烧伤科低年资护士护理大面积烧伤患者休克期液体复苏的情景模拟教学前瞻性自身前后对照研究

解琳; 张寅; 王佳玉; 杨定婷; 滕培敏; 汪雯靓; 黄一

doi:10.3760/cma.j.cn501120-20201105-00456

烧伤科低年资护士护理大面积烧伤患者休克期液体复苏的情景模拟教学前瞻性自身前后对照研究

doi: 10.3760/cma.j.cn501120-20201105-00456

1.
上海交通大学医学院附属瑞金医院灼伤整形科　　200025
2.
上海交通大学医学院附属瑞金医院医学模拟中心　　200025

基金项目:

上海交通大学医学院附属瑞金医院护理科研基金 RJHK-2019-19

瑞金医院成人应急重症专科护理实训基地建设项目 GWV-5-TB001

详细信息

通讯作者:
张寅，Email：inazhang2001@163.com

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出版历程
- 收稿日期: 2020-11-05

A prospective before-after self-control study of the scenario simulation teaching of junior nurses in a burns department on the fluid resuscitation care of massive burn patients during shock stage

1.
Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
2.
Healthcare Simulation Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Funds:

Nursing Scientific Research in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine RJHK-2019-19

Construction Project of Adult Emergency Intensive Nursing Training Base in Ruijin Hospital GWV-5-TB001

More Information

Corresponding author: Zhang Yin, Email: inazhang2001@163.com

摘要

摘要: 目的探讨对烧伤科低年资护士护理大面积烧伤患者休克期液体复苏进行情景模拟教学的效果。方法 2018年3月—2019年7月，在上海交通大学医学院附属瑞金医院灼伤整形科定科的25名符合入选标准的低年资护士，纳入此前瞻性自身前后对照研究。护士中女21名、男4名，年龄23~26岁，在灼伤整形科工龄为1.0（1.0，2.0）年。根据大面积烧伤患者休克期液体复苏护理中的三大问题确定教学的3个情景，以Jeffries护理模拟教学理论框架为基础撰写教案，通过专家咨询法和低年资护士评价得出教案的可行性和实用性高。根据教案中的3个情景，对低年资护士进行情景模拟教学，每个情景2个学时，共6个学时。在教学前1个月（以下称教学前）和教学后1个月（以下称教学后），由教师采用自行设计的低年资护士综合能力评分表，对低年资护士的综合能力进行评价；低年资护士采用护理高仿真模拟教学中学生行为表现自评量表，对自我行为进行评价。对数据行配对样本t检验。结果教学后，教师对低年资护士综合能力评价中的沟通能力、患者接收、病情评估、液体复苏、应急处理、药物使用、操作技能、仪器使用、团队合作、人文关怀评分和总分均明显高于教学前（t=-8.060、-11.421、-17.232、-24.800、-4.670、-11.916、-12.131、-11.606、-14.632、-13.325、-25.068，P<0.01），其中液体复苏、病情评估、操作技能、仪器使用4项评分较高。教学后，低年资护士自我行为评价中的沟通交流、分工合作、临床决策、专业知识和技能、专业发展和评判性思维得分和总分分别为（4.6±0.4）、（4.8±0.3）、（4.6±0.3）、（4.6±0.4）、（4.6±0.4）、（23.2±1.5）分，分别明显高于教学前的（4.1±0.7）、（4.2±0.7）、（3.9±0.5）、（3.7±0.6）、（3.9±0.5）、（18.8±2.6）分（t=-3.361、-5.721、-6.987、-7.923、-7.922、-7.367，P<0.01）。结论情景模拟教学通过以解决大面积烧伤休克期液体复苏护理中实际问题为切入点，训练低年资护士临床实践操作能力和应变能力，从而提高低年资护士对大面积烧伤患者液体复苏护理临床实践操作的综合能力，提升其自信心和评判性思维能力。
- 烧伤 /
- 休克 /
- 情景模拟教学 /
- 液体复苏
Abstract: Objective To explore the effects of scenario simulation teaching of junior nurses in a burns department on the fluid resuscitation care of massive burn patients during shock stage. Methods From March 2018 to July 2019, 25 junior nurses fixed in the Department of Burn of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine met the inclusion criteria and were recruited in this prospective before-after self-control study, including 21 females and 4 males, aged 23 to 26 years. They had a work experience of 1.0 (1.0, 2.0) years in the Department of Burn. Three teaching scenarios were made according to the three major problems in the fluid resuscitation nursing of extensive burn patients during shock stage. The teaching plans were written based on the theoretical framework of Jeffrie's nursing simulation teaching. The high feasibility and practicability of the teaching plans was verified through expert consultation and evaluation by junior nurses. According to the three scenarios in the teaching plan, the junior nurses were performed with scenario simulation teaching, with 2 hours for each scenario, 6 hours in total. In one month before and after the teaching (hereinafter referred to as before and after teaching), the comprehensive ability of junior nurses was evaluated by the teachers using the self-designed junior nurse comprehensive ability evaluation scale, and their behaviors were evaluated by themselves with Performance Self-rating Scale for Nursing Students on High Simulation Training. Data were statistically analyzed with paired sample t test. Results After teaching, the scores on communication skills, patient admissions, condition assessments, fluid resuscitation, emergency treatment, drug management, nursing skills, instrument use, teamwork, and humanitarian care and total score in the comprehensive ability evaluation of junior nurses as evaluated by teachers were significantly higher than those before teaching (t=-8.060, -11.421, -17.232, -24.800, -4.670, -11.916, -12.131, -11.606, -14.632, -13.325, -25.068, P<0.01), with 4 items including fluid resuscitation, condition assessment, nursing skills, and equipment operation having higher scores. After teaching, the nurses' self-rating scores on communication, division of labor and cooperation, clinical decision-making, professional knowledge and skills, and professional development and critical thinking and total score were (4.6±0.4), (4.8±0.3), (4.6±0.3), (4.6±0.4), (4.6±0.4), and (23.2±1.5) points respectively, which were significantly higher than the corresponding scores of (4.1±0.7), (4.2±0.7), (3.9±0.5), (3.7±0.6), (3.9±0.5), and (18.8±2.6) points before teaching (t=-3.361, -5.721, -6.987, -7.923, -7.922, -7.367, P<0.01). Conclusions With solving the practical problems in nursing works of fluid resuscitation care of massive burn patients during shock stage as entry point, scenario simulation teaching aims to train the clinical practice ability and adaptability of junior nurses, thereby improving junior nurses' comprehensive ability of clinical practice in the fluid resuscitation care of massive burn patients during shock stage, enhancing their self-confidence and critical thinking ability.
- Burns /
- Shock /
- Scenario simulation teaching /
- Fluid resuscitation
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表1 情景模拟教学前后教师对25名低年资护士综合能力评价评分比较（分，x¯±s）

