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Competence to expertise in nursing practice. 具备护理实践的能力和专业知识。
Pub Date : 2024-12-23 DOI: 10.1080/10376178.2024.2445276
Susan Welch

Background: A shift from a content-focused curriculum to a competency-based curriculum has occurred in nursing education. Competency-based education (CBE) is highly debated within higher education despite the need for competency. Competency-based education (CBE) is a form of education that takes a curriculum from a focus on an actual role or analysis perspective to an individual student's progress based on their demonstrated performance of aspects of the role. While debate exists regarding the pros and cons of CBE, theories of expertise exist to understand competency via the worldview of expert performance. Researchers and educational scholars are delving into the role of knowledge, particularly clinical knowledge, in developing and enhancing expertise and the practice of experts. In addition, CBE focuses on individual students' development and skill performance into experts. Many competency frameworks prioritize applying clinical knowledge, skills, and abilities as the building blocks of professional expertise. However, these models often overlook the capability of a nurse to handle unforeseen challenges effectively in practice as an expert.Aim and Design: This discussion piece is dedicated to exploring the ongoing debates and developments in the conceptualization of expertise. It also serves to underscore the urgent and crucial need for a paradigm shift in our approach to competency-based education (CBE) in nursing. The discussion will delve into various cognitive perspectives on expertise, particularly how accumulated knowledge is conceptualized in expert development and practice models and the implications for understanding competence through expert performance. This piece will also provide critical implications for understanding competence through expert performance, such as the conceptualizations of knowledge. Finally, this discussion will highlight the significant impact of competence as expertise within CBE, emphasizing the weight and importance of competency as expertise in nursing education.Findings and Conclusion: Literature has found that expertise in nursing practice is a result of a developmental pathway involving appropriate training and substantial practice. We propose that an integrated understanding of expertise could lead to a more comprehensive set of expert nursing practice competencies. This integration of educational concepts and situated knowledge into competency and expertise understanding requires a shift in learning environments where future experts are educated.

背景:从以内容为中心的课程到以能力为基础的课程在护理教育中已经发生了转变。尽管对能力的需求越来越大,但在高等教育中,能力本位教育(CBE)仍备受争议。能力为基础的教育(CBE)是一种教育形式,它将课程从关注实际角色或分析的角度转向基于学生个人在角色方面的表现而取得的进步。虽然关于CBE的利弊存在争议,但专业知识理论的存在是为了通过专家绩效的世界观来理解能力。研究人员和教育学者正在深入研究知识,特别是临床知识,在发展和提高专家的专业知识和实践中的作用。此外,CBE注重学生个人的发展和技能表现,成为专家。许多能力框架优先考虑应用临床知识、技能和能力作为专业知识的组成部分。然而,这些模式往往忽视了护士作为专家在实践中有效处理不可预见挑战的能力。目的和设计:这篇讨论文章致力于探索专业知识概念化方面正在进行的辩论和发展。它还强调了迫切和至关重要的需要,在我们的方法范式转变,以能力为基础的教育(CBE)在护理。讨论将深入探讨关于专业知识的各种认知观点,特别是如何在专家发展和实践模型中概念化积累的知识,以及通过专家表现理解能力的含义。这篇文章还将提供通过专家表现理解能力的关键含义,例如知识的概念化。最后,本讨论将强调能力作为专业知识在CBE中的重要影响,强调能力作为专业知识在护理教育中的重要性。研究结果和结论:文献发现,护理实践中的专业知识是一个发展途径的结果,包括适当的培训和大量的实践。我们建议,对专业知识的综合理解可以导致一套更全面的专家护理实践能力。这种将教育概念和情境知识整合到能力和专业知识的理解中,需要改变教育未来专家的学习环境。
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引用次数: 0
Introducing new nurse leadership roles through an educational framework to protect the planet and human health. 通过教育框架引入新的护士领导作用,以保护地球和人类健康。
Pub Date : 2024-12-13 DOI: 10.1080/10376178.2024.2432630
Janet Roden, Victoria Pitt, Anna Anäker, Teresa Lewis, Julie Reis, Amanda Johnson

Aims and objectives: This discussion paper proposes four new nursing leadership roles to address planetary health challenges.

