BACKGROUND:Debriefing is the essential element of simulation teaching. Peer-led structured debriefing simulations could be a suitable approach because of the peers' similarity in age and experience to the students. The purpose of this study was to compare the teaching effectiveness of peer-led debriefing versus instructor-led debriefing in high-fidelity simulation scenarios. METHODS:The study used a mixed-method approach, integrating quasi-experimental and qualitative components. A total of 88 third-year nursing students were randomly distributed into the instructor-led or peer-led group, with equal sample sizes in both cohorts. The study compared knowledge acquisition, simulation performance, student satisfaction and self-confidence in learning, and debriefing experience between the two groups. In addition, interviews were conducted with students in the peer-led group after the course. RESULTS:The scores of students' simulation performance scale were higher in the peer-led group than in the instructor-led group, and both groups made significant gains in knowledge. The peer-led group and instructor-led group demonstrated similar performance in terms of knowledge, simulated performance, reporting experience, student satisfaction, and learning confidence. The semi-structured interview results indicated that students in the peer-led group expressed approval of peer facilitators. CONCLUSIONS:Our study demonstrated that students in the peer-led group showed better performance in the simulation, and both groups demonstrated improved knowledge. Thus, with the premise of peers receiving training, the peer-led simulation teaching method can be regarded as a supplementary strategy for simulation teaching to enrich the form of simulation teaching and improve the effectiveness of simulation teaching.

Background Fear-of-pain is a common feeling of patients and their family who experience or witness severe or chronic pain. Fear-of-pain may disturb patient's recovery, and also influence family support to assist patients' recovery. Aim This study is to measure the level of family support for each patient; evaluate the extent of the supporting families' fear-of-pain; and identify possible interventions in family support and family fear-of-pain. Methods This cross-sectional descriptive research involved 77 participants in the orthopedics department of a tertiary hospital by convenience sampling. The online questionnaire includes general information, and scales of fear-of-pain, pain anxiety, pain vigilance and awareness, pain catastrophizing, and family support. T-test, Pearson correlation analysis and Spearman correlation analysis were used to analyze data. Results Most participants reported that they experienced a moderate-to-high level of fear-of-pain, pain anxiety, pain vigilance and awareness. A total of 15.6% of participants are at risk of pain catastrophizing. The family's pain vigilance and awareness, and fear-of-pain were often similar to those of the patient, and their levels of pain anxiety and catastrophizing were often higher than the patient's. Family support and families' fear-of-pain affect patients' feelings of pain and families' behavior in decision-making for patient recovery, necessitating the development of interventions for patients' families. Conclusions Family members can develop the fear-of-pain from witnessing painful experiences and may exhibit fear-avoidance behaviors in deciding on patients' rehabilitation plan. Family support, including the type of relationship with families, and length of time family spent with the patient, had an effect on patients' pain and fear-of-pain.

Background The Debriefing Experience Scale (DES) is a tool that is used to explore nursing students’ subjective experiences during a debriefing and to help determine best debriefing practices. A Chinese version of the scale has not been found; its development can enhance learning in simulation activites in Chinese healthcare education programs. Methods A simplified Chinese version of the DES was developed and tested using 34 Chinese undergraduate (second year) nursing students. They participated in six simulation scenarios and debriefings. Eight experts were consulted to determine the content validity of the scale. Critical ratio method, Cronbach’s alpha, intraclass correlation coefficient, correlation coefficient and factor analysis were used in testing the psychometric properties of the scale. Results Analysis of 200 scales showed that the simplified Chinese version of the DES had good potential in discriminatiing Chinese nursing students’ experiences of debriefing. Conclusions The simplified Chinese DES was effective in evaluating the experience of debriefing. A larger sample size and multicenter research is needed to confirm these findings.

AIM:This study aimed to illustrate the relationship between nurse staffing and missed care, and how missed care affects quality of care and adverse events in Thai hospitals.BACKGROUND:Quality and safety are major priorities for health care system. Nurse staffing and missed care are associated with low quality of care and adverse events. However, examination of this relationship is limited in Thailand.METHODS:This cross-sectional study collected data from 1188 nurses in five university hospitals across Thailand. The participants completed questionnaires that assessed the patient-to-nurse ratio, adequacy of staffing, missed care, quality of care and adverse events. Logistic regression models were used to estimate associations.RESULTS:Higher patient-to-nurse ratio, poor staffing and lack of resource adequacy were significantly associated with higher odds of reporting missed care. Higher nurse-reported missed care was significantly associated with higher odds of adverse events and poor quality of care.CONCLUSIONS:Poor nurse staffing was associated with missed care, and missed care was associated with adverse events and lower quality of care in Thai university hospitals.IMPLICATIONS FOR NURSING MANAGEMENT:Improving nurse staffing and assuring adequate resources are recommended to reduce missed care and adverse events and increase quality of care.