项目与总分	教学前1个月	教学后1个月	t值	P值
沟通能力	7.61±1.17	9.44±0.38	-8.060	<0.001
患者接收	6.89±1.27	9.46±0.47	-11.421	<0.001
病情评估	6.74±1.01	9.52±0.49	-17.232	<0.001
液体复苏	5.63±0.98	9.65±0.49	-24.800	<0.001
应急处理	7.42±2.30	9.46±0.40	-4.670	<0.001
药物使用	5.92±1.13	9.30±0.55	-11.916	<0.001
操作技能	7.00±1.06	9.50±0.32	-12.131	<0.001
仪器使用	7.49±0.88	9.50±0.32	-11.606	<0.001
团队合作	7.06±0.89	9.42±0.24	-14.632	<0.001
人文关怀	6.87±0.94	9.33±0.23	-13.325	<0.001
总分	68.63±6.49	94.58±2.01	-25.068	<0.001

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表2 情景模拟教学前后25名低年资护士自我行为评价评分比较（分，x¯±s）

各维度与总分	教学前1个月	教学后1个月	t值	P值
沟通交流	4.1±0.7	4.6±0.4	-3.361	0.003
分工合作	4.2±0.7	4.8±0.3	-5.721	<0.001
临床决策	3.9±0.5	4.6±0.3	-6.987	<0.001
专业知识和技能	3.7±0.6	4.6±0.4	-7.923	<0.001
专业发展和评判性思维	3.9±0.5	4.6±0.4	-7.922	<0.001
总分	18.8±2.6	23.2±1.5	-7.367	<0.001