摘要
研究背景
护理学是一门实践性和应用性很强的综合学科,护理人员独特的工作环境和服务对象决定了其经常面临生物性伤害、物理性伤害、化学性伤害、心理社会性伤害,是发生针刺伤及感染经血液传播疾病、噪声辐射危害、职业性骨骼肌肉疾患、化学药物损害、工作场所暴力和心理疾患的高危职业群体。这些职业性危害因素不仅严重损害护理人员的身心健康,使其不能履行促进健康、预防疾病、协助康复的职责,同时给家庭和社会增加沉重负担。很多国家已充分认识到护理职业安全与健康的重要性,包括美国、英国在内的发达国家的护理院校陆续将护理职业安全与健康纳入课程设置中。国内护理职业安全与健康立法滞后、医疗机构中有关的管理制度不健全,防护设施用品供应不足,个人防护知识缺乏、防护意识淡漠、防护依从性差,就更加迫切需要相关教育。近年来,我国开始重视护理人员职业安全与健康的教育,很多医院开始对临床护士开展职业安全与健康专题培训,极少数护理院校也开始进行实习前培训,但时间短,内容单一,教学内容、教学方法、教学评价等方面缺乏深入研究。因此,本研究通过调查护理高职生职业安全与健康知识、态度、行为及培训需求,同时结合焦点团体访谈法征询护理教育及临床护理专家意见,编制、实施并评价“护理职业安全与健康”课程,探索提高护理高职生职业安全与健康知识、态度和行为的有效途径,最终为完善护理高职教育课程体系提供参考依据。
目的
了解护理高职生职业安全与健康知识、态度、行为和教育现况及培训需求,编制适应于护理高职生的职业安全与健康课程；开展护理职业安全与健康的课程教学并评价效果,从而为完善护理高职教育课程体系,深入开展护理职业安全与健康的课程教学提供有效依据。
方法
(1)采用问卷法调查979名浙江医学高等专科学校有临床实习经历的护理高职生的职业安全与健康的知信行及教育现况和需求；
(2)采用焦点团体访谈法征询8名杭州市临床护理和护理教育专家对“护理职业安全与健康”的课程编制的建议；根据课程编制的理论和原则、护理职业安全与健康教育相关文献、知信行和教育需求的调查结果以及专家焦点团体访谈结果编制“护理职业安全与健康”课程；
(3)开设“护理职业安全与健康”课程,组建教师队伍,以浙江医学高等专科学校的部分高职生护理0845班～护理0848班护生(113人)为试验组进行18学时的系统教学；护理0841班～护理0844班护生(104人)为对照组根据教学材料自学；结束后两组护生均进行理论知识、态度、技能方面的测试,同时试验组护生完成课程反馈评价表。
结果
1.护理高职生职业安全与健康的知信行及教育需求的调查
调查结果显示：护理职业安全与健康知识的平均得分为56.25±10.78(百分制)；态度的平均得分为4.57±0.38(5分制)；行为的平均得分为3.89±0.50(5分制)；绝大部分护生愿意参加课程学习,只有9人(0.9%)表示不愿意参加相应课程学习。
2.“护理职业安全与健康”课程的编制
焦点团体访谈法明确了在护理高职生中开设“护理职业安全与健康”课程的必要性、课程目标、教学内容、教学方法以及课程评价方式；编制了适应于护理高职生的职业安全与健康课程。
3.“护理职业安全与健康”课程的实施和评价
(1)干预前两组护生的一般资料、护理职业安全与健康的知识、态度无统计学差异(p>0.05)；
(2)干预后两组护生护理职业安全与健康的知识、态度水平都较干预前提高(p<0.001)；
(3)干预后试验组护生护理职业安全与健康的理论考试得分、知识问卷得分均高于对照组(p<0.001)；
(4)干预后两组护生的态度得分差别无统计学意义(p>0.05)
(5)干预后试验组护生职业安全与健康技能考核得分高于对照组(p<0.001)：
(6)课程反馈评价表结果提示：护生认为该课程内容理论联系临床实践,绝大多数护生对课程结构、课时安排、教学内容、考核方式满意,但对教学方法和参考资料的提供方面提出改进意见。
结论
1.护理高职生关于护理职业安全与健康的知识缺乏,态度虽然比较重视但仍有不足,没有采用足够的安全行为,对其身心健康构成威胁,亟待进行系统的培训教育；
2.“护理职业安全与健康”课程有开设的必要性,课程目标应体现导向性和实用性,内容安排要有系统性和全面性,教学兼有灵活性和连续性,课程评价要注重有效性和多元性；
3.系统的“护理职业安全与健康”课程教育能够提高护理高职生的知识、态度和技能水平。
Background
Nursing is a practical and applicable discipline, its unique working environment and the clients of service determine that the nursing staff often face biological harm, physical harm, chemical harm and psychological social harm, and they are at high risks of needle stick injuries and infections transmitted through blood, the noise or radiation hazards, occupational musculoskeletal disorders and drug damages, workplace violence and psychological disorders. Those occupational hazards not only do serious harm to the health of nursing staff, hinder them to help patients, but also increase the burden on families and the state. Many countries have realized the importance of occupational safety and health (OSH), and many developed countries including the United States and Britain, developed the curriculum of OSH in nursing colleges. Because of the laggard legislation of nursing occupational precaution, the defective administration of medical institutions, lacking of protection facilities and personal shortage of knowledge, positive attitude and protective behaviours in domestic, nursing staff urgently need nursing occupational safety and health (NOSH) education. China began to pay attention to NOSH education recently, many hospitals began to train their clinical nurses about NOSH in some special fields, and very few nursing colleges trained students before their clinical practice. But its research and practice is on beginning period, the content is more onefold, and the curriculum development needs further research.
