Enfermeria clinica (English Edition)最新文献_第2页

Registration of advance directives in patients admitted to an intensive care unit: A prevalence study 入住重症监护病房的患者的预先指示登记：一项流行病学研究。

Enfermeria clinica (English Edition)

Pub Date : 2026-01-01 DOI: 10.1016/j.enfcle.2025.502215

Estela Hernández Bello , Alberto Hernández Embid , María Luisa de la Rica Escuin

Introduction

Advance planning, and its registration in the advance directives document, makes it possible to define goals and preferences, assuring patients of the fulfillment of their wishes, and facilitating decision making by professionals in an end-of-life process. In people admitted to an ICU for treatment, life support or pathologies, communication can be difficult.

Objectives

To identify how many patients admitted to an ICU had VAD recorded during the years 2019 and 2021, and to study the relationships with age, sex, pathology, population of origin, reason for discharge, and whether the record was before or after admission, and to study whether there were changes in the record after the first year of the pandemic.

Methodology

Cross-sectional descriptive study carried out in an ICU in Zaragoza during the years 2019 and 2021. The study population consisted of all patients admitted during the study period. A descriptive and bivariate analysis of the variables under study was performed, establishing a confidence level of p < 0.05.

Results

In 2019 there were 694 people admitted, 63% of whom were men, with a mean age of 66 years (SD = 14.5). 1.7% had VAD registered. Only 3 of 12 persons registered their VAD after ICU admission. In 2021 there were 1,137 patients admitted, the majority being men (64.1%), with mean age 63.43 years (SD = 14.6). Of the patients admitted in 2021, 1.8% had VAD recorded. Only 4 people out of 21 registered VAD after admission to the ICU. Only a relationship could be established between having registered VAD and origin in the year 2021, being more frequent in those who lived in the city.

Conclusion

The registration of VAD in patients admitted to our service was scarce, with no differences observed between the years 2019 and 2021. Most had the DVA registered before admission to the ICU, so it is considered important to raise awareness of making adequate planning of care wishes in the last days of life.

导读：预先计划，并在预先指示文件中登记，使得确定目标和偏好成为可能，确保患者实现他们的愿望，并促进专业人员在生命结束过程中的决策。在ICU接受治疗、生命支持或病理治疗的患者中，沟通可能很困难。目的：确定在2019年和2021年期间有多少入住ICU的患者记录了VAD，并研究其与年龄、性别、病理、原籍人口、出院原因以及记录是在入院前还是入院后的关系，并研究大流行第一年之后记录是否有变化。方法：横断面描述性研究于2019年和2021年在萨拉戈萨的一家ICU进行。研究人群包括在研究期间入院的所有患者。对所研究的变量进行了描述性和双变量分析，建立了p的置信水平。结果：2019年有694人入院，其中63%是男性，平均年龄为66岁（SD = 14.5）。1.7%的患者有VAD记录。12例患者中仅有3例在ICU入院后出现VAD。2021年共有1137例患者入院，其中男性居多（64.1%），平均年龄63.43岁（SD = 14.6）。在2021年入院的患者中，1.8%有VAD记录。21人中只有4人在入住ICU后出现VAD。只有在2021年登记的VAD与原籍之间才能建立关系，这种情况在居住在城市的人中更为常见。结论：在我们服务的患者中，VAD的登记很少，2019年和2021年之间没有观察到差异。大多数患者在入住ICU前已登记了DVA，因此在生命的最后几天提高对护理愿望进行充分规划的意识是很重要的。

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引用次数: 0

Mental health literacy: a formative response to suicide risk among nursing students 心理健康素养：护理学生自杀风险的形成性反应。

Enfermeria clinica (English Edition)

Pub Date : 2026-01-01 DOI: 10.1016/j.enfcle.2025.502415

Edwin Gustavo Estrada-Araoz

引用次数: 0

Implementation of a bad news communication protocol in nursing: Impact on communication skills 护理中坏消息沟通协议的实施：对沟通技巧的影响。

Enfermeria clinica (English Edition)

Pub Date : 2026-01-01 DOI: 10.1016/j.enfcle.2025.502401

Enoc Isaí Hernández-Cantú , Kareli Montserrath Alcaraz-Ávalos , María Guadalupe Martínez-León , Héctor Alberto Covarrubias-Arriaga , Giselle Alexandra Luevano-Díaz

Objective

To assess the impact of implementing a Bad News Communication Protocol (BNCP) on nurses’ communication skills, patients’/families’ perceived communication quality, and the frequency of communication-related hospital conflicts.