Background: Nurses are essential in reducing healthcare's greenhouse emissions. The Planetary Health Education Framework (PHEF) supports integrating planetary health concepts into sustainable healthcare practice. Nurse educators with planetary health expertise should teach the PHEF, while nurse climate advocates promote it to health professionals, with nurse-led planetary health researchers undertaking climate-change research and Planetary Health Nurse Practitioners practicing sustainable healthcare.

Design: Discussion paper.

Data sources: A PICO framework was used to identify relevant articles: In nursing (P) should new roles be introduced (I) compared to no new roles (C) to understand climate change impacts on both nursing and planetary health (O).

Discussion: Barriers to sustainable healthcare include denial, group-think, and ignorance. National and International organisation enablers highlight the importance of climate change in nurse education. The Australian College of Nursing recommends government funding for nurse-led planetary health research.

Conclusion: Educators should focus on curricula development, nurse climate advocates on education and policy, researchers on supporting planetary health research, and PHNPs on climate justice, environmental protection, and emissions reduction.

目的和目标:本讨论文件提出了四个新的护理领导角色,以应对全球健康挑战。背景:护士在减少医疗保健的温室气体排放方面至关重要。地球健康教育框架(PHEF)支持将地球健康概念纳入可持续保健实践。具有行星健康专业知识的护士教育者应该教授PHEF,而护士气候倡导者则向卫生专业人员推广它,由护士领导的行星健康研究人员进行气候变化研究,行星健康护士从业人员实施可持续医疗保健。设计:讨论文件。数据来源:PICO框架用于识别相关文章:在护理中(P)应该引入新角色(I)与没有新角色(C)相比,了解气候变化对护理和地球健康的影响(O)。讨论:可持续医疗保健的障碍包括否认,群体思维和无知。国家和国际组织的推动者强调了气候变化在护士教育中的重要性。澳大利亚护理学院建议政府为护士主导的全球健康研究提供资金。结论:教育工作者应关注课程开发,护理气候倡导者关注教育和政策,研究人员关注支持地球健康研究,PHNPs关注气候正义、环境保护和减排。
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引用次数: 0
Eliminating low-value care to enhance sustainable practice. 消除低价值护理,加强可持续实践。
Pub Date : 2024-12-13 DOI: 10.1080/10376178.2024.2440017
Julia Gheller, Kylie Feely, Rochelle Wynne
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引用次数: 0
Development of the quality improvement collaborative questionnaire (QuIC) to explore quality improvement partnerships to teach pre-registration nursing students. 开发质量改进合作问卷 (QuIC),探索质量改进合作关系,为注册前护理专业学生授课。
Pub Date : 2024-11-19 DOI: 10.1080/10376178.2024.2424797
Verity Mak, Gabrielle Brand, Julia Morphet

Background: Quality improvement partnerships between healthcare organisations and higher education require further research to explore their potential to provide a valuable education experience for pre-registration nursing students.

Aims: Develop and validate a questionnaire for nurse academics to evaluate quality improvement content in pre-registration nursing curricula and the extent of partnership with higher education providers in developing this content. Conduct a pilot test of the questionnaire.

Study design: Use a content validity approach.

Methods: The Australian higher education sector was the setting and participants were nurse academics with knowledge of the quality improvement content taught in pre-registration nursing courses. The quality improvement collaboration (QuIC) questionnaire was informed by the literature and sent to ten quality improvement and higher education experts for content validation. Each question was scored on a Likert scale for relevance and clarity. The QuIC questionnaire was distributed by email to the 37 higher education organisations offering pre-registration programmes in Australia. Descriptive statistics were used to analyse the questionnaire data.

Results: Eight experts completed the content validity questionnaire in full, with the QuIC questionnaire achieving an excellent content validity score of 0.94 for relevance and clarity. The QuIC questionnaire was completed by 24 participants. The results indicated that quality improvement education partnerships are only used occasionally in Australia. The education methods used to teach this content were case studies (online cases n = 11, 46%; patient cases n = 9, 38%) and the development of quality improvement education materials (n = 7, 29%).

Conclusions: The QuIC questionnaire demonstrates excellent relevance and clarity, and is the first in the literature to address the constructs of quality improvement education and partnerships. The pilot results provide insight into quality improvement education methods used in Australia and the presence of partnerships. These results may be used to assist in the implementation of quality improvement education partnerships into curricula across the health professions.

