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探究神经内科专科护士核心能力指标体系的建立

时间:2019-07-03

摘要

  目的:本研究拟在通过德尔菲法和层次分析法构建神经内科专科护士核心能力指标体系,为神经内科专科护士的课程设置、培养方及认证等提供参考依据,有针对性培养专科护理人才,提高护理服务质量,促进神经内科专科护理的建设和发展。

  方法:本研究通过文献研究、问卷调查、头脑风暴法、半结构式访谈、德尔菲法等构建神经内科专科护士核心能力指标体系的各级维度和条目,计算函询专家的权威系数、积极系数、专家意见的集中程度以及协调系数,通过层次分析法确立各指标的权重系数,最终形成神经内科专科护士核心能力指标体系。

  结果:通过 2 轮专家函询构建的神经内科专科护士核心能力指标体系包括 6 个一级指标、19 个二级指标、74 个三级指标。第一轮、第二轮问卷回收率分别为 95.23%和 100%,均>70%,专家的积极性高。本研究的专家权威系数(Cr)为 0.935,专家判断系数(Ca)为0.90,专家熟悉程度(Cs)为 0.97,研究认为专家权威系数(Cr)≥0.7 说明专家的信度较高,因此我们邀请的函询专家权威程度高,函询结果可靠。专家意见集中程度用各级指标重要性赋值的均数、标准差、满分比和变异系数来表示,本研究各指标均数在 4.2~5 之间,每个指标的均数均>3.5;标准差在 0~0.83 之间,满分比在 40%~100%,有93.75%的指标满分比超过 60%,变异系数在 0~0.2 之间,变异系数均<0.25;专家意见集中程度较高;各级指标的专家协调程度分析显示,一级、二级、三级指标的肯德尔和谐系数(Kendall W)分别为 0.298、0.352、0.201,经卡方检验计算出 P 值均<0.05,表明具有统计学意义。经层次分析法计算出的一级指标权重值(Wi)前三位分别是"临床专科知识、技能"、"临床护理思维能力"、"管理与执行能力".二级指标组合权重值(Wij)前三位分别是"掌握神经内科常见疾病基础医学知识:定义、病因、临床表现、治疗原则"、"掌握神经内科疾病的症状体征的护理:评估、病情观察、治疗要点、护理措施"、"评判性思维".

  结论:本研究专家一致性好、专家权威程度高,函询结果可靠,可以为进一步研究神经内科专科护士课程设置、培养方法及认证等提供参考依据。对一级指标权重赋值排序可见专科护士核心能力中"临床专科知识、技能"、"临床护理思维能力"以及"管理与执行能力"是重点。

  关键词:神经内科,专科护士,核心能力,指标体系

神经内科

ABSTRACT

  Objectives:In this study, we propose to construct the core competence index system of neurological nurse specialist through Delphi method and analytic hierarchy process, and provide reference for the curriculum, training methods and authentication of neurological specialist nurses, and to cultivate specialist nursing talents and improve nursing quality of service, to promote the construction and development of neurology specialist care.

  Methods:In this study, we construct the dimensions and entries of neurological nurse specialists' core competence index system through literature research, questionnaire survey, brainstorming method, semi-structured interview and Delphi method, and calculate the authority coefficient, positive coefficient and expert opinion The degree of concentration and the coordination coefficient, through the analytic hierarchy process to establish the weight coefficient of each index, and ultimately the formation of neurological nurse specialist core competence index system.

  Results: The core competency target system of neurological specialist nurses constructed by two rounds of expert correspondence letters including six first - level indicators, 19 second - level targetes and 74 third -level indicators. The weight coefficient of each target is determined by using analytic hierarchy process (AHP)。 The enthusiasm of the experts were high,and the recovery of the first round questionnaire was 95.23% the second round was 100%, all of them were> 70%. The expert authority coefficient (Cr) is 0.935, the expert judgment coefficient (Ca) is 0.90, the expert familiarity degree (Cs) is 0.97, and the author thinks that the expert authority coefficient (Cr) ≥0.7 shows that the expert's reliability is high, so we Invitation of the letter to the authority of a high degree of authority, letter results reliable. The degree of expert opinion concentration is expressed by the mean, standard deviation, full score and coefficient of variation of the target of importance at all levels. The average of the indicators in this research is between 4.2 and 5, and the average of each target is 3.5. The difference is between 0 and 0.83, the full score is 40% ~ 100%, 93.75% of the target is over 60%, the coefficient of variation is between 0 and 0.2, the coefficient of variation is <0.25; the expert opinion is concentrated; The analysis of the degree of expert coordination of the indicators at all levels shows that the Kendall W (Kendall W) of the primary, secondary and tertiary indicators is 0.298, 0.332, 0.201, and the P value is calculated by the chi-square test. Statistical significance.The top three indicators of weight index (Wi) calculated by the analytic hierarchy process are "clinical specialist knowledge, skills", "clinical nursing thinking ability", "management and execution ability". The top three indicators of weight (Wij) are "master the basic knowledge of neurological diseases basic knowledge: definition, etiology, clinical manifestations, treatment principles", "master the symptoms and symptoms of neurological diseases care: assessment, disease observation , Treatment points, nursing measures "," critical thinking ".