Method

Quasi-experimental pretest–posttest study with 247 nurses at a secondary-level hospital. Communication skills were measured using a 5-point Likert questionnaire (α = 0.89). Patients’/families’ perception was assessed with 356 structured 5-point Likert surveys (pre = 178; post = 178). Communication-related conflicts were extracted from institutional complaint and internal-report records six months before and after implementation. Paired t-tests, Chi-square tests, and ANOVA were used.

Results

Communication-skills scores increased from 2.8 ± 0.9 to 4.2 ± 0.7 (t = 15.87; p < 0.001). In patients’/families’ perception, “poor” decreased from 18.5% to 5.6%, “fair” from 28.7% to 6.7%, “good” rose from 34.3% to 44.9%, and “excellent” from 18.5% to 42.7% (χ² = 36.21; p < 0.001). Communication-related conflicts dropped from 78 to 29 (−62.8%; p < 0.001).

Conclusions

BNCP implementation improved nurses’ communication skills, enhanced patients’/families’ perception, and reduced conflicts. Embedding structured communication protocols in nursing continuing education may enhance care quality.

目的：评估实施坏消息沟通协议（BNCP）对护士沟通技巧、患者/家属感知沟通质量和沟通相关医院冲突发生频率的影响。方法：对247名二级医院护士进行准实验前测后测研究。沟通技巧采用5点Likert问卷（α = 0.89）。通过356份结构化5点李克特调查（前= 178；后= 178）评估患者/家属的认知。从实施前后六个月的机构投诉和内部报告记录中提取与沟通有关的冲突。采用配对t检验、卡方检验和方差分析。结果：沟通技巧得分从2.8±0.9提高到4.2±0.7 （t = 15.87; p）。结论：实施BNCP后，护士的沟通技巧得到改善，患者/家属的认知得到增强，冲突减少。在护理继续教育中嵌入结构化的沟通协议可以提高护理质量。

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引用次数: 0

Utilization of telehealth services among multiple sclerosis patients in Iran 伊朗多发性硬化症患者远程保健服务的利用情况。

Enfermeria clinica (English Edition)

Pub Date : 2026-01-01 DOI: 10.1016/j.enfcle.2025.502186

Farnaz Zare , Rezvan Rahimi , Hanieh Zehtab Hashemi

Introduction

Telehealth services, as an innovative solution in the healthcare sector, hold potential benefits for addressing the needs of individuals with Multiple sclerosis (MS). This study aims to investigate the level of telehealth service utilization among MS patients in Iran and explore the factors influencing their use.

Method

This study adopts a descriptive-analytical approach for its research objective and employs a survey-based method for data collection and analysis. The validity and reliability of the questionnaires underwent evaluation through content analysis and quantitative methods. Hypotheses regarding factors such as age, education level, sex, and type of disease affecting the extent of telehealth service utilization were examined.

Results

A majority of patients have availed themselves of telehealth services (78%), with a lower percentage using mobile applications for MS management (18%). Among patients, higher utilization of telehealth services was observed for finding a doctor and scheduling appointments (46%), accessing information about symptoms and disease conditions (39%), and communicating with physicians (38%). The study revealed no significant association between sex, age, and type of disease with the extent of telehealth service usage (p > 0.05). However, the study demonstrated that education level is linked to the extent of telehealth service utilization (p < 0.05).

Conclusion

The effective advancement of telehealth services for MS patients necessitates a thorough understanding of the needs, preferences, and constraints within this demographic. Consequently, telehealth platforms should be designed to be accessible and user-friendly for all patients, irrespective of age, sex, type of disease, or education level.