Objective
To investigate the basic situation of knowledge, attitude and practice (KAP) and related education demands about NOSH of nursing students; to develop NOSH curriculum by focus group interview; and to implement systematic NOSH curriculum for some nursing students and evaluate the effectiveness. It can improve nursing education curriculum system and provide systematic NOSH curriculum for the future.
Methods
1. To investigate the basic situation of knowledge, attitude and practice (KAP) and related education demands about NOSH of 979 nursing students who have had 4 months clinical practice in Zhejiang medical college by questionnaire;
2. To gain NOSH curriculum construction by focus group interview from 8 clinical nursing and nursing education experts in Hangzhou third-level hospitals; and develop NOSH curriculum according to the curriculum theories and principles, documentary analysis and the result of KAP and demands investigation and focus group interview;
3. To perform a controlled educational intervention for some nursing students of Zhejiang medical college. Students in class 0845～0848 were at the experimental group (n=113), who attended 18 hours NOSH curriculum, while students in class 0841～0844 were at the control group (n=104), who learned teaching material themselves. Both experimental and control group students were surveyed NOSH theoretical knowledge, attitude and skills immediately after the intervention. In addition, the experimental group was given curriculum feedback questionnaires to show their evaluation on teaching process and effectiveness.
Results
1. The survey on nursing students'KAP and education demands of NOSH.
The average score on knowledge, attitude and practice is 56.25±10.78 (hundred-mark system),4.57±0.38 (5 points is the full marks) and 3.89±0.50 (5 points is the full marks) respectively. Most students are willing to attend this course, only 9 students (0.9%) say no.
2. The study on nursing occupational safety and health curriculum development.
It is important to open NOSH curriculum. The main objective, contents, teaching and evaluation methods were identified by focus group interview.
3. The study on implementation and evaluation of NOSH curriculum.
1) Before the intervention, two groups of students'general information and KAP of NOSH have no statistically significant difference (p> 0.05);
2) After the intervention, both group students'scores of knowledge and attitute are higer than before (p<0.001);
3) After the intervention, experimental group students'theory exam scores and scores of knowledge questionnaires are higher than those in the control group (p<0.001);
4) After the intervention, both group students'scores of attitude have no statistically significant difference (p> 0.05);
5) After the intervention, experimental group students'skill exam scores are higher than those in the control group (p<0.001);
6) After the intervention, the result of curriculum feedback questionnaires shows that students think NOSH curriculum are very helpful. Most of students are satisfied with course structure, scheduling, teaching contents and methods of evaluation, but they put forward constructive suggestions on teaching methods and references.
Conclusion
1. Nursing students are short of knowledge, positive attitude, protection behaviors. Their safety and health are threatened, and educators need to implement effective strategies to provide systematic training and education;
2. NOSH curriculum should be conducted, the curriculum goal should reflect orientation and practicability, the content must be systematic and comprehensive, teaching should be flexible and continuous, evaluation methods should be more effective and diversity.
3. Systematic NOSH curriculum can improve nursing students' knowledge, attitude and practical skills.
引文
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[1]李映兰.现代护士职业安全[M].长沙：湖南科学技术出版社,2004：1.
[2]魏丽丽.护理职业防护管理[M].北京：军事医学科学出版社,2006：6-10.
[3]宋亦男,李红.护理人员职业环境危害因素的研究进展[J].国际护理学杂志,2007,26(1)：6-9.
[4]Nhiwatiwa FG. The effects of single session education in reducing symptoms of distress following patient assault in nurses working in medium secure settings[J]. J Psychiatr Ment Health Nurs,2003,10(5):561-568.
[5]Whitaker S, Wynn P, Williams N. Occupational health teaching for pre registration nursing students[J]. Nurse Educ Today,2002,22(2):152-158.
[6]Menzel NN, Hughes NL, Waters T, et al. Preventing musculoskeletal disorders in nurses:a safe patient handling curriculum module for nursing schools[J]. Nurse Educ,2007,32(3):130-135.
[7]柯永红,杜丹丹,陈靖.开设护士职业防护课程的思考[J].护士进修杂志,2003,18(7)：605-606.
[8]陈炼红.卫校护理职业防护教育现状调查[J].实用预防医学,2004,11(2)：406-408.
[9]朱秋群.在护基教学中加强针刺伤教育的思考[J].护士进修杂志,2007,22(6)：542-543.
[10]Yang YH, Liou SH, Chen CJ, et al. The effective of a training program on r educing needlestick injuries/sharp object injuries among soon graduate voca tional nursing school students in southern Taiwan[J]. J Occup Health,2007,4 9:424-429.
[11]吴莉,张冬梅.实习护士生职业暴露血源性疾病防护的调查[J].职业与健康,2007,23(15)：1294-1296.
[12]周惠,聂岚.牛瑞丽.护生标准预防及职业防护专项实践教育研究[J].护士进修杂志,2006,21(10)：890-892.
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