关键词: Miller金字塔模型, 血液净化, 进修护士, 在职培训, 德尔菲法

Abstract:

Objective To construct a standardized training program targeting the vascular access nursing competence of blood purification nurses and to empirically validate its effectiveness in clinical practice. Methods A preliminary program framework was established through systematic literature retrieval and analysis，with the four hierarchical stages of Miller’s Pyramid Theory serving as the core module for organizing training content. Nineteen interdisciplinary experts，including clinical nursing specialists，nursing educators，and vascular surgery physicians，were invited to conduct two rounds of Delphi correspondence consultations. The program was revised and finalized based on expert feedback regarding content validity，feasibility，and scientific rigor. A total of 80 refresher nurses rotating through the Blood Purification Center of a tertiary Grade A hospital in Nanjing were enrolled in this study. The control group（n=40） consisted of nurses who received conventional one-on-one clinical preceptorship from January to December 2023，while the experimental group（n=40） received the Miller’s Pyramid-based training program from January to December 2024. The two groups were compared in terms of theoretical knowledge of vascular access，knowledge application proficiency，hands-on practical skills evaluation，clinical scenario simulation testing，and satisfaction with the training. Results Post-training comparative analysis revealed no statistically significant difference in theoretical knowledge and knowledge application scores between the two groups（P>0.05）. However，the experimental group demonstrated significantly higher performance in professional practical skills（P<0.05） and clinical scenario simulation assessment（P<0.05） compared to the control group. The overall satisfaction score of the experimental group was significantly higher than that of the control group（P<0.05）. Conclusion The Miller’s Pyramid-based training program for vascular access nursing competence in blood purification effectively enhances refresher nurses’ capabilities in vascular access assessment，rational utilization，standardized maintenance，and complication prevention. Characterized by standardization and scientific rigor，the program provides a structured approach to nursing competence development. Future research should further explore the long-term impact of this training on nurses’ actual clinical performance and patient outcomes through longitudinal follow-up studies.

Key words: Miller Pyramid Model, Blood Purification, Refresher Nurses, In-service Training, Delphi Method