远程医疗服务作为医疗保健领域的一种创新解决方案，在解决多发性硬化症（MS）患者的需求方面具有潜在的好处。本研究旨在了解伊朗多发性硬化症患者的远程医疗服务利用水平，并探讨影响其使用的因素。方法：本研究采用描述性分析方法作为研究目标，采用基于调查的方法进行数据收集和分析，通过内容分析和定量方法对问卷的效度和信度进行评价。对年龄、受教育程度、性别和疾病类型等影响远程医疗服务利用程度的因素进行了假设。结果：大多数患者利用远程医疗服务（78%），使用移动应用程序进行MS管理的比例较低（18%）。在寻找医生和安排预约（46%）、获取有关症状和疾病状况的信息（39%）以及与医生沟通（38%）方面，患者对远程保健服务的利用率较高。研究显示，性别、年龄和疾病类型与远程医疗服务使用程度之间没有显著关联（p < 0.05）。然而，研究表明，教育水平与远程医疗服务的利用程度有关(p结论：MS患者远程医疗服务的有效推进需要彻底了解这一人群的需求、偏好和限制。因此，远程保健平台的设计应使所有患者，不论其年龄、性别、疾病类型或教育水平，都能方便地使用和使用。

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引用次数: 0

Relationship between caregiver role adoption, care duration, and burden among female caregivers of individuals with chronic illnesses 慢性病患者女性照护者角色采用、照护持续时间和负担的关系

Enfermeria clinica (English Edition)

Pub Date : 2026-01-01 DOI: 10.1016/j.enfcle.2025.502337

Sonia Carreño-Moreno , Lorena Chaparro-Díaz , Zoraida Rojas-Marín , Sandra Milena Hernández Zambrano , Lina M. Vargas-Escobar

Objective

To describe and correlate sociodemographic and caregiving characteristics, caregiving overload and general role adoption and medication use among family caregivers of individuals with Non-Communicable Chronic Diseases (NCDs).

Methods

Quantitative, descriptive and analytical cross-sectional study conducted between 2021 and 2022 in Bogotá (Colombia). A total of 321 female family caregivers of individuals with non-communicable chronic diseases (NCDs) participated. Validated instruments were applied to assess caregiver and care recipient characteristics, caregiver burden, and adoption of both the general caregiving role and the role in medication management. Descriptive and inferential statistical analyses were performed.

Results

Caregivers provide care to elderly individuals with multiple chronic conditions and high dependency. They have achieved satisfactory adoption of the general caregiver role, showing an absence of overload. Correlations and regression models indicate that greater adoption of the general caregiving role, combined with less time spent in caregiving tasks, is associated with lower levels of caregiver burden.

Conclusions

The results suggest that the adoption of the general caregiving role and medication management may serve as useful clinical indicators for anticipating assessment enhances the understanding of concepts such as excessive caregiving burden and guides more specific and context-sensitive interventions.

目的：描述和关联非传染性慢性疾病（ncd）患者家庭照顾者的社会人口学和照顾特征、照顾超载和一般角色采用和药物使用。方法：在2021年至2022年期间在波哥大（哥伦比亚）进行定量、描述性和分析性横断面研究。共有321名非传染性慢性病患者的女性家庭照顾者参与了调查。应用验证的工具来评估照顾者和受照顾者的特征，照顾者负担，以及采用一般照顾角色和药物管理中的角色。进行描述性和推断性统计分析。结果：护理人员对患有多种慢性疾病和高度依赖的老年人提供护理。他们已经取得了满意的采用一般照顾者的角色，显示没有超载。相关性和回归模型表明，更多地采用一般的照顾角色，加上更少的时间花在照顾任务上，与较低水平的照顾者负担有关。结论：采用一般护理角色和药物管理可以作为预测评估的有用临床指标，增强对过度护理负担等概念的理解，并指导更具体和情境敏感的干预措施。

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引用次数: 0

Complexity and intensity of care: Key elements in determining health needs 护理的复杂性和强度：确定卫生需求的关键因素。

Enfermeria clinica (English Edition)

Pub Date : 2026-01-01 DOI: 10.1016/j.enfcle.2025.502440

Jordi Adamuz, Maribel González-Samartino, Maria Eulàlia Juvé-Udina

引用次数: 0

Effectiveness of telematic follow-up programme to promote physical activity after hematological transplantation: a randomized clinical trial 远程信息跟踪计划促进血液移植后身体活动的有效性：一项随机临床试验。

Enfermeria clinica (English Edition)

Pub Date : 2026-01-01 DOI: 10.1016/j.enfcle.2025.502303

Àngels Pera-Jambrina , Anna Esteve , Andrea González , Lidia Hurtado , Albert Mussetti , Paz Fernández-Ortega

Aim

To analyse benefits of tele-monitoring to promote adherence to a home-based physical activity for patients under hematopoietic stem cell transplantation.

