A Study On Training Program Of ICU Clinical Nurse Specialist

BackgroundClinical nurse specialists emerged and developed with the demand on improving the quality of nursing after world war Ⅱ. Nurse educators realized that they should train the high-level nurses to adapt to the fast development of technology and increasingly sophisticated demands of medical system. Today, the training of clinical nurse specialist in some developed countries has been mature. Clinical nurse specialists are universally acknowledged for giving high quality services. And to intensive care unit, a place where critical patients, advanced rescue equipments, high and new technologies are concentrated, nurses’abilities and qualities are extremely important. Development of clinical nurse specialists in intensive care units is the irresistible general trend. To be in line with international standards of training of nurses, and to promote the development of nursing, it is necessary to draw on the foreign experiences to develop the training program of clinical nurse specialists in intensive care units in our country.ObjectiveTo understand the attitude, competence level and related education demands of target group of students; to investigate the expectation about competency of ICU clinical nurse specialist (CNS) among ICU medical staff; to explore experts’ expectations of ICU CNS; to develop ICU CNS training program in our country.Method1. To understand the attitude, competence level and related education demands of target group of students,213nurses were investigated on the principle of concenience sampling. Factor analysis was applied to extract factors. With results of this factor analysis, an evaluation model was built, followed by a fuzzy comprehensive evaluation on attitude and competency of ICU nurses. And then a group interview was used to develop insights into students’perceptions. Twelve students who were recommended by nursing department participated in this qualitative study.2. To investigate the expectation about competency of ICU clinical nurse specialist (CNS) among ICU medical staff, totally406ICU nurses and58doctors were investigated by filling out questionnaires on the principle of convenience sampling. The collected data were analyzed by multidimensional scaling. 3. To explore experts’ expectations of ICU CNS,10ICU medical professionals were interviewed individually.4. Basing on the content mentioned above, the training goals of ICU CNS were identified. Then the training program was developed and conformed after two rounds Dephi expert’s consultion,10experts involved.Results1. Study on students’s attitude, competence level and related education demandsThe survey had revealed that the heaviest weight dimension in the evaluation model was "capacity of research", followed by "capacity of direct care", while "capacity of consultation" and "capacity of education" were at the lowest level in rank. The total score of attitude and competence of ICU nurses was3.529, and the score sequence from high to low was "attitude"(4.262),"capacity of direct care"(4.168),"capacity of therapeutic communication"(3.814),"capacity of management"(3.693),"capacity of education"(3.688),"capacity of consultation"(3.227) and "capacity of research"(3.214).The group interview found that the training of ICU CNS was essential and feasible; the training objective should come up to master level; training contents should include direct nursing care, education, research, management and consultation, and should reflect the recent development of nursing; according to the characteristic of adult learning, several teaching methods could be used, such as lecture, seminar, situational simulation and self-study; comprehensive evaluation should be used.2. Investigation on the competence expectations of ICU CNS among ICU medical staffsMedical staffs’ expectations on competence of ICU CNS were in two dimensions: clinical significance and expectation degree of development. These abilities could be divided into the following four categories:capacity of clinical practice, teamwork, education, control and improvement. Capacity of clinical practice and capacity of teamwork had the greatest clinical significance. Capacity of teamwork and capacity of control and improvement had the highest expectation degree of development.3. Qualitative research on role expectations of ICU CNSTwo main themes were identified:①Role features include passionate about intensive and critical care nursing, professional competence, critical thinking, and self-directed learning.②Role implementations include patients’ caring, guiding and knowledge spreading, leading and coordinating. 4. Study on ICU CNS training program developmentThe training goals included three grades:5items in the first grade,18items in the second grade and61items in the sub-second grade. The first grade of goals were positive attitudes, comprehensive capability of clinical practice, skilled capability of education, basic capability of research and strong capability of management. The curriculum was formed to achieve these goals, including three modules:graduate obligatory courses; core courses of CNS; and specialty courses of CNS, there were totally19courses. The arrangement for clinical practice included8practical goals and6practical aspects.Conclution1. Professional attitude of the students is passable, but their competence needs improving.2. It is suggested that ICU CNS training program should value professional attitude; focus on the competencies of teamwork, partial clinical practice, control and improvement; develop critical thinking and self-directed learning; and enhance comprehensive ability.3. In this paper we identified the training goals by the following aspects:students, society and experts, and we constructed the training program by Delphi method. The growth of ICU CNS requires a lot of clinical practices and multi-disciplinary education.