Background Although simulated teaching was introduced to China in the 1990s, it remains underused in nursing education. Determining how Chinese nurse educators feel about using simulation in their institutions is very important for faculty training and has the potential to influence simulation implementation. Method This cross-sectional descriptive study was undertaken to identify the nurse educators’ experiences in the use of simulation from various regions of China. One hundred and thirty-six nurse educators provided demographic data and information about simulation implementation within their institutions and explored the perceived barriers and benefits of simulation usage. Results The survey data shows that 108 participants have used simulation in their work, but less than 92 (67.6%) of the respondents had used this teaching strategy more than ten times in last year. The study identified four factors hindering nurse faculty from simulation adoption: (1) concerns with student readiness; (2) the need for faculty team-building for simulation teaching; (3) lack of adequate simulation resources; and (4) thoughtful integration of simulation into nursing curricula. Conclusions Study data suggest that faculty training programs for simulation should be based on the nurse educators’ training needs, including systematically designed training topics, and the provision of hands-on learning simulation activities with expert feedback to help nurse educators achieve the competencies required for effective simulation-based education.

Objective:To analyze the implementation of evidence-based nursing indicators for deep open wound pain management and its difficulties.Methods:From May to October 2018 at Department of Traumatology and Orthopaedics, Nanfang Hospital, 2 nurses were selected by objective sampling and 20 patients with deep open wound by convenient sampling. According to the 13 best practices in nursing guidelines for pain management, we formulated a no-pain dressing change program for deep open wounds on the basis of the research evidence in wound care and pain management. After the program was implemented, its effect on pain relief was evaluated. Practical Application of Clinical Evidence System (PACES) and software GRiP were used to evaluate the whole implementation process. IBM SPSS 21.0 was used to analyze the pain scores before and after implementation.Results:The results of PACES showed that the implementation rate of best practices by the 2 nurses increased significantly during the project period and remained at a reasonable level one month after the project. The patients＇ pain scores before dressing were 3.2±2.3 and 3.5±1.2 at the baseline evaluation and the follow-up evaluation 1, respectively; the pain scores during dressing at the base evaluation and the subsequent evaluation 1 were 5.4±2.3 and 4.2±2.4. The effect of implementation of evidence-based nursing indicators for deep open wound pain management on pain relief was significant ( P<0.05). Conclusions:This project improved the implementation rate of the best pain management practices in dressing change for deep open wounds, but the implementation encountered difficulties in interdisciplinary cooperation and organizational structure. This study may provide a reference for other evidence-based nursing projects aiming at transforming evidence-based nursing guidelines into clinical practice.

模拟教学中,导师的引导能力是模拟教学效果的保证.该文旨在通过解读国际护理临床模拟教学协会(International Nursing Association of Clinical Simulation Learning,INACSL)发表的《国际护理临床模拟教学协会最佳实践标准:模拟引导》中的主要标准,详细阐述引导对模拟教学导师知识技能的要求、引导方法的选择、引导的内涵和目的以及引导中应注意的问题,为广大护理模拟教学导师提供参考.

将模拟教学运用于医学跨专业教育可以促进多学科团队沟通、协作,改善患者健康结局.该文结合当前模拟强化跨专业教育的研究,立足于国际护理临床模拟教学协会的最佳实践标准,综述模拟跨专业教育的研究进展,为护理领域的跨学科专业教育提供参考.

学员评价是所有教学当中的必备环节,不仅是对学生学习效果的评价,也能作为教学的间接反馈促进教学相长.该文从教学及模拟教学的背景出发,根据国际护理临床模拟教学协会最佳实践标准中的学员评价标准,对护理模拟教学中实施学员评价的全过程和质量把控环节进行了评价叙述,望能提高我国护理模拟教学中学员评价的标准化实施,并为制订我国的模拟教学标准提供参考,进一步促进护理模拟教学的高质量发展和提高护理专业教学质量.