Methods

A randomized clinical trial controlled. Patients, in total 56 with 28 in control group (CG) and 28 intervention group (IG). Autologous and allogeneic transplant patients in ratio 1:1. Both groups received advice on physical activity recommendations to be performed at home, based on walking and squats. The intervention IG consisted in physical activity monitored with a pedometer and tele-monitoring by physiotherapist weekly, during 3 months. Variables as: Exercise tolerance, muscle strength, fatigue, dyspnoea, and quality of life were measured presently with validated scales, at hospital admission, discharge and, 3 months after discharge. P value was stablished ≤0.05. Comparative analysis was performed using R software v.4.1.

Results

In terms of quality of life (EQ-5D-5L), at 3 months after discharge, the IG showed better ability to perform daily activities than the CG (p: .009). In the 6-minute walk test, the GI recovered the meters they had made before admission, but the GC was 41 m below (p: .048). In the 30-second chair stand test: IG recovered baseline and performed 1.7 but CG performed 0.8 repetitions below baseline. These differences between groups were more pronounced in patients who underwent allogeneic transplant compared to patient under autologous transplant.

Conclusion

The results indicate that physical telematic support improves the functional capacity and adherence of patients undergoing transplantation to perform physical activity at home

目的：分析远程监测对促进造血干细胞移植患者坚持家庭体育活动的益处。方法：随机对照临床试验。患者共56例，对照组（CG） 28例，干预组（IG） 28例。自体与异体移植患者比例为1:1。两组人都收到了关于在家进行体育锻炼的建议，包括散步和深蹲。干预IG包括用计步器监测身体活动，每周由物理治疗师远程监测，为期3个月。变量为：运动耐量、肌肉力量、疲劳、呼吸困难和生活质量，在入院时、出院时和出院后3个月用有效的量表进行测量。结果：在生活质量方面（eq - 5d - 5l），在出院后3个月，IG组的日常活动能力优于CG组（P: 0.009）。在6分钟步行测试中，GI恢复了入院前的距离，但GC比入院前低41米（p: 0.048）。在30秒的椅子站立测试中，IG恢复基线，重复1.7次，而CG比基线低0.8次。同种异体移植患者与自体移植患者相比，组间差异更为明显。结论：物理远程信息处理支持提高了移植患者在家进行体力活动的功能能力和依从性。

{"title":"Effectiveness of telematic follow-up programme to promote physical activity after hematological transplantation: a randomized clinical trial","authors":"Àngels Pera-Jambrina , Anna Esteve , Andrea González , Lidia Hurtado , Albert Mussetti , Paz Fernández-Ortega","doi":"10.1016/j.enfcle.2025.502303","DOIUrl":"10.1016/j.enfcle.2025.502303","url":null,"abstract":"<div><h3>Aim</h3><div>To analyse benefits of tele-monitoring to promote adherence to a home-based physical activity for patients under hematopoietic stem cell transplantation.</div></div><div><h3>Methods</h3><div>A randomized clinical trial controlled. Patients, in total 56 with 28 in control group (CG) and 28 intervention group (IG). Autologous and allogeneic transplant patients in ratio 1:1. Both groups received advice on physical activity recommendations to be performed at home, based on walking and squats. The intervention IG consisted in physical activity monitored with a pedometer and tele-monitoring by physiotherapist weekly, during 3 months. Variables as: Exercise tolerance, muscle strength, fatigue, dyspnoea, and quality of life were measured presently with validated scales, at hospital admission, discharge and, 3 months after discharge. P value was stablished ≤0.05. Comparative analysis was performed using R software v.4.1.</div></div><div><h3>Results</h3><div>In terms of quality of life (EQ-5D-5L), at 3 months after discharge, the IG showed better ability to perform daily activities than the CG (p: .009). In the 6-minute walk test, the GI recovered the meters they had made before admission, but the GC was 41 m below (p: .048). In the 30-second chair stand test: IG recovered baseline and performed 1.7 but CG performed 0.8 repetitions below baseline. These differences between groups were more pronounced in patients who underwent allogeneic transplant compared to patient under autologous transplant.</div></div><div><h3>Conclusion</h3><div>The results indicate that physical telematic support improves the functional capacity and adherence of patients undergoing transplantation to perform physical activity at home</div></div>","PeriodicalId":72917,"journal":{"name":"Enfermeria clinica (English Edition)","volume":"36 1","pages":"Article 502303"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enfermeria clinica (English Edition)

