| BACKGROUNDIn recent years, comprehensive experiments and simulation teaching play an important part in the reform of medical education in the world. In foreign countries, simulation teaching is a very popular teaching approach. Many researches on a variety of elements in simulation teaching have been conducted in foreign countries to achieve the best teaching effect. Domestic colleges also start to pay more attention to studying high simulation teaching method and comprehensive simulation teaching method and have achieved some results. Comprehensive simulation training of nursing refers to a practical training method of comprehensively applying medical foundation and professional knowledge and skills to give clinical nursing for simulated patients in simulated scenes similar to clinical practical work. However, in the field of domestic nursing education, comprehensive simulation training is not universally implemented. In particular, ordinary nursing colleges in China still hardly carry out such training pattern. The documents found are mostly related to the reports on the application of comprehensive simulation training in teaching of operating room nursing, pre-job training and ICU (Intensive Care Unit). The results of these studies show that comprehensive simulation training can enliven classroom atmosphere, stimulate students’ enthusiasm and initiative in learning, arouse students’ learning interests and cultivate students’ cooperation spirits so as to connect nursing teaching with nursing practice and shorten the clinical period for the adaptation of students better.At present, nursing education belongs to typical educational pattern of division of segmentation and subjects. Though students can pass theoretical knowledge and skill operation in one subject, they are unable to integrate knowledge and skills of all the subjects. Clinical teachers point out that students are lacking in the ability of analyzing and solving the problems by means of knowledge and skills and present low ability in comprehensive ability of clinical nursing after starting clinical practice. In addition, it will take at least several months for students to start clinical practice and students will forget or get unfamiliar with much operation after the majority of professional courses are ended. Therefore, it is absolutely necessary to conduct intensive training for students before practice. Intensive training of nursing skills before practice is a bridge link of classroom knowledge and clinical application and also the best time to cultivate nursing students to apply professional knowledge and skills to solve clinical practical problems. More and more nursing educators realize the great importance of implementing intensive training of skills for students before practice, research and probe into the effects and training patterns of intensive training. So far, reports related to implementation of comprehension simulation training in nursing skills training before practice are very few. Our university is an ordinary undergraduate university merged by four technical colleges. Due to limitation of various conditions including training grounds, equipment and teachers, our university has seldom implemented comprehensive simulation training. Training of nursing skills mostly follows the traditional model "demonstration—practice—assessment". Though the traditional model promotes the standardized teaching and clinical nursing operation, it still has many disadvantages.With regard to intensive training of nursing skills before practice, students majoring in Nursing in our university conduct independent practice by means of adopting the traditional project of divided courses and divided operation in ordinary laboratories and take models as operational objectives. As a result, certain limitation and disadvantages can be seen. According to the reports of related documents, similar problems are also found in some local vocational colleges which focus on operating skills of basic nursing in the aspect of intensive training and emphasize on "take technical operation as the center", which is not beneficial to cultivating clinical comprehensive ability of students. Some studies also point it out that emphasizing on proficient skills before practice can not achieve the goal of improving ability in the aspect of nursing assessment, communication, analysis and decision-making and health education. Comprehensive intensive training can better help students to adapt themselves to complicated work of clinic.Based on a comprehensive analysis of document literatures relevant to intensive training of nursing skills and comprehensive simulation training before practice, taking that universities greatly enhance construction of practical teaching to cater for conformity assessment of undergraduate teaching level of the Ministry of Education as an opportunity, the paper attempts to apply the mode of comprehensive simulation training to intensive training of nursing skills before practice, adopts some teaching methods including case teaching method, role play and scenario simulation, reasonably integrates important knowledge and skills of all the subjects like Basic Nursing and Specialist Nursing, implements intensive training of comprehensive simulation and explores its training plans and application effects.OBJECTIVE1. To formulate feasible comprehensive simulation training plans of intensive training of skills for nursing undergraduates;2. To probe into the training effects of comprehensive simulation training through implementing intensive training of comprehensive simulation for nursing undergraduates before practice and comparing it with the traditional intensive training;3. To summarize the experience and provide a certain basis for implementing comprehensive simulation training in intensive training of nursing skills.OBJECT AND METHOD1Research ObjectIt takes100nursing undergraduates in Grade2009who will start their internship and are voluntary to take part in the study as the research object and randomly divides them into two groups, adopt the method of simple random grouping,,namely the experimental group and control group with50persons in each group.2Research MethodThe courses of intensive training of nursing skills before practice which are opened in the second semester of the junior year for nursing undergraduate classes in Grade2009, including40class hours in total and the intensive training for five main specialized courses are carried out, including basic nursing, medical nursing, surgical nursing, nursing of gynecology and obstetrics and nursing for pediatrics.(1) The control group adopts the traditional method of intensive training, namely independent practice of projects via divided courses and divided operation. Teachers are responsible for demonstrating and then students repeatedly practice operation. In the process of practice, teachers offer corresponding guidance.(2) The experimental group adopts the training method of comprehensive simulation. According to the key teaching points of internal medicine, surgery, gynecology and obstetrics and pediatrics nursing, typical clinical cases are designed by teachers based on the system or various common diseases in each department, and the scenes of clinical reception and rescue of clinical common diseases are simulated and reappeared in the simulation scenarios. Students simulate the work task of clinical nursing according to clinical cases, detect, analyze and solve problems of patients by comprehensively applying basic and professional knowledge of medical science and complete the work of clinical reception and rescue. The goal of realizing intensive training of nursing skills of comprehensive simulation is to be achieved by carrying out the training under the environment of analog simulation, involving students in clinical comprehensive professional environment, familiarizing students with professional practice and closing the distance between nursing teaching and clinical nursing work.3Effect evaluation methods(1)Before the intensive training, the Objective Structured Clinical Examination (OSCE) was used to assess on two groups of students, compared two groups of students of nursing assessment ability, communication ability, analysis and decision ability, technical skills, health education ability five aspects of performance, with or without significant difference.(2) After the intensive training, the Objective Structured Clinical Examination (OSCE) was used to assess on two groups of students, compared two groups of students of nursing assessment ability, communication ability, analysis and decision ability, technical skills, health education ability five aspects of performance differences, strengthen the training effect evaluation. using self-designed questionnaire:1) to investigate the effect of two groups of students to strengthen skills training evaluation and suggestion.2) to