背景:目的:为护士学者开发并验证一份问卷,以评估注册前护理课程中的质量改进内容,以及在开发这些内容时与高等教育机构的合作程度。对问卷进行试点测试:研究方法:采用内容效度法:方法:以澳大利亚高等教育部门为背景,参与者为了解注册前护理课程中质量改进内容的护士学者。质量改进合作(QuIC)问卷参考了相关文献,并发送给十位质量改进和高等教育专家进行内容验证。每个问题的相关性和清晰度均采用李克特量表评分。QuIC 问卷通过电子邮件发送给了澳大利亚 37 家提供注册前课程的高等教育机构。问卷数据采用描述性统计方法进行分析:八位专家完整填写了内容效度问卷,QuIC问卷在相关性和清晰度方面获得了0.94分的优异内容效度分数。24 名参与者完成了 QuIC 问卷。结果表明,质量改进教育伙伴关系在澳大利亚只是偶尔使用。用于教授该内容的教育方法是案例研究(在线案例 n = 11,占 46%;患者案例 n = 9,占 38%)和编写质量改进教育材料(n = 7,占 29%):QuIC问卷具有极高的相关性和清晰度,是文献中第一份涉及质量改进教育和合作伙伴关系的问卷。试点结果有助于深入了解澳大利亚使用的质量改进教育方法以及伙伴关系的存在情况。这些结果可用于协助在卫生专业课程中实施质量改进教育伙伴关系。
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引用次数: 0
Multifactorial fall interventions for people over 65 years in the acute hospital setting: pre-post-test design. 针对急症医院环境中 65 岁以上老人的多因素跌倒干预措施:前后试验设计。
Pub Date : 2024-11-12 DOI: 10.1080/10376178.2024.2420088
Allison Wallis, Christina Aggar, Deb Massey

Background: Falls are the most reported patient safety incident for patients >65 years in acute hospital settings worldwide. While multifactorial fall interventions reduce the number of falls in subacute and rehabilitation settings, fall interventions in acute hospital settings are unknown.

Aim: To evaluate the effectiveness of multifactorial fall interventions on the number of falls using codesigned education targeting staff and the patient and review the environment in acute hospital settings in NSW, Australia for patients over 65 years of age.

Method: A pre-post-test design with a non-equivalent group was conducted. All acute hospital inpatient falls occurring both pre- and post-intervention within one health district were included in this study. The use of Quality Improvement methodology identified gaps in risk screening and assessment, education and information, communication of risk, and standardised fall prevention equipment. Codesigned interventions to address these gaps were undertaken.

Results: The number of falls (p = 0.038) and injurious falls (p < 0.001) significantly decreased in the post-intervention group. There was a significant improvement in fall assessments (p < 0.001), delirium risk screening (p < 0.001), the provision of fall information (p < 0.001) and fall risk discussed at shift handover (p < 0.001) in the post-intervention group. Following the intervention, staff were significantly more likely to undertake fall education modules (p < 0.001) and develop a fall management plan (p < 0.001).

Conclusion: Falls continue to have a significant economic impact on the acute hospital setting. Our findings highlight multifactorial fall interventions that included staff and patients in the development phases reduced the number of falls. Multifactorial fall interventions targeting staff, patients and the environment may influence a reduction in the number of falls and the severity of falls in the acute hospital setting.

Impact statement: Multifactorial fall interventions reduce injurious falls, minor injuries, and falls resulting in serious injury and death.