Pub Date : 2026-01-01 DOI: 10.1016/j.enfcle.2025.502295

Zahra Khazir , Mohammad Saeed Jadgal , Javad Shahraki

Introduction and objective

Colorectal cancer is one of the most common gastrointestinal cancers, accounting for approximately 10% of cancer-related deaths. This study aimed to determine determine factors associated with the intention to perform a fecal occult blood test for colorectal cancer screening, based on the health belief model and health literacy.

Methods

In this descriptive-analytical and cross-sectional study, 170 elderly people were selected through multi-stage simple random sampling. Data were collected using a questionnaire comprising demographic and background characteristics, health literacy questions, and the Health Belief Model constructs. Data were analyzed using SPSS software version 16 through descriptive and analytical tests.

Results

Logistic regression results showed that self-efficacy (OR = 1.40, P = .000), access dimension (OR = 0.28, P = .009), understanding and comprehension dimension (OR = 0.05, P = .000), and history of lower gastrointestinal bleeding in the last month (OR = 0.03, P = .000) increased the likelihood of intending to undergo colorectal cancer screening.

Conclusion

It seems that using a health belief model combined with health literacy with an emphasis on self-efficacy constructs, access, and understanding of health information can increase individuals' intention to undergo FOBT.

简介和目的：结直肠癌是最常见的胃肠道癌症之一，约占癌症相关死亡人数的10%。本研究旨在基于健康信念模型和健康素养，确定与结肠直肠癌筛查中粪便潜血检查意愿相关的因素。方法：采用描述性分析和横断面研究的方法，采用多阶段简单随机抽样的方法，抽取170名老年人。数据收集使用问卷调查，包括人口统计和背景特征，健康素养问题和健康信念模型结构。数据分析采用SPSS软件16版，通过描述性和分析性检验。结果：Logistic回归结果显示，自我效能感（OR = 1.40, P = 0.000）、可及性维度（OR = 0.28, P = 0.009）、理解理解维度（OR = 0.05, P = 0.000）和最近一个月下消化道出血史（OR = 0.03, P = 0.000）增加了结肠直肠癌筛查意愿的可能性。结论：健康信念模型与健康素养相结合，强调自我效能感的构建、健康信息的获取和理解，可以提高个体接受FOBT的意愿。

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引用次数: 0

Analysis of quality of life of parents of newborns admitted to the neonatal intensive care unit. 新生儿重症监护病房新生儿父母生活质量分析。

Enfermeria clinica (English Edition)

Pub Date : 2025-11-19 DOI: 10.1016/j.enfcle.2025.502304

Lucía Jesús Muñiz-Ceballos, Silvia Arroyo-Fresneña, Laura Vázquez-Alvira, Ana Velasco-Iruretagoyena, Laura González-Cabeza, Josep-Oriol Casanovas-Marsal

Objective: To evaluate and compare the health-related quality of life of parents of newborns admitted to the Neonatal Intensive Care Unit, during neonatal hospitalization and at home, and to identify the factors that influence it by analyzing sex differences.

Method: Observational, prospective, and analytical study conducted with 92 parents of 46 newborns admitted to the Neonatal Intensive Care Unit. Health-related quality of life was assessed using the PedsQL-FIM 2.0 questionnaire at three different time points. Sociodemographic variables of the parents and clinical data of the newborns, including the use of medical devices, were recorded. The study was approved by the Ethics Committee, and statistical analysis was performed using the Jamovi® v.2.3.13 software.

