三级综合医院急诊科护士置信职业行为指标的构建与验证

doi:10.3761/j.issn.0254-1769.2023.09.011

摘要/Abstract

摘要：

目的构建三级综合医院急诊科护士置信职业行为指标并进行初步验证，为评价三级综合医院急诊科护士岗位胜任力提供参考。方法通过文献研究、研究小组会议及专家咨询法确定急诊科护士置信职业行为指标，并于2022年5月使用三级综合医院急诊科护士置信职业行为评价指标满意度问卷对无锡市某三级综合医院40名急诊科护士进行问卷调查，以初步验证指标的应用效果。结果对21名专家进行2轮咨询，咨询问卷的有效回收率均为100%；专家权威系数分别为0.881、0.898；肯德尔和谐系数分别为0.509、0.535（P<0.01），最终形成了18个三级综合医院急诊科护士置信职业行为指标条目及说明，并确定各指标在不同年限的预期置信级别。急诊科护士对置信职业行为评价指标较满意，满意度得分为（22.25±3.04）分。结论该研究形成的三级综合医院急诊科护士置信职业行为指标具有科学性和实用性，可为评价三级综合医院急诊科护士岗位胜任力提供参考。

关键词: 急诊科, 护士, 胜任力, 置信职业行为, 护理管理研究

Abstract:

Objective To construct indicators of nurse entrustable professional activities（EPAs） in emergency departments of tertiary general hospitals，and to conduct preliminary validation，so as to provide references for evaluating the competence of nurses in emergency departments. Methods EPAs indicators for emergency department nurses were identified through literature research，research group meetings and Delphi consultation. A questionnaire survey was conducted in May 2022 on 40 nurses in an emergency department of a tertiary general hospital in Wuxi using Entrustable Professional Activities Evaluation Indicators Satisfaction Questionnaire to verify the effectiveness of the indicator application. Results 2 rounds of Delphi consultations were conducted with 21 experts. The effective recovery rates for the 2 rounds of Delphi consultation questionnaires were 100%. The authority coefficient values were 0.881 and 0.898，respectively. Kendall concordance coefficients were 0.509 and 0.535，respectively（P<0.01）. Finally，a set of 18 indicators and descriptions of EPAs in emergency department nurses were formed，and the expected entrust level of each indicator in different years were determined. Emergency department nurses were satisfied with the indicators of EPAs evaluation，with a score of（22.25±3.04）. Conclusion The indicators of nurse EPAs in emergency department are scientific and practical，which can provide a better reference for the evaluation of nurses’ competence in emergency department of tertiary hospitals.

Key words: Emergency Department, Nurse, Competency, Entrustable Professional Activities, Nursing Management Research

黄浩, 焦雨晨, 嵇艳. 三级综合医院急诊科护士置信职业行为指标的构建与验证[J]. 中华护理杂志, 2023, 58(9): 1096-1103.

HUANG Hao, JIAO Yuchen, JI Yan. Construction and verification of entrustable professional activities for nurses in emergency departments of tertiary general hospitals[J]. Chinese Journal of Nursing, 2023, 58(9): 1096-1103.

图/表 3

表1 三级综合医院急诊科护士置信职业行为指标条目及描述

Table 1 Indicators and descriptions of EPAs indexes for emergency department nurses of tertiary general hospitals

表2 三级综合医院急诊科护士置信职业行为指标的专家咨询结果

Table 2 The results of expert consultation of EPAs for emergency department nurses of tertiary general hospitals

表3 三级综合医院急诊科护士置信职业行为的预期置信级别

Table 3 Expected entrust levels of EPAs for emergency department nurses of tertiary general hospitals

