高仿真模擬教學(xué)在護(hù)理實(shí)習(xí)生臨床推理教學(xué)中的應(yīng)用效果

羅嶠茜

[摘要] 目的 探討高仿真模擬教學(xué)在臨床推理教學(xué)中的應(yīng)用效果。 方法 采用方便取樣法選取武漢市一所三甲醫(yī)院2017年6月～2018年5月護(hù)理實(shí)習(xí)生72名為研究對(duì)象，并按照隨機(jī)數(shù)字表法將其分為實(shí)驗(yàn)組和對(duì)照組。實(shí)驗(yàn)組采用高仿真模擬教學(xué)輔助臨床推理課程，對(duì)照組采用傳統(tǒng)教學(xué)方法教授臨床推理課程，兩組均為期1個(gè)月。分別在課程開(kāi)始前、課程結(jié)束以及課程結(jié)束3個(gè)月后對(duì)兩組臨床推理能力進(jìn)行評(píng)價(jià)，使用自制的調(diào)查問(wèn)卷調(diào)查其對(duì)臨床推理課程教學(xué)效果進(jìn)行評(píng)價(jià)。 結(jié)果 教學(xué)前，兩組臨床推理能力評(píng)分比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P < 0.01）;教學(xué)后，兩組的臨床推理能力評(píng)分均較教學(xué)前顯著提升，且實(shí)驗(yàn)組明顯高于對(duì)照組（P < 0.01）。實(shí)驗(yàn)組在專科護(hù)理知識(shí)、護(hù)理操作能力、團(tuán)隊(duì)合作能力、溝通交流能力四個(gè)方面的評(píng)分均高于對(duì)照組（P < 0.01）。 結(jié)論 在護(hù)理教學(xué)中應(yīng)用高仿真模擬教學(xué)可以模擬臨床情況，從而為學(xué)生創(chuàng)造一個(gè)安全、持續(xù)、高效的學(xué)習(xí)環(huán)境，可以有效提高學(xué)生的臨床推理能力。

[關(guān)鍵詞] 臨床推理;高仿真模擬教學(xué);護(hù)理教育;臨床教師;護(hù)理實(shí)習(xí)生

[中圖分類號(hào)] R47-4;G712? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-7210（2019）06（b）-0173-05

Application effect of high-fidelity simulation teaching in nursing clinical reasoning education of nursing students

LUO Qiaoqian

VIP Ward of General Medical Department， Zhongnan Hospital of Wuhan University， Hubei Province， Wuhan? ?430071， China

[Abstract] Objective To explore the application effect of high-fidelity simulation teaching in clinical reasoning teaching. Methods A total of 72 nursing interns from June 2017 to May 2018 in a third-class A hospital in Wuhan were selected by convenient sampling method. They were divided into experimental group and control group according to random number table method. The experimental group used high-fidelity simulation teaching to assist clinical reasoning courses， and the control group used traditional teaching methods to teach clinical reasoning courses. Both groups were for one month. The clinical reasoning ability of two groups were evaluated before the start of the course， at the end of the course， and three months after the end of the course. The self-made questionnaire was used to evaluate the teaching effect of the clinical reasoning course. Results Before the teaching， the scores of clinical reasoning ability were not significantly different between the two groups （P < 0.01）. After the teaching， the scores of clinical reasoning ability of the two groups were significantly higher than those before the teaching， and the experimental group was significantly higher than the control group （P < 0.01）. The scores of the experimental group in the four aspects of specialist nursing knowledge， nursing operation ability， team cooperation ability and communication ability were higher than those of the control group （P < 0.01）. Conclusion The application of high-fidelity simulation teaching in nursing teaching can simulate the clinical situation， thus creating a safe， continuous and efficient learning environment for students， and can effectively improve their clinical reasoning ability.

[Key words] Clinical reasoning; High-fidelity simulation teaching; Nursing education; Clinical teacher; Nursing students

臨床推理的相關(guān)研究在國(guó)外已經(jīng)開(kāi)展了30多年，是醫(yī)療研究的一個(gè)重要內(nèi)容，也是提供高質(zhì)量護(hù)理服務(wù)的關(guān)鍵因素。Levett-Jones等[1]將臨床推理定義為“護(hù)士和其他臨床工作人員收集線索、處理信息、了解患者問(wèn)題或情況、計(jì)劃和實(shí)施干預(yù)、評(píng)估結(jié)果、反思和從過(guò)程中學(xué)習(xí)的邏輯過(guò)程”。臨床推理在護(hù)理實(shí)踐中有著重要的地位[2]。然而，剛畢業(yè)的護(hù)士可能缺乏提供安全、有效的患者護(hù)理的臨床推理技能[3]。這種情況下，提高護(hù)理實(shí)習(xí)生的臨床推理能力就顯得尤為重要。

高仿真模擬教學(xué)是指通過(guò)計(jì)算機(jī)控制模擬人、虛擬現(xiàn)實(shí)系統(tǒng)或標(biāo)準(zhǔn)化患者等臨床真實(shí)情境，使學(xué)習(xí)者身臨其境，在和模擬患者進(jìn)行全面互動(dòng)的過(guò)程中展現(xiàn)臨床護(hù)理過(guò)程、決策和評(píng)判性思維的教學(xué)活動(dòng)[4]。……