Results: The mean age of the parents was 35,41 ± 6,20 years; 51,32% were women. No correlation was found between age and quality of life at any of the time points, but differences were observed by sex in emotional well-being during intensive care (P = .007), physical health and activities during hospitalization (P = .01), and daily activities at home (P = .01). Quality of life was negatively associated with the duration of medical device use, both in intensive care and during hospitalization.

Conclusions: Age does not influence the quality of life of parents. However, women showed lower scores in emotional well-being and cognitive function. Prolonged use of medical devices is associated with poorer quality of life, which improves as the newborn's health condition evolves favorably.

目的：评价和比较新生儿重症监护病房新生儿父母、新生儿住院期间和在家中的健康相关生活质量，并通过分析性别差异找出影响其健康相关生活质量的因素。方法：对46名新生儿重症监护病房的92名父母进行观察性、前瞻性和分析性研究。使用PedsQL-FIM 2.0问卷在三个不同的时间点评估与健康相关的生活质量。记录了父母的社会人口学变量和新生儿的临床数据，包括医疗设备的使用情况。本研究经伦理委员会批准，采用Jamovi®v.2.3.13软件进行统计分析。结果：父母平均年龄35、41±6、20岁；51.32%是女性。在任何时间点，年龄与生活质量之间均未发现相关性，但在重症监护期间，性别在情绪幸福感方面存在差异(P =。007)，住院期间的身体健康和活动(P =。家中日常活动（P = 0.01）。在重症监护和住院期间，生活质量与医疗器械使用时间呈负相关。结论：年龄不影响父母的生活质量。然而，女性在情感健康和认知功能方面得分较低。长期使用医疗器械与较差的生活质量有关，随着新生儿健康状况的良好发展，这种情况会改善。

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引用次数: 0

Effectiveness of using software integrated with the ECOE for teaching paediatric medication administration to nursing students. 应用与ECOE集成的软件对护生进行儿科药物管理教学的效果。

Enfermeria clinica (English Edition)

Pub Date : 2025-11-13 DOI: 10.1016/j.enfcle.2025.502246

Mery Luz Valderrama Sanabria, Felipe Andrés Corredor Chavarro, Javier Eduardo Martínez Baquero, Sandra Carolina Montaño Contreras

Objective: The use of teaching methods that challenge and stimulate students' interest and clinical decision-making skills is pertinent. The appropriate use of educational software can reduce teaching problems and facilitate learning in pediatric medication administration. The objective was todetermine the effectiveness of the use of software in the training of nursing professionals at the University de los Llanos.

Method: Quantitative quasi-experimental pre-post study with a control group. The competence administration of medications in pediatrics were evaluated by means of the instrument called structured objective clinical examination, which is recognized by the acronym ECOE which has constructed validity and an alpha value of 0.68, it is known and used for the evaluation of clinical competencies.

Results: The students of both groups received training in the selected procedure and performed the ECOE for the administration of medications in pediatrics. The intervention group was administered the software. Statistical analysis was performed with ANCOVA, students who learned with the software presented on average 0.75 more score or rating, compared to those of traditional teaching.

Conclusions: It was possible to determine that learning with educational software and the clinical simulation favored learning in the administration of medications in pediatrics; this study provides solid evidence that demonstrates the need for further research in this area to improve the knowledge, skills and attitudes of future nursing professionals.

目的：采用挑战和激发学生兴趣和临床决策能力的教学方法是有针对性的。在小儿用药管理中，适当使用教学软件可以减少教学问题，促进学习。目的是确定在los Llanos大学护理专业人员培训中使用软件的有效性。方法：定量准实验前后研究，设对照组。本研究采用结构化客观临床检验（ECOE）方法对儿科药物管理能力进行评价，该方法具有构建效度，alpha值为0.68，是公认的临床能力评价方法。结果：两组学生均接受了选择程序的培训，并进行了儿科学药物给药的ECOE。干预组使用该软件。使用ANCOVA进行统计分析，与传统教学相比，使用该软件学习的学生平均得分或评分高出0.75分。结论：可以确定使用教学软件和临床模拟学习有利于儿科药物管理的学习；本研究提供了坚实的证据，表明需要进一步研究这一领域，以提高未来护理专业人员的知识，技能和态度。

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引用次数: 0