背景:跌倒是全球急症医院65岁以上患者中报告最多的患者安全事故。目的:在澳大利亚新南威尔士州的急症医院中,对 65 岁以上的患者进行针对员工和患者的编码设计教育,并对环境进行审查,以评估多因素跌倒干预措施对跌倒数量的影响:方法:对非等效组进行前测后测设计。在一个卫生区内,干预前后发生的所有急症医院住院病人跌倒事件均被纳入本研究。通过使用质量改进方法,确定了在风险筛查和评估、教育和信息、风险沟通以及标准化防跌倒设备方面存在的差距。为弥补这些不足,我们采取了编码设计干预措施:结果:跌倒次数(p = 0.038)和伤害性跌倒(p p p p p p p 结论:跌倒继续对急症医院的经济产生重大影响。我们的研究结果表明,将员工和患者纳入开发阶段的多因素跌倒干预措施可减少跌倒次数。针对员工、患者和环境的多因素跌倒干预措施可能会减少急症医院环境中的跌倒次数并降低跌倒的严重程度。
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引用次数: 0
Detecting and managing cognitive impairment in cardiac patients: insights from qualitative interviews with nurses. 检测和管理心脏病患者的认知障碍:从对护士的定性访谈中获得的启示。
Pub Date : 2024-10-18 DOI: 10.1080/10376178.2024.2415896
Emma Zhao, Jacqueline Bloomfield, Nicole Lowres, Robyn Gallagher

Background: Cognitive impairment and cardiovascular disease often coexist, and nurses are ideally positioned to detect and manage cognitive impairment in cardiac patients.Objectives: This study explored nurses' perspectives on understanding, detecting, and acting on cognitive impairment in cardiac patients.Design and Methods: Using an exploratory descriptive design, nurses from acute and outpatient cardiac units were interviewed. Data were thematically analyzed.Results: Sixteen nurses were interviewed, working in acute cardiology (n=7), cardiothoracic and intensive care (n=4), and cardiac rehabilitation (n=5). Three themes emerged: (1) Cognitive screening was not routine, with no clear protocols on who, when, and how to screen; (2) Nurses had varying understanding of cognitive impairment, dementia, and delirium; (3) Nurses acted on suspected cognitive changes to ensure patient safety, including referrals and care modifications.Conclusions: Cognitive screening was inconsistent, with barriers, such as workload and lack of education. Guidelines for feasible screening across settings are needed.

背景:认知功能障碍与心血管疾病往往同时存在,而护士是检测和管理心脏病患者认知功能障碍的理想人选:本研究探讨了护士对心脏病患者认知障碍的理解、检测和处理的观点:采用探索性描述设计,对急诊和门诊心脏科的护士进行了访谈。对数据进行了主题分析:结果:16 名护士接受了访谈,他们分别在急诊心脏科(7 人)、心胸外科和重症监护室(4 人)以及心脏康复科(5 人)工作。访谈中出现了三个主题:(1)认知筛查不是常规筛查,对筛查对象、筛查时间和筛查方式没有明确的规定;(2)护士对认知障碍、痴呆和谵妄的理解各不相同;(3)护士对可疑的认知变化采取行动以确保患者安全,包括转诊和护理调整:结论:认知筛查不一致,存在工作量和缺乏教育等障碍。需要制定在不同环境中进行可行筛查的指南。
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引用次数: 0
The role of the ward nurse in recognition and response to clinical deterioration: a scoping review. 病房护士在识别和应对临床病情恶化中的作用:范围界定综述。
Pub Date : 2024-10-09 DOI: 10.1080/10376178.2024.2413125
Nikita Donnelly, Margaret Fry, Rosalind Elliott, Eamon Merrick

Background: Nurses play a key role in the recognition and response to clinical deterioration.

Aim: The aim of this scoping review was to explore, map and synthesise existing research related to the ward nurses' role in recognising and responding to clinical deterioration.

Methods: A scoping review was undertaken to identify English only studies focused on the ward nurse's role in recognition and response to clinical deterioration of the hospitalised adult. Search terms included 'clinical deterioration', 'nurses', 'wards', 'general', 'hospital, units' and 'hospitals'. The Cumulative Index to Nursing and Allied Health Literature, EMBASE, Ovid MEDLINE, PubMed, ProQuest and Science Direct databases were searched for eligible studies.

Results: Forty-six studies met the inclusion criteria and three major themes were synthesised: (i) recognition of deterioration; (ii) nursing assessment; and, (iii) challenges responding to patient deterioration.

Conclusion: The review highlighted significant variability in the ward nurses' role, activities, and skills in assessing, monitoring, managing and escalating care for clinical deterioration.