目的 探讨情境模拟教学方法在急危重症护理学课程教学中的应用效果.方法 在2015级57名护理学本科学生中应用基于动态案例的情境模拟教学方法.通过课程考核成绩评价教学效果,同时采用自设问卷调查学生对该教学方法的认可情况.结果 学生总成绩为(82.36±4.06)分,93.0％的学生对教学组织安排表示满意,认为可促进急救技能的掌握(96.5％),91.3％的学生认为可优化学习行为,加强团队协作(93.0％)及创新(79.0％)和应变能力(93.0％)的培养.结论 基于动态案例设计的情境模拟教学方法能激发学生的学习兴趣,有助于提高临床急救意识和综合能力,提高教学效果.

ABSTRACT Objectives: The aim of this project was to implement best practice in pain relief during wound care for patients with deep open wounds in the orthopedic trauma department of a tertiary teaching hospital in China. Introduction: Patients with deep open wounds often suffer from severe pain during wound care. Inadequate pain relief for these patients calls for evidence-based changes to close the gap between current and best practice. Methods: The current quality improvement project was carried out over six months using the JBI Practical Application of Clinical Evidence System (JBI PACES). A baseline and two follow-up audits of wound pain management practice were conducted to identify practice gaps and post implementation compliance in pain management in wound care. The sample comprised 20 patients and two dressing nurses. The Getting Research into Practice tool identified barriers to and strategies for improvement in practice. The patients’ pain experiences were measured following the implementation of changes. Results: The baseline audit identified poor compliance with best practice. Following implementation of the recommended changes, some significant improvements in practice were made by the dressing nurses; however, these were inadequately maintained at the second post implementation audit. Patients’ pain scores improved following the nurses’ practice changes (t = 2.272, P > 0.05). Conclusion: The implementation of best practice in pain relief during wound care for patients with deep open wounds has led to significant improvement in nurses’ performance in the orthopedic trauma department. The most challenging barriers involved interdisciplinary collaborations and organizational structure.

目的 调查分析中青年肠造口人性生活现状及其影响因素,为肠造口人性生活质量干预提供参考依据.方法 选取市内多所三甲医院121例中青年肠造口人,采用自编的一般资料调查问卷,亚利桑那州性体验量表(ASEX)、社会影响量表(SIS)及中文版造口患者自我效能量表(SSES)进行问卷调查.结果中青年肠造口人性体验得分为(21.34 ±6.074)分,性功能异常者有70 例(57.9%);患者性功能异常症状依次体现在性驱动(4.76 ±1.155)、性觉醒(4.45 ±1.291)、性高潮能力(4.15 ±1.333)、阴道润滑/阴茎勃起(4.09 ±1.402)、性高潮满意(3.89 ±1.454);患者性体验的影响因素包括家庭关系、性生活指导、家庭所在地、年龄、病耻感及自我效能(P＜0.05).结论 中青年肠造口人性问题突出,且受家庭关系、性生活指导、家庭所在地、年龄、病耻感及自我效能的影响.医护人员需重点关注中青年肠造口人的性生活问题,加强性教育,强调家属参与和同辈教育,帮助患者建立正确的价值观和性爱观,改善性生活应对状态,促进幸福感的获得,改善生活质量.

模拟教学在当代"以学生为中心"的护理教育中展现出越来越重要的作用 ,但是对于如何实现高质量的模拟教学效果是广大护理教育工作者共同关注的问题 . 国外专家认为 ,模拟教学不仅仅是要实现护理技能的训练 ,更重要的是形成护理思维和促进"有意义的学习" [1] ,而"模拟教学中的心脏与灵魂"就是引导性反馈[2] . 引导性反馈可被用于多种教学与考核形式 ,如案例教学 、以问题为导向的学习 、基于实践的学习 、角色扮演 、标准化患者 、虚拟教学与虚拟游戏教学 、综合性教学 、教学辅导以及教学的形成性评价和终结性评价(客观结构化临床考核)[3] .由于引导性反馈对学生形成护理临床逻辑思维 、护理临床判断 、护理临床实践行为有重要训练作用 ,本文旨在结 合 美 国护 理 联 盟 (National League for Nursing ,NLN)发布的标准模拟教学中引导性反馈的培训课程内容 ,从引导性反馈的类型 、方式 、提问策略等方面 ,对引导性反馈进行文献综述 ,以期为广大护理教学者提供参考 . 本文所列举的引导性反馈的方法均是在模拟教学的背景下讨论的 .

