Delphi method，this study preliminarily established EPAs indicators，descriptive explanations，and expected entrustment levels stratified by working years for nurses in the cardiovascular department of tertiary hospitals. The feasibility of the indicators was verified by EPAs evaluation in 56 nurses. Results Two rounds of questionnaire surveys were distributed to 22 cardiovascular nursing experts from 16 hospitals in 12 provinces. The effective response rates for both rounds were 100%. Expert authority coefficients was 0.842 and 0.856，with Kendall’s W coefficient of concordance being 0.289 and 0.309 respectively（P<0.001）. Ten EPAs indicators（including 29 description items） and expected entrustment levels were established. Preliminary clinical application showed that the achievement rates for most EPAs items increased with working years，but the rates for EPA8（Integrated Nursing for One-stop Hybrid Surgery） and EPA10 （Professional Practice Development） were relatively low（59% and 53% at the end of the fifth year，respectively）. Conclusion The EPAs indicators of cardiovascular nurses in tertiary hospitals constructed in this study integrate the 5C competency framework and cardiovascular nursing practice requirements，including five competency dimensions：professional integrity，critical thinking，communication skills，teamwork，and innovative thinking，with 10 EPAs indicators focusing on 29 observable and quantifiable clinical tasks. These EPAs indicators can effectively identify competency gaps and promote professional growth，providing a reference for the assessment of job competency and the direction of clinical teaching and training for cardiovascular nurses in the context of the integration of cardiovascular internal and surgical departments and the treatment of critical illnesses in tertiary hospitals.

Key words: Cardiovascular Department, Nurse, Competency, Entrustable Professional Activities

冯洁惠, 徐建宁, 朱旭菁, 王阳秭, 殷钰, 朱含. 三级医院心血管科护士置信职业行为指标的构建及应用研究[J]. 中华护理教育, 2025, 22(11): 1349-1357.

FENG Jiehui, XU Jianning, ZHU Xujing, WANG Yangzi, YIN Yu, ZHU Han. Construction and application of entrustable professional activities for cardiovascular nurses in tertiary hospitals[J]. Chinese Journal of Nursing Education, 2025, 22(11): 1349-1357.

