ICU护士血液滤过知识与技能创情境竞赛的实施_于洋.pdf

中国病案2023 年第 24 卷第 2 期 105 ICU 护士血液滤过知识与技能创情境竞赛的实施 于 洋 张 煜 王淑芹*万 娜 张春艳 贾燕瑞 摘要 目的 应用医疗护理病案系统筛选病例，设计 ICU 护士血液滤过知识与技能创情境竞赛方案，以达到护士专业知识与技能的持续改进。方法 2021 年 4 月 1 日-30 日某三级甲等医院 ICU 系统 N1 及 N2护士 15 人，按自愿原则分为 5 队参赛。根据病案系统进行 ICU 护士血液滤过知识与技能创情境竞赛，分为理论知识及操作技能两部分。竞赛组织者 10 人。通过问卷调查参赛者与竞赛组织者对竞赛的评价。结果 通过竞赛，操作技能平均得分为(94.002.32)分，和竞赛前(89.002.00)分相比显著提高，操作完成平均时间(25.602.30)min，和竞赛前完成时间(35.001.41)min 相比显著缩短，P值0.01，均具有统计学意义。15 名参赛者均表示能很大程度或较大程度促进理论知识和操作技能的掌握，并能发现自身的薄弱点。10 名竞赛组织者均认为能很大程度上或较大程度上达到以赛促学目的，促进教学方法改革，缩短临床教学与临床实践之间的差距，有助于发现临床教学培训环节盲点。结论 通过 ICU 护士血液滤过知识与技能创情境竞赛，促进了 ICU 护士理论与操作技能的提升，并能以赛促学，促进教学方法的改革，具有良好的教学成效，为临床专科护理知识技能的持续改进和推广提供借鉴。关键词 护理；竞赛；血液滤过；ICU 护士；护理记录 Implementation of Situational Competition for Hemofiltration Knowledge and Skills of CRRTImplementation of Situational Competition for Hemofiltration Knowledge and Skills of CRRT in ICU nurses in ICU nurses Yu Yang,Zhang Yu,Wang Shuqin*,Wan Na,Zhang Chunyan,Jia Yanrui AbstractAbstract ObjectivesObjectives To select cases with medical nursing medical record system and design a situational competition scheme for knowledge and skills of CRRT in ICU nurses,so as to achieve the continuous improvement and promotion of nurses professional knowledge and skills.MethodsMethods From April 1st to April 30th,2021,15 N1 and N2 nurses in ICU system of Three A and Tertiary Hospital were divided into 5 teams according to the principle of voluntariness.According to the medical record system,the situational competition of ICU nurses hemofiltration knowledge and skills is divided into two parts:theoretical knowledge and operational skills.There were 10 organizers.The evaluation of contestants and competition organizers on the competition was investigated by questionnaire.ResultsResults Through the competition,the average score of operation skills was(94.002.32),which was significantly higher than that before the competition(89.00 2.00),and the average time to complete the operation was(25.602.30)min,which was significantly shorter than that before the competition(35.001.41)min,P0.01.100%of the 15 contestants said that they could greatly or greatly promote the mastery of theoretical knowledge and operation skills,and find their own weaknesses.100%of the 10 competition organizers believe that they could achieve the purpose of promoting learning through competition to a great extent,promote the reform of teaching methods,shorten the gap between clinical teaching and clinical practice,and help to find the blind spots in clinical teaching and training.100%of the 15 contestants said that they could greatly or greatly promote the mastery of theoretical knowledge and operation skills,and find their own weaknesses.100%of the 10 competition organizers believed that they could achieve the purpose of promoting learning through competition to a great extent or to a great extent,promote the reform of teaching methods,shorten the gap between clinical teaching and clinical practice,and help to find the blind spots in clinical teaching and training.ConclusionsConclusions Through the situational competition of ICU nurses hemofiltration knowledge and skills,it promoted the improvement of ICU nurses theoretical and operational skills,promoted learning through competition,promoted the reform of teaching methods,had good teaching results,and provided reference for the continuous improvement and promotion of clinical specialty nursing knowledge and skills.Key wordsKey words Nursing；Competition；CRRT；ICU nurses；Nursing records FirstFirst-authorauthors addresss address Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China Corresponding authorCorresponding author Wang Shuqin 1持续性肾脏替代治疗(continuous renal replacement therapy，CRRT)是指采用每日 24 小时或接近 24 小时的一种长时间、连续的体外血液净化疗法以替代受损的肾功能。主要用于急、慢性肾功能衰竭合并严重并发症，越来越多地应用于非肾脏领域的重症患者，为其提供了赖以生存的内环境的平衡，其生命支持作用逐渐凸显1。护士是 CRRT 治疗顺利进行的重要保障，护理操作的各个环节都关系到治疗的顺利和抢救的及时有效。专业化、规范化、标准 基金项目：北京市属医院科研培育计划项目(PX2018012)首都医科大学附属北京朝阳医院，北京市，100020 *通信作者 化的各种护理记录及专业的护理记录结构化、半结构化的设计，是保证患者护理安全，表达高质量护理操作的载体，是护理教学的最基本的资料。既往的培训以先进行理论知识的讲解，再进行相关的实际技能培训为主，单项技能采用分散练习方式，如预冲、更换液袋、上下机、回血等。这种教学方法在实际应用中，不利于将问题处置与实战相结合，CRRT 情境模拟操作竞赛是在教学过程中，结合多种、大量的临床护理记录资料，创设临床实际的生动具体的报警处置场景，将理论知识和实践技能结合起来，设计为直观、立体的场景和内容，进行操作及竞赛，从而培养护士的临床思维和应变能力。中国病案2023 年第 24 卷第 2 期 106 1 资料与方法 1.1 资料来源 2021 年 4 月 1 日-30 日方便抽样选取某三级甲等医院呼吸重症监护病房(Intensive Care Unit,ICU)N1 护士(工作年限 1 年-3 年)及 N2 护士(工作年限4 年)15 人参赛，按自愿原则分为 5 队，每队 3 名护士，均包含 N1 及 N2 能级的护士。其中女性 13 人，男性 2 人，年龄 28.604.88 岁；ICU工作年限 7.204.76 年；护士 2 人，护师 11 人，主管护师 2 人；大学专科学历 11 人，大学本科学历4 人。每支参赛队配备指导教师 1 名，具有危重症护理工作经验 10 年以上，并担任护理责任组长。竞赛组织者包括护士长 2 名、教学组成员 3 名、血滤专业组成员 5 名，共 10 人组成。1.2 方法 竞赛前常规采用每季度一次 CRRT 理论授课及操作演示，进行理论和技能培训，要求呼吸ICU 护士 N1 及 N2 护士参加。2021 年 3 月 31 日考核理论应用闭卷考试，试题包括填空题、选择题和简答题，由教学老师统一阅卷；技能考核血滤机预充操作流程，均为百分制。2021 年 4 月 1 日-30日进行创情境竞赛方案设计与实施：CRRT 竞赛的设计以病案为主线，充分利用护理记录的信息和数据，采用患者模拟与报警情境设置相结合的方式，具体做法为：情境创建。查阅相关文献及指南，检索 HIS 系统中进行过 CRRT 治疗的实例，并结合重症监护病房电子护理记录系统中临床实际问题及护理质控记录，特别关注 CRRT 治疗患者的护理信息与数据。进行竞赛试题内容的情境创建，模仿实际病情、实验室检查肾功能、出凝血指标、循环 功能指标、治疗目的及治疗目标等进行设计问题。竞赛内容及评分