临床儿科新护士评判性思维能力的培养
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摘要
如何培养高素质的护理人才是现代护理教育的当务之急。国内外的众多护理教育专家进行的不懈探索表明,评判性思维能力是高素质的护理人才必不可少的核心才能之一,培养评判性思维能力成为护理教育的关键目标和任务。临床学习是新护士成长的关键阶段,如何在临床环境中培养其评判性思维能力,是关系到护理专业能否持续良性发展的重要保证。
本课题的第一章是理论研究。在查阅国内外评判性思维理论与应用研究的文献资料基础上,运用理论研究、结构分析的方法,考察了评判性思维发展的简要历史、评判性思维的定义、构成要素、重要性、培养方法和评价方法,以达到对其本质的清晰认识。并对本研究中评判性思维的概念作了操作性定义,我们认为“护理学中的评判性思维是以护理目标为导向的,以护理专业知识、技能为基础,在护理实践过程中不断地作出合理的评估判断的自我调控的反思推理过程。”为下一步进行临床情境中新护士评判性思维能力培养试验提供理论基础。
第二章为评判性思维的实证研究:临床儿科新护士评判性思维能力的培养。采用定量研究中的随机对照试验方法并结合质性研究中的现象学方法进行。新护士按学历分层后随机分为试验组和对照组。观察培训时间为18个月,每6个月为一个培训阶段,分别轮转小儿内科、外科和门诊等临床科室。在第一阶段两组均进行常规培训,第二、三阶段中试验组学员除进行常规培训外分别给予了特殊培训课程和反思日记书写训练,对照组则进行常规培训。在试验期初、期中、期末采用“评判性思维能力量表”进行测评,并采用现象学研究中的观察、访谈和文字资料分析方法来描述学员的学习经历和个人经验。
结论与建议:本研究结论为儿科新护士评判性思维能力较弱,自然的临床学习环境不能促进儿科新护士评判性思维能力的增长,培训课程和反思日记书写可提高新护士评判性思维能力,并认为反思日记书写是目前较为简便易行的训练新护士评判性思维的有效方法。
本课题的研究为今后培养新护士评判性思维能力提供了可以借鉴的经验。
For many years, nursing educators around the world have been investigating strategies to train high quality nursing professionals. As a result, critical thinking has been considered as a core competency of the excellent nursing practice, and has become one of the pivotal tasks and outcomes of modern nursing education. Knowing how to training novice nurses in critical thinking ability in the clinical situation is important for both individual professional development and for the nursing profession in general. This study investigates this field and is composed of the following three chapters:
Chapter one,theory-based study. Information on critical thinking theory and application from home and abroad is reviewed. In particular, a theory-based study and structural analysis methodology was used: to review a brief history of critical thinking; to compose a definition of critical thinking; to understand the meaning of this definition; and, to learn how to cultivate and assess it. Based on a comprehensive understanding of critical thinking theory,“critical thinking of nursing”was defined in this study as“an outcome-directed, reasonable and reflective thinking and a self-regulatory judgment that is based on knowleges, skills and experience of nursing practice”. Information gained from this review of theory provided guidelines for the positivist study outlined in the next chapter.
Chapter two, positivist study: to train pediatric novice nurses to critical thinking in the clinical situation. A randomized control trail of quantitative research combined with a phenomenological approach of qualitative research was the method used in this study. 47 pediatric novice nurses were divided into two groups according to the educational background: a trail group and a control group. The novice nurses received 18 months of instruction based on normal hospital training guidelines; and included three 6-month phases ,during which novice nurses were equally trained in medical wards, surgical wards and outpatient department in turn. In the first phase, routine training was given for both the control and trial groups. During the second and the third phase, besides the same routine training program as the control group received, the trial group received special training courses built on the principles of critical thinking and journal writing. At the beginning , the middle and the end of the 18 months training period, all the participants were tested by Critical Thinking Disposition Inventory-Chinese Version(CTDI-CV). Results were analyzed by SPSS 12.0. Unobtrusive observation, in-depth interviews and writing materials were used to record the personal experiences of the participants in the clinical learning process.
Conclusion and suggestion: Pediatric novice nurses have weak critical thinking abilities. Further, results show that without purposeful training in critical thinking, normal clinical training does not increase this ability of novice nurses. We strongly recommended journal writing as a simple and effective training method to help novice nurses develop a capacity for critical thinking..