背景:护士在识别和应对临床病情恶化方面发挥着关键作用:护士在识别和应对临床病情恶化方面发挥着关键作用。目的:本范围综述旨在探索、绘制和综合与病房护士在识别和应对临床病情恶化方面的作用有关的现有研究:方法:我们进行了一次范围界定审查,以确定只有英文研究侧重于病房护士在识别和应对住院成人临床病情恶化方面的作用。检索词包括 "临床恶化"、"护士"、"病房"、"普通"、"医院、单位 "和 "医院"。在《护理及相关健康文献累积索引》、EMBASE、Ovid MEDLINE、PubMed、ProQuest 和 Science Direct 数据库中检索了符合条件的研究:结果:46 项研究符合纳入标准,并归纳出三大主题:(i) 识别病情恶化;(ii) 护理评估;(iii) 应对患者病情恶化的挑战:综述强调了病房护士在评估、监测、管理和升级临床病情恶化护理方面的角色、活动和技能存在很大差异。
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引用次数: 0
Communicating health information to children: is a child-rights-based approach being adopted by nurses? An integrative review. 向儿童传达健康信息:护士是否采用了基于儿童权利的方法?综述。
Pub Date : 2024-10-09 DOI: 10.1080/10376178.2024.2409737
Victoria Egli, Emma McIntyre, Nina Duggan

Background: Childhood is a time when health behaviours are established and the foundations for health literacy are cemented. In Aotearoa New Zealand nurses are responsible for communicating health messages to children at key stages in children's lives.

Objectives/aims: This review explores the ways in which nurses communicate health messages to children and adolescents in Aotearoa New Zealand. It evaluates whether current approaches to health communication are in-line with a child's rights-based approach.

Design: An integrative review using a systematic literature search strategy.

Data sources: In July 2022, 9 databases were searched including: Medline (Ovid), Embase (Ovid), Scopus (Elsevier), Cochrane Library, EBSCO (host), Web of Science Core Collection, CINHIAL plus, psychINFO and PsychEXTRA.

Methods: Following title and abstract screening 41 articles went through to full-text screening. These were uploaded into NVivo v.12 for analysis. Results were analysed using content analysis with a deductive coding framework informed by the UN Convention on the Rights of the Child. A total of 20 articles met all inclusion criteria and were assessed of high quality using the Mixed Methods Appraisal Tool.

Results: Nurses communicate health messages using a variety of strategies, some of which align with the rights of the child. No evidence was found of nurses communicating health messages through play or creative activities or by adopting principles and practice of continuity of care, including health communication beyond the paediatric context.

Conclusion: Opportunities exist for improvements to the rights of children and adolescents within nursing practice. Further research about the rights of children in healthcare services including not only identifying the barriers but research that includes interventions and proposes solutions is necessary .

背景儿童时期是建立健康行为和巩固健康知识基础的时期。在新西兰奥特亚罗瓦,护士负责在儿童生命的关键阶段向儿童传达健康信息:本综述探讨了新西兰奥特亚罗瓦地区护士向儿童和青少年传达健康信息的方式。设计:设计:采用系统文献检索策略进行综合审查:2022 年 7 月,共检索了 9 个数据库,包括Medline (Ovid)、Embase (Ovid)、Scopus (Elsevier)、Cochrane Library、EBSCO (host)、Web of Science Core Collection、CINHIAL plus、psychINFO 和 PsychEXTRA:在对标题和摘要进行筛选后,对 41 篇文章进行了全文筛选。这些文章被上传到 NVivo v.12 进行分析。根据联合国《儿童权利公约》,采用内容分析法和演绎编码框架对结果进行分析。共有 20 篇文章符合所有纳入标准,并使用混合方法评估工具进行了高质量评估:结果:护士使用各种策略传播健康信息,其中一些策略与儿童权利相一致。没有证据表明护士通过游戏或创造性活动传达健康信息,或采用连续性护理的原则和做法,包括儿科以外的健康信息沟通:结论:在护理实践中存在改善儿童和青少年权利的机会。有必要进一步研究儿童在医疗保健服务中的权利,其中不仅包括确定障碍,还包括研究干预措施并提出解决方案。
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引用次数: 0
Trauma Connect Clinic: Continuing the trauma case management model for patients affected by traumatic injuries: A quality improvement initiative. 创伤连接诊所:继续为受创伤影响的患者提供创伤病例管理模式:质量改进计划。
Pub Date : 2024-10-08 DOI: 10.1080/10376178.2024.2410920
Kate Dale, Kathy Heathcote, Sarah Czuchwicki, Elizabeth Wake

Background: A case-management model of care is frequently used in acute-care settings for patients with major traumatic injuries; however, its application to trauma follow-up care after hospital discharge remains unclear.