  Conclusion: The research experts have good agreement, expert authority is high, the letter is reliable, which can provide reference for further study of neurological specialist nurse curriculum, training methods and certification. According to the rankings of six primary indicators, we can reflect the importance of "clinical specialist knowledge, skills", "clinical nursing thinking ability" and "management and execution ability" in core competence.

  Key words: Neurology, nurse specialist ,core competence,index system
 

目录

  前言

  神经内科病人有病情危急、病情变化快、潜在高危因素多、并发症多、住院时间长、医患沟通困难等特点[1].其中高致残率、高死亡率、高复发率的脑卒中在中国疾病死因排行榜中居于首位[2],约占神经内科住院病人数的 60%[3].重庆地区 2015 年脑卒中发病率 278. 82 /10 万,居于世界中等偏上水平[4].我国脑卒中的年直接医疗费用高达 100 亿人民币,住院平均费也在 10000 元以上,给患者、家庭及社会带来巨大负担[5].可见神经内科病人具有多、危、重、急的特点,对专科的、系统的、规范的高质量护理需求呼声极高[6].缪卫琴等[7-8]对神经内科护士需求调查显示,目前神经科专科护士数量严重不足,80%的医护人员希望培养神经内科专科护士。毛永香等[9]对重庆地区神经内科专科护士需求问卷调查得到同样的结果。专科护士核心能力是保证护理安全和质量的决定性因素,各专业有针对性的开展专科护士核心能力标准构建研究成为专科护理研究的热点。重医一院神经内科自 2012 年已连续 5 年开办重庆市神经内科专科护士培训班,培养护士200 余名,但神经内科专科护士的核心能力是什么?在课程设置上应注重哪些方面才能让其具有这些核心能力,查阅国内各项资料,目前还没有一个规范的标准。虽然欧美等国已经构建完成神经科护士核心能力,但核心能力具有独特性,我们不可照搬其他国家或者其他学科的专科护士核心能力标准[10].2016 年国家卫计委《全国护理事业发展规划(2016-2020 年)的通知》,"十三五"期间将明确专科护士培训要求、工作职责及服务范畴等,构建具有中国特色的神经内科专利护士核心能力体系势在必行。本研究旨在通过科学严谨的方法构建神经内科专科护士核心能力指标体系,明确神经内科专科护士应该具备的核心能力,指导神经内科专科护理人才的培养,培养专业、社会和国家需要的实用性专科护理人才,提高护理质量,保障患者安全,促进神经内科专科护理的建设和发展。

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  1概述
  1.1研究背景
  1.2研究目的和意义
  1.3研究内容
  1.4研究方法
  1.5研究路线

  2指标体系的构建
  2.1指标的拟定原则
  2.2成立研究小组
  2.3指标体系草案的形成
  2.4预调查
  2.5专家函询
  2.6统计分析
  2.7质量控制

  3研究结果
  3.1专家的基本情况
  3.2专家的积极性
  3.3专家的权威程度
  3.4专家意见的协调程度
  3.5专家意见整理
  3.6权重的确定

  4讨论
  4.1构建神经内科专科护士核心能力指标体系的意义
  4.2研究方法的科学性
  4.3指标体系分析
  4.4本研究的创新之处
  4.5本研究的不足与下一步研究

5结论

  通过2轮专家函询构建的神经内科专科护士核心能力指标体系包括6个一级指标、19个二级指标、74个三级指标。本研究构建的神经内科专科护士核心能力指标体系的各级指标专家一致性好、专家权威程度高,函询结果可靠,可以为下一步研究课程设置以及培养模式改进提供参考依据。本研究一级指标分别是临床专科知识和技能、临床护理思维能力、管理与执行能力、沟通与协调能力、教育与咨询能力、个人特质。权重赋值排序可见神经内科专科护士应侧重"临床科知识、技能"、"临床护理思维能力"以及"管理与执行能力"的培养,其中"神经内科疾病基础医学知识"、"神经内科疾病的症状体征护理"、"评判性思维"培养是重点。

  参考文献

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