This study provides information which may help nursing educators to develop training programmes in critical thinking for novice nurses in the future.
本课题的第一章是理论研究。在查阅国内外评判性思维理论与应用研究的文献资料基础上,运用理论研究、结构分析的方法,考察了评判性思维发展的简要历史、评判性思维的定义、构成要素、重要性、培养方法和评价方法,以达到对其本质的清晰认识。并对本研究中评判性思维的概念作了操作性定义,我们认为“护理学中的评判性思维是以护理目标为导向的,以护理专业知识、技能为基础,在护理实践过程中不断地作出合理的评估判断的自我调控的反思推理过程。”为下一步进行临床情境中新护士评判性思维能力培养试验提供理论基础。
第二章为评判性思维的实证研究:临床儿科新护士评判性思维能力的培养。采用定量研究中的随机对照试验方法并结合质性研究中的现象学方法进行。新护士按学历分层后随机分为试验组和对照组。观察培训时间为18个月,每6个月为一个培训阶段,分别轮转小儿内科、外科和门诊等临床科室。在第一阶段两组均进行常规培训,第二、三阶段中试验组学员除进行常规培训外分别给予了特殊培训课程和反思日记书写训练,对照组则进行常规培训。在试验期初、期中、期末采用“评判性思维能力量表”进行测评,并采用现象学研究中的观察、访谈和文字资料分析方法来描述学员的学习经历和个人经验。
结论与建议:本研究结论为儿科新护士评判性思维能力较弱,自然的临床学习环境不能促进儿科新护士评判性思维能力的增长,培训课程和反思日记书写可提高新护士评判性思维能力,并认为反思日记书写是目前较为简便易行的训练新护士评判性思维的有效方法。
本课题的研究为今后培养新护士评判性思维能力提供了可以借鉴的经验。
For many years, nursing educators around the world have been investigating strategies to train high quality nursing professionals. As a result, critical thinking has been considered as a core competency of the excellent nursing practice, and has become one of the pivotal tasks and outcomes of modern nursing education. Knowing how to training novice nurses in critical thinking ability in the clinical situation is important for both individual professional development and for the nursing profession in general. This study investigates this field and is composed of the following three chapters:
Chapter one,theory-based study. Information on critical thinking theory and application from home and abroad is reviewed. In particular, a theory-based study and structural analysis methodology was used: to review a brief history of critical thinking; to compose a definition of critical thinking; to understand the meaning of this definition; and, to learn how to cultivate and assess it. Based on a comprehensive understanding of critical thinking theory,“critical thinking of nursing”was defined in this study as“an outcome-directed, reasonable and reflective thinking and a self-regulatory judgment that is based on knowleges, skills and experience of nursing practice”. Information gained from this review of theory provided guidelines for the positivist study outlined in the next chapter.
Chapter two, positivist study: to train pediatric novice nurses to critical thinking in the clinical situation. A randomized control trail of quantitative research combined with a phenomenological approach of qualitative research was the method used in this study. 47 pediatric novice nurses were divided into two groups according to the educational background: a trail group and a control group. The novice nurses received 18 months of instruction based on normal hospital training guidelines; and included three 6-month phases ,during which novice nurses were equally trained in medical wards, surgical wards and outpatient department in turn. In the first phase, routine training was given for both the control and trial groups. During the second and the third phase, besides the same routine training program as the control group received, the trial group received special training courses built on the principles of critical thinking and journal writing. At the beginning , the middle and the end of the 18 months training period, all the participants were tested by Critical Thinking Disposition Inventory-Chinese Version(CTDI-CV). Results were analyzed by SPSS 12.0. Unobtrusive observation, in-depth interviews and writing materials were used to record the personal experiences of the participants in the clinical learning process.
Conclusion and suggestion: Pediatric novice nurses have weak critical thinking abilities. Further, results show that without purposeful training in critical thinking, normal clinical training does not increase this ability of novice nurses. We strongly recommended journal writing as a simple and effective training method to help novice nurses develop a capacity for critical thinking..
This study provides information which may help nursing educators to develop training programmes in critical thinking for novice nurses in the future.
引文
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[4]陈保红. 评判性思维与护理教育[J]. 国外医学护理学分册. 1997,16(3):113-115
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