Prospective study on application of mind mapping combined with scenario simulation training on the ability training of junior nurses in hospital transfer of patients with critical burns and trauma
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摘要:
目的 探讨思维导图联合情景模拟训练在低年资护士的院内危重烧创伤患者转运能力培训中的应用效果。 方法 采用前瞻性随机对照研究方法。2019年12月—2020年12月，将陆军军医大学（第三军医大学）第一附属医院全军烧伤研究所符合入选标准的55名女性低年资护士纳入本研究，按照随机数字表法，将其分为常规组［27名，年龄（24.0±0.9）岁］和联合组［28名，年龄（24.2±0.8）岁］。采用理论与操作技能相结合的方式对常规组护士进行院内危重烧创伤患者转运培训，采用思维导图联合情景模拟训练的方式对联合组护士进行院内危重烧创伤患者转运培训。培训前、后，均采用自制理论考卷和技能考核项目对护士进行考试和考核，统计并比较其得分；均采用自制应急能力评分系统对护士的团队协作能力、应急反应能力、操作技术能力、专科业务能力、护患沟通能力5个维度的应急处置能力进行考核评估，统计并比较其得分。统计并比较培训前后护士在转运危重高仿真模拟人（以下简称模拟人）过程中，物品准备不全、患者沟通效果不佳、管道护理不到位、交接不清、终末处理不到位的转运护理措施执行不规范率；统计并比较培训后模拟人转运病情变化率及转运成功率。考核后，采用自制满意度调查问卷调查并比较护士对培训模式、培训内容、培训效果的满意度。对数据行独立样本 t检验、Pearson χ 2检验或Yates矫正 χ 2检验。 结果 纳入的55名护士均全程参与培训、考试、考核及调查问卷的填写。培训前，2组护士理论考试及技能考核得分比较，差异均无统计学意义（ P>0.05）；培训后，联合组护士理论考试及技能考核得分均明显高于常规组（ t值分别为-3.89、-4.24， P<0.05）。培训前，2组护士应急处置能力各维度考核得分比较，差异均无统计学意义（ P>0.05）；培训后，联合组护士的团队协作能力、应急反应能力、操作技术能力、专科业务能力、护患沟通能力得分均明显高于常规组（ t值分别为-6.49、-6.44、-2.21、-2.85、-2.34， P<0.05）。培训前，2组护士转运护理措施执行不规范率比较，差异均无统计学意义（ P>0.05）；培训后，联合组护士的物品准备不全、交接不清、终末处理不到位的不规范率均明显低于常规组（ t值分别为3.87、5.89、5.28， P<0.05）。培训后，联合组护士的模拟人转运病情变化率为7.14%（2/28），明显低于常规组的33.33%（9/27）， χ 2=5.89， P<0.05；转运成功率为96.43%（27/28），明显高于常规组的74.07%（20/27）， χ 2=3.87， P<0.05。考核后，联合组护士对培训满意度的总得分及对培训模式、培训效果满意度的得分均明显高于常规组（ t值分别为5.22、4.67、10.71， P<0.05）；2组护士对培训内容的满意度得分比较，差异无统计学意义（ P>0.05）。 结论 基于循证基础的思维导图联合情景模拟训练显著提高了低年资护士的转运危重烧创伤患者护理技能及应急处置能力。 Abstract:Objective To explore the application effects of mind mapping combined with scenario simulation training on the ability training of junior nurses in hospital transfer of patients with critical burns and trauma. Methods A prospective randomized controlled study was conducted. From December 2019 to December 2020, 55 female junior nurses from the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University) who met the inclusion criteria were enrolled in this study and divided into routine group (27 nurses, aged (24.0±0.9) years) and combined group (28 nurses, aged (24.2±0.8) years), according to the random number table. The nurses in routine group were trained with hospital transfer of patients with critical burns and trauma by theory combined with operational skill, and the nurses in combined group were trained with hospital transfer of patients with critical burns and trauma by mind mapping combined with scenario simulation training. Before and after the training, the self-made theoretical examination papers and skill assessment items were used for the examination and assessment to nurses, and their scores were calculated and compared. The self-made emergency ability scoring system was used to evaluate the emergency disposal ability of nurses from five dimensions, including team cooperation ability, emergency response ability, operative technique ability, specialized business ability, and nurse-patient communication ability, and their scores were calculated and compared. The non-standard implementation rates of transfer nursing measures, such as incomplete preparation of goods, poor communication effect of patients, inadequate pipeline nursing, unclear handover, and inadequate final treatment, were calculated and compared in the process of transporting highly simulated human (hereinafter referred to as simulated human) by nurses before and after training; and the rate of disease change and successful rate of transport of simulated human were calculated and compared after training. After assessment, self-made satisfaction questionnaire was used to compare nurses' satisfaction with the training mode, content, and effects. Data were statistically analyzed with independent sample t test, Pearson chi-square test, or Yates corrected chi-square test. Results Fifty-five enrolled nurses were fully involved in the training, examination, assessment, and questionnaire filling. Before training, there were no statistically significant differences in theoretical examination and skill assessment scores between the 