参考文献 31

[1]	国家卫生健康委. 关于印发《全国护理事业发展规划(2021—2025年)》的通知[EB/OL]. (2022-05-07)[2022-06-01]. http://www.nhc.gov.cn/yzygj/s7653pd/202205/441f75ad347b4ed68a7d2f-2972f78e67.shtml.
	National Health Commission,PRC. Circular of the issuance of the national nursing development plan[EB/OL]. (2022-05-07)[2022-06-01]. http://www.nhc.gov.cn/yzygj/s7653pd/202205/441f-75ad347b4ed68a7d2f2972f78e67.shtml.
[2]	国家卫生健康委. 国家卫生计生委办公厅关于印发三级综合医院医疗服务能力指南(2016年版)的通知[EB/OL]. (2016-10-18)[2022-06-01]. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=6e6780e8b7c24c57bf386d35e9f952df.
	National Health Commission PRC. Circular of the General Office of the National Health and Family Planning Commission on the issuance of the guidelines for medical service capacity of tertiary general hospitals(2016 edition)[EB/OL]. (2016-10-18)[2022-06-01]. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=6e6780e8b7c24c57bf386d35e9f952df.
[3]	闫红丽, 张玲. 急诊护士胜任力评价工具比较[J]. 解放军医院管理杂志, 2020, 27(10):993-994.
	Yan HL, Zhang L. Comparative study on tools for evaluating competency of nurses in emergency department[J]. Hosp Adm J Chin PLA, 2020, 27(10):993-994.
[4]	ten Cate O. Entrustability of professional activities and competency-based training[J]. Med Edu, 2005, 39(12):1176-1177. DOI URL
[5]	American Association of Colleges of Nursing. White paper re-envisioning the clinical education of advanced practice registered nurses[EB/OL]. (2015-03-01)[2022-06-01]. https://www.aacnnursing.org/Portals/42/News/White-Papers/APRN-Clinical-Education.pdf.
[6]	Meade LB, Suddarth KH, Jones RR, et al. Patients,nurses,and physicians working together to develop a discharge entrustable professional activity assessment tool[J]. Acad Med, 2016, 91(10):1388-1391. DOI URL
[7]	van Houwelingen CT, Moerman AH, Ettema RG, et al. Competencies required for nursing telehealth activities:a Delphi-study[J]. Nurse Edu Today, 2016, 39:50-62.
[8]	Lau ST, Ang E, Samarasekera DD, et al. Development of undergraduate nursing entrustable professional activities to enhance clinical care and practice[J]. Nurse Edu Today, 2020, 87:104347.
[9]	Royal College of Physicians and Surgeons of Canada. Entrustable professional activity guide:emergency medicine[EB/OL].(2018-11-01)[2022-06-01]. https://www.royalcollege.ca/rcsite/documents/cbd/epa-guide-emergency-med-e.pdf.
[10]	Beeson MS, Warrington S, Bradford-Saffles A, et al. Entrustable professional activities:making sense of the emergency medicine milestones[J]. J Emerg Med, 2014, 47(4):441-452. DOI URL
[11]	冯莉莉, 陈旭岩, 张向阳, 等. 急诊住院医师置信职业行为指标构建及应用初探[J]. 中国毕业后医学教育, 2021, 5(3):197-201.
	Feng LL, Chen XY, Zhang XY, et al. Establishment and preliminary application of the entrustable professional activities in the emergency medicine residents training[J]. Chin J Gradua-te Med Edu, 2021, 5(3):197-201.
[12]	Hoyt KS, Ramirez EG, Proehl JA. Making a case for entrustable professional activities for nurse practitioners in emergency care[J]. Adv Emerg Nurs J, 2017, 39(2):77-80. DOI PMID
[13]	Ten Cate O, Chen HC, Hoff RG, et al. Curriculum development for the workplace using entrustable professional activities(EPAs):AMEE guide No. 99[J]. Med Teach, 2015, 37(11):983-1002. DOI URL
[14]	金静芬, 刘颖青. 急诊专科护理[M]. 北京: 人民卫生出版社, 2018.
	Jin JF, Liu YQ. Emergency specialized nursing[M]. Beijing: People’s Medical Publishing House, 2018.
[15]	刘菁, 鲁敏. 基于德尔菲法构建肺移植个案管理师准入标准及角色职能[J]. 国际护理学杂志, 2020, 39(9):1576-1580.
	Liu J, Lu M. Based on Delphi method,the admission criteria and role functions of case managers of lung transplantation are constructed[J]. Int J Nurs, 2020, 39(9):1576-1580.
[16]	卢佳美, 李维, 廖金莲, 等. 鼻咽癌放化疗患者健康教育效果评价指标体系的构建[J]. 中华护理杂志, 2022, 57(8):942-950. DOI