Objectives: To gain a better understanding of nurse burnout and work-family conflict for nurses and to help the hospital prepare for hospital grade reevaluation.Methods: This study is a cross-sectional study, and 95 nurses participated. The questionnaires included MBI and Carlson work-family conflict questionnaires, and the data were analyzed using SPSS 17.Results: A total of 71.6% of nurses worked over 8 h per day during the last two months before the reevaluation. The total score of burnout of nurses was 66.84 ± 12.60, and the proportion of heavy work burnout was 44.2%. The personal accomplishment takes the heaviest portion（80.0%）. The total score of work-family conflict is 55.19 ± 9.27. The scores of work-to-family conflict are all higher than that of family-to-work conflict. The time dimension had the highest score.Conclusions: During the preparation period, nurses suffered from a heavy workload and intense job burnout, and many aspects of work-family conflict existed.

PURPOSE:To investigate regarding workplace health and safety factors, and to identify strategies to preserve and promote a healthy nursing workplace.METHODS:Data collected using the Delphi technique with input from 41 key informants across four participant categories drawn from a Chinese university and four hospitals were thematically analysed.RESULTS:Most respondents agreed on the importance of nurses' health and safety, and that nurse managers should act to protect nurses, but not enough on workplace safety. Hospital policies, staff disempowerment, workload and workplace conflicts are major obstacles.CONCLUSION:The reality of Chinese nurses' workplaces is that health and safety risks abound and relate to socio-cultural expectations of women. Self-management of risks is neccessary, gaps exist in understanding of workplace risks among different nursing groups and their perceptions of the professional status, and the value of nurses' contribution to ongoing risks in the hospital workplace. The Chinese hospital system must make these changes to produce a safer working environment for nurses.IMPLICATIONS FOR NURSING MANAGEMENT:This research, based in China, presents an instructive tale for all countries that need support on the types and amounts of management for nurses working at the clinical interface, and on the consequences of management neglect of relevant policies and procedures.

Objective To investigate the current situation of quality of care for people with disabilities and the related factors. Methods In November, 2015, 399 disabled persons from five special service institutions in Hubei, China were conveniently sampled, and investigated with the Chinese version of Quality of Care and Support (QOCS) for people with disability scale and demographic questionnaire. Results The total score of QOCS was (38.11±6.24), and the proportion of total score in the dimensions of caring provision, caring environment and caring information were more than 70%. The score of QOCS was various with the age, domicile, employment, medical insurance, monthly household expenditure and expenditure for food of the people with disabilities, and the age (β=0.06, P<0.01) and medical insurance (β=-0.850, P<0.001) were the independent factors related with the score of QOCS. Conclusion People with disabilities self-reportedly satis-fied in the quality of care in Hubei, and it can be improved from the increase of medical insurance level.

顺应2015年的医改潮流，中国的护理事业处于不断发展进步之中，中西方临床护理的对比往往对中国的护理事业的发展有借鉴意义。笔者有幸于2013年作为交换生到美国克利夫兰诊所间断实习两个多月，对于中美临床护理有很多感触，在此，仅对个人观点进行总结。中国与美国由于各自不同的社会背景、社会文化、社会责任和期望，造就了中美两国之间国家建设、经济生活以至于医疗体系的众多不同。例如，中国的社会医疗保险覆盖广大人民群众，而美国的医疗保险大多为高投入的商业保险，并不为广大人民所拥有。中国的医疗制度间接导致了医院负担重，医护人员过度辛劳的情况。因此，医疗改革、临床护理的改革，是很有必要的。为了更好地改革临床护理，就要充分了解其他国家临床护理的情况，以中国国情为基础，制订合理的改革计划。

Objective To investigate the quality of life, quality of care and support and social integration in persons with severe disabili-ties, and to analyze the relationship of quality of life with quality of care and support and social integration. Methods From September, 2015 to March, 2016, 399 persons with severe disabilities in Wuhan, China were investigated with World Health Organization Quality of Life-Dis-ability Scale, World Health Organization Quality of Care and Support Scale-Disability Scale and Social integration Scale. Results The quali-ty of life was in middle level in persons with severe disabilities, and positively correlated with the scores of quality of care and support (r>0.11, P<0.05) and social integration (r>0.39, P<0.01). Conclusion The quality of life is related with the quality of care and support and so-cial integration in persons with severe disabilities. Policy and support system should be targeted on it for the social security and rehabilita-tion.