2 groups ( P>0.05); After training, the theoretical examination and skill assessment scores of nurses in combined group were significantly higher than those in routine group (with t values of -3.89 and -4.24, respectively, P<0.05). Before training, there were no statistically significant differences in the scores of each item of emergency disposal ability between the 2 groups ( P>0.05); after training, the scores in terms of team cooperation ability, emergency response ability, operative technique ability, specialized business ability, and nurse-patient communication ability of nurses in combined group were significantly higher than those in routine group (with t values of -6.49, -6.44, -2.21, -2.85, and -2.34, respectively, P<0.05). Before training, there were no statistically significant differences in the non-standard implementation rates of transfer nursing measures of nurses between the 2 groups ( P>0.05); after training, the non-standard rates of incomplete preparation of goods, unclear handover, and inadequate final treatment of nurses in combined group were significantly lower than those in routine group (with t values of 3.87, 5.89, and 5.28, respectively, P<0.05). After training, the rate of disease change of simulated human of nurses in combined group was 7.14% (2/28), which was significantly lower than 33.33% (9/27) in routine group ( χ 2=5.89, P<0.05); the successful rate of transport was 96.43% (27/28), which was significantly higher than 74.07% (20/27) in routine group ( χ 2=3.87, P<0.05). After assessment, the total score of training satisfaction and scores of satisfaction with training mode and training effect of nurses in combined group were significantly higher than those in routine group (with t values of 5.22, 4.67, and 10.71, respectively, P<0.05). There was no statistically significant difference in the satisfaction score on training content between the two groups ( P>0.05). Conclusions Evidence-based mind mapping combined with scenario simulation training significantly improves the nursing skills and emergency handling capabilities of junior nurses in transferring patients with critical burns and trauma. -
Key words:
- Burns /
- Nurses /
- Evidence-based nursing /
- Critical care nursing /
- Low seniority nurses /
- Mind mapping /
- Scenario simulation
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参考文献
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表1 2组护士培训前后理论和技能考核得分比较（分，
组别 人数 培训前 培训后 理论考试 技能考核 理论考试 技能考核 联合组 28 74±4 88.9±4.0 90±4 94.8±3.1 常规组 27 72±5 87.3±2.6 85±4 91.3±2.6 t值 -1.26 -1.63 -3.89 -4.24 P值 0.210 0.104 <0.001 <0.001 注：联合组采用思维导图联合情景模拟训练的培训方式，常规组采用理论与操作技能相结合的培训方式 
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表2 2组护士培训前后应急处置能力各维度考核得分比较（分，
组别 人数 培训前 培训后 团队协作能力 应急反应能力 操作技术能力 专科业务能力 护患沟通能力 团队协作能力 应急反应能力 操作技术能力 专科业务能力 护患沟通能力 联合组 28 10.4±1.3 9.4±1.4 13.1±1.3 11.0±1.1 11.3±0.8 16.8±1.3 15.8±1.2 18.1±0.9 16.4±1.1 15.9±0.7 常规组 27 10.2±1.3 9.1±1.1 13.3±1.1 11.2±1.0 11.3±0.8 13.0±1.0 12.2±1.3 17.3±1.4 15.5±1.1 15.4±0.8 t值 -0.55 -0.62 -0.48 -0.76 -0.12 -6.49 -6.44 -2.21 -2.85 -2.34 P值 0.581 0.534 0.630 0.448 0.907 <0.001 <0.001 0.027 0.004 0.019 注：联合组采用思维导图联合情景模拟训练的培训方式，常规组采用理论与操作技能相结合的培训方式
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表3 2组护士培训前后在转运危重高仿真模拟人过程中转运护理措施执行不规范率比较[名（%）]
组别 人数 培训前 培训后 物品准备不全 患者沟通效果不佳 管道护理不到位 交接不清 终末处理不到位 物品准备不全 患者沟通效果不佳 管道护理不到位 交接不清 终末处理不到位 联合组 28 8（28.57） 7（25.00） 8（28.57） 14（50.00） 15（53.57） 1（3.57） 1（3.57） 1（3.57） 2（7.14） 3（10.71） 常规组 27 10（37.04） 10（37.04） 7（25.93） 14（51.85） 14（51.85） 7（25.93） 3（11.11） 3（11.11） 9（33.33） 10（37.04） χ 2值 0.45 1.55 0.05 0.01 0.02 3.87 0.31 0.31 5.89 5.28 P值 0.504 0.214 0.826 0.912 0.898 0.049 0.577 0.577 0.015 0.022 注：联合组采用思维导图联合情景模拟训练的培训方式，常规组采用理论与操作技能相结合的培训方式
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表4 2组护士对培训满意度的比较（分，
组别 人数 培训模式 培训内容 培训效果 总得分 联合组 28 23.9±0.4 22.9±0.3 24.6±0.5 73.3±1.4 常规组 27 19.5±1.0 21.8±0.4 18.5±0.9 64.2±4.2 t值 5.22 0.81 4.67 10.71 P值 <0.001 0.416 <0.001 <0.001 注：联合组采用思维导图联合情景模拟训练的培训方式，常规组采用理论与操作技能相结合的培训方式
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