	Lu JM, Li W, Liao JL, et al. Establishment of an evaluation index system for health education among nasopharyngeal carcinoma patients with radio-chemotherapy[J]. Chin J Nurs, 2022, 57(8):942-950. DOI
[17]	屈京楼, 朱亚鑫, 曲波. 德尔菲法在医学教育研究中的应用[J]. 中华医学教育杂志, 2019, 39(3):227-230.
	Qu JL, Zhu YX, Qu B. The Delphi method and its application in medical education research[J]. Chin J Med Educ, 2019, 39(3):227-230.
[18]	ten Cate O, Scheele F. Competency-based postgraduate training:can we bridge the gap between theory and clinical practice?[J]. Acad Med, 2007, 82(6):542-547. DOI URL
[19]	齐心, 金哲, 韩晓宁, 等. 住院医师置信职业行为指标的构建研究[J]. 中华医学教育杂志, 2021, 41(2):104-108.
	Qi X, Jin Z, Han XN, et al. Establishment of the entrustable professional activities for the residents[J]. Chin J Med Educ, 2021, 41(2):104-108.
[20]	Wagner LM, Dolansky MA, Englander R. Entrustable professional activities for quality and patient safety[J]. Nurs Outlook, 2018, 66(3):237-243. DOI PMID
[21]	高冬, 黄霞, 贾培培, 等. 护士应用体外膜肺氧合技术核心能力评价指标的构建[J]. 中华护理杂志, 2022, 57(18):2239-2246.
	Gao D, Huang X, Jia PP, et al. Construction of a core competence evaluation index system for nurses participating in ECMO technology[J]. Chin J Nurs, 2022, 57(18):2239-2246.
[22]	Carraccio C, Englander R, Holmboe ES, et al. Driving care qua-lity:aligning trainee assessment and supervision through practical application of entrustable professional activities,competencies,and milestones[J]. Acad Med, 2016, 91(2):199-203. DOI PMID
[23]	急诊危重症患者院内转运共识专家组. 急诊危重症患者院内转运共识:标准化分级转运方案[J]. 中华卫生应急电子杂志, 2017, 3(5):257-261.
	Consensus Expert Group on Intra-hospital Transport of Critically Ill Emergency Patients. Consensus on hospital transport of emergency critically ill patients-standardized grading transport scheme[J]. Chin J Hyg Rescue Electron Ed, 2017, 3(5):257-261.
[24]	急诊预检分诊专家共识组. 急诊预检分诊专家共识[J]. 中华急诊医学杂志, 2018, 27(6):599-604.
	Emergency Pre-examination Triage Expert Consensus Group. Expert consensus on emergency pre-inspection and triage[J]. Chin J Emerg Med, 2018, 27(6):599-604.
[25]	何小军, 马岳峰, 张国强. 高质量发展时代的急诊医学学科建设[J]. 中华急诊医学杂志, 2022, 31(1):1-3.
	He XJ, Ma YF, Zhang GQ. Discipline construction of emergency medicine in the era of high-quality development[J]. Chin J Emerg Med, 2022, 31(1):1-3.
[26]	王欣月, 吴巍, 李慧, 等. 急诊科护士胜任力现状及影响因素分析[J]. 护理研究, 2022, 36(17):3144-3147.
	Wang XY, Wu W, Li H, et al. Analysis on status quo and influencing factors of nurses competency in emergency department[J]. Chin Nurs Res, 2022, 36(17):3144-3147.
[27]	宋庆娜, 修麓璐, 代月光, 等. 急诊护士胜任力标准研究现状[J]. 齐鲁护理杂志, 2018, 24(16):95-98.
	Song QN, Xiu LL, Dai YG, et al. Research status of competency standards for emergency nurses[J]. J Qilu Nurs, 2018, 24(16):95-98.
[28]	杨志广. 基于胜任力急诊专业护士岗位准入标准体系的构建[D]. 兰州: 甘肃中医药大学, 2022.
	Yang ZG. Construction of the access standard system for emergency nurse based on competency[D]. Lanzhou: Gansu University of Chinese Medicine, 2022.
[29]	张娜, 郭慧芳, 尹安春. 客观结构化临床考试在急诊专科护士培训中的应用[J]. 中华护理杂志, 2013, 48(10):898-900.
	Zhang N, Guo HF, Yin AC. Application of the objective structured clinical examination in emergency specialist nurse train-ing[J]. Chin J Nurs, 2013, 48(10):898-900.
[30]	王筝扬, 黄一琳, 万姗姗, 等. 德雷福斯模型在临床能力评估与教学中应用的启示[J]. 中华医学教育杂志, 2021, 41(11):1038-1041.
	Wang ZY, Huang YL, Wan SS, et al. The elicitation of Dreyfus model in medical education and training of clinical skills in China[J]. Chin J Med Educ, 2021, 41(11):1038-1041.
[31]	李珊, 齐建光, 齐心, 等. 基于置信职业行为的儿科住院医师形成性评价体系的构建探索[J]. 中国毕业后医学教育, 2021, 5(3):193-196,201.
	Li S, Qi JG, Qi X, et al. Exploration of a formative assessment system based on entrustable professional activities in pediatric residency training[J]. Chin J Graduate Med Educ, 2021, 5(3):193-196,201.