Aim: To describe the services provided by the Trauma Connect Clinic (TCC): a NP- led case management model, in trauma follow-up care.

Methods: An exploratory descriptive study design was used. Data collected included patient and injury characteristics, clinic activities, attendance rates, referral patterns and complications.

Results: Three-hundred and twenty-four TCC appointments were scheduled for 194 patients (n = 302) with an attendance rate of 93% (n = 302). Ongoing health issues included pain (n = 22, 37%), thrombotic events (n = 8, 13%) and infection (n = 7, 12%). Clinic activity included 77 referrals to the wider MDT (n = 77), radiology reviews (n = 225) and 39 prescribing events, consisting mainly of analgesia.

Conclusion: A case management model can successfully deliver trauma follow-up care and efficiently use limited resources. Key elements involve careful assessment and management of patients' physical and emotional needs. Evaluation of longer-term outcomes of this model of care in trauma settings is required.

背景:目的:描述创伤连接诊所(TCC)在创伤后续护理中提供的服务:一种由护士主导的个案管理模式:方法: 采用探索性描述研究设计。方法:采用探索性描述研究设计,收集的数据包括患者和伤情特征、诊所活动、就诊率、转诊模式和并发症:共为 194 名患者(302 人)安排了 324 次 TCC 预约,就诊率为 93%(302 人)。持续存在的健康问题包括疼痛(22 人,37%)、血栓事件(8 人,13%)和感染(7 人,12%)。门诊活动包括 77 例转诊至更广泛的 MDT(n = 77)、放射学复查(n = 225)和 39 例处方事件,主要包括镇痛:结论:病例管理模式可以成功提供创伤后续护理,并有效利用有限的资源。结论:病例管理模式可以成功提供创伤后续护理,并有效利用有限的资源,其关键因素包括仔细评估和管理患者的身体和情感需求。需要对这种创伤护理模式的长期效果进行评估。
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引用次数: 0
Older nurses and work-related factors that impact their mental health and wellbeing: a qualitative systematic review. 影响老年护士心理健康和福祉的工作相关因素:定性系统综述。
Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1080/10376178.2024.2368625
Jed Montayre, Celia Harris, Weicong Li, Liyaning Maggie Tang, Sancia West, Mark Antoniou

Background: The COVID-19 pandemic has placed a significant pressure on the nursing workforce, leading to an increased risk of infection and work-related issues impacting nurses' mental health. This review aims to explore the workplace challenges faced by older nurses and their impact on mental health.

Method: This qualitative systematic review followed the Joanna Briggs Institute methodology.

Results: The review included 32 studies and identified three interconnected themes: heavy workload and nature of nursing, lack of recognition and feeling undervalued, and challenges in balancing personal life and work. These themes illustrated the complexity of the workplace challenges faced by older nurses.

Discussion and conclusion: Workplace demands and shift work were common negative contributors to mental health and wellbeing. The physical and cognitive capacity of older nurses may diminish due to age-related changes, making the workload more challenging. Recognition and support from the organisation, especially from management and leadership, played a crucial role in nurses' resilience.

背景:COVID-19 大流行给护理人员队伍带来了巨大压力,导致感染风险增加以及影响护士心理健康的工作相关问题。本综述旨在探讨老年护士面临的工作场所挑战及其对心理健康的影响:这项定性系统综述采用了乔安娜-布里格斯研究所的方法:综述包括 32 项研究,确定了三个相互关联的主题:繁重的工作量和护理工作的性质、缺乏认可和感觉价值被低估,以及平衡个人生活和工作方面的挑战。这些主题说明了老年护士面临的工作场所挑战的复杂性:讨论和结论:工作场所的要求和轮班工作是影响心理健康和幸福的常见负面因素。由于年龄的变化,老年护士的体力和认知能力可能会下降,从而使工作量更具挑战性。来自组织的认可和支持,尤其是来自管理层和领导层的认可和支持,对护士的抗压能力起着至关重要的作用。
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引用次数: 0
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Contemporary nurse
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