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参考文献 23

[1]	国家心血管病中心, 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2024概要[J]. 中国循环杂志, 2025, 40(6):521-559.
	National Center for Cardiovascular Diseases, The Writing Com-mittee of the Report on Cardiovascular Health and Diseases in China. Report on cardiovascular health and diseases in China 2024:an updated summary[J]. Chin Circ J, 2025, 40(6):521-559.
[2]	Fan DM. Holistic integrative medicine:toward a new era of medical advancement[J]. Front Med, 2017, 11(1):152-159. doi: 10.1007/s11684-017-0499-6
[3]	魏锐, 刘坚, 白新文, 等. “21世纪核心素养5C模型” 研究设计[J]. 华东师范大学学报(教育科学版), 2020, 38(2):20-28. doi: 10.16382/j.cnki.1000-5560.2020.02.003
	Wei R, Liu J, Bai XW, et al. The research design of the 5Cs framework for twenty-first century key competences[J]. J East China Norm Univ Educ Sci, 2020, 38(2):20-28.
[4]	常玉兰, 郭舒婕, 杨巧芳, 等. 心血管专科护士岗位胜任力模型的构建[J]. 中华护理教育, 2020, 17(12):1110-1114.
	Chang YL, Guo SJ, Yang QF, et al. The development of a competence model for cardiovascular specialty nurses[J]. Chin J Nurs Educ, 2020, 17(12):1110-1114.
[5]	蔡灵芝. 心血管内科责任护士岗位胜任力评价指标体系的构建[D]. 杭州: 浙江大学, 2013.
	Cai LZ. Study on establishing the evaluation index system for the post competency of charge nurse in cardiovascular internal medicine department[D]. Hangzhou: Zhejiang University, 2013.
[6]	刘兴红, 杨林杰, 王慧华, 等. 心脏移植护士岗位胜任力评价指标体系的构建[J]. 中国实用护理杂志, 2020, 36(36):2862-2867.
	Liu XH, Yang LJ, Wang HH, et al. Construction of competency evaluation index system for heart transplantation specialized nurses[J]. Chin J Prac Nurs, 2020, 36(36):2862-2867.
[7]	ten Cate O. Entrustability of professional activities and compe-tency-based training[J]. Med Educ, 2005, 39(12):1176-1177. doi: 10.1111/med.2005.39.issue-12
[8]	齐心. 置信职业行为的演进、内涵与实践[J]. 中华医学教育探索杂志, 2024, 23(9):1153-1160.
	Qi X. The evolution,connotation,and practice of entrustable professional activities[J]. Chin J Med Edu Res, 2024, 23(9):1153-1160.
[9]	鹿笑寒, 宋洁, 刘霖, 等. 本科护理实习生老年护理置信职业行为评价指标体系的构建[J]. 中华护理教育, 2022, 19(9):779-785.
	Lu XH, Song J, Liu L, et al. Establishment of the evaluation index system of the entrustable professional activities in geriatric nursing interns[J]. Chin J Nurs Educ, 2022, 19(9):779-785.
[10]	周娜, 张静, 路潜, 等. 口腔护理硕士专业学位研究生置信职业行为指标的构建研究[J]. 中华医学教育杂志, 2023, 43(8):633-637.
	Zhou N, Zhang J, Lu Q, et al. Research on the construction of entrustable professional activities index for postgraduates with master’s degree in oral nursing[J]. Chin J Med Educ, 2023, 43(8):633-637.
[11]	黄浩, 焦雨晨, 嵇艳. 三级综合医院急诊科护士置信职业行为指标的构建与验证[J]. 中华护理杂志, 2023, 58(9):1096-1103. doi: 10.3761/j.issn.0254-1769.2023.09.011
	Huang H, Jiao YC, Ji Y. Construction and verification of entrustable professional activities for nurses in emergency departments of tertiary general hospitals[J]. Chin J Nurs, 2023, 58(9):1096-1103. doi: 10.3761/j.issn.0254-1769.2023.09.011
[12]	穆莉, 王琤, 齐心, 等. 手术室新入职护士置信职业行为指标的构建研究[J]. 中华医学教育杂志, 2023, 43(3):226-230.
	Mu L, Wang C, Qi X, et al. Development of the entrustable professional activities for operating room new entrant nurses[J]. Chin J Med Educ, 2023, 43(3):226-230.
[13]	秦雪, 李莹. 心脏外科ICU新入职护士置信职业行为评价指标的构建[J]. 中国护理管理, 2024, 24(7):1029-1033.
	Qin X, Li Y. Construction of entrustable professional activi-ties indicators for newly hired nurses in Cardiac Surgery ICU[J]. Chin Nurs Manag, 2024, 24(7):1029-1033.
[14]	ten Cate O, Chen HC, Hoff RG, et al. Curriculum develop-ment for the workplace using entrustable professional activi-ties(EPAs):AMEE guide No. 99[J]. Med Teach, 2015, 37(11):983-1002. doi: 10.3109/0142159X.2015.1060308
[15]	齐心, 金哲, 韩晓宁, 等. 住院医师置信职业行为指标的构建研究[J]. 中华医学教育杂志, 2021, 41(2):104-108.
	Qi X, Jin Z, Han XN, et al. Establishment of the entrustable professional activities for the residents[J]. Chin J Med Educ, 2021, 41(2):104-108.
[16]	屈京楼, 朱亚鑫, 曲波. 德尔菲法在医学教育研究中的应用[J]. 中华医学教育杂志, 2019, 39(3):227-230.
	Qu JL, Zhu YX, Qu B. The Delphi method and its application in medical education research[J]. Chin J Med Edu, 2019, 39(3):227-230.
[17]	冯洁惠, 朱含, 王阳秭, 等. 心脏移植围手术期护理质量评价指标的构建[J]. 中华护理杂志, 2024, 59(4):425-431. doi: 10.3761/j.issn.0254-1769.2024.04.006
	Feng JH, Zhu H, Wang YZ, et al. Construction of nursing quality evaluation indicators in perioperative period of heart transplantation[J]. Chin J Nurs, 2024, 59(4):425-431. doi: 10.3761/j.issn.0254-1769.2024.04.006
[18]	崔甜恬, 童宇平. 七步紧急护理评估框架的护理应用研究进展[J]. 护理学报, 2023, 30(24):20-23. doi: 10.16460/j.issn1008-9969.2023.24.020
	Cui TT, Tong YP. Research progress on nursing application of seven-step emergency nursing evaluation framework[J]. J Nurs(China), 2023, 30(24):20-23.
[19]	冯洁惠, 徐建宁, 朱旭菁, 等. 心血管危重症患者院内转运执行单的设计及应用研究[J]. 中华急危重症护理杂志, 2022, 3(5):389-395.
	Feng JH, Xu JN, Zhu XJ, et al. Design and application of an intra-hospital transport checklist for critically ill cardiovas-cular patients[J]. Chin J Emerg Crit Care Nurs, 2022, 3(5):389-395.
[20]	Morya AK, Behera RK, Gupta PC, et al. CICARE based com-munication technique:a passage to faster and smoother visual rehabilitation in post cataract surgery patients[J]. World J Clin Cases, 2024, 12(36):6947-6949. doi: 10.12998/wjcc.v12.i36.6947
[21]	Ryan SL, Logan M, Liu X, et al. Long-term sustainability and adaptation of I-PASS handovers[J]. Jt Comm J Qual Patient Saf, 2023, 49(12):689-697.
[22]	Davis BP, Mitchell SA, Weston J, et al. Situation,background,assessment,recommendation(SBAR) education for health care students:assessment of a training program[J]. MedEdPORTAL, 2023,19:11293.
[23]	Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health:a presidential advisory from the American Heart Association[J]. Circulation, 2023, 148(20):1606-1635. doi: 10.1161/CIR.0000000000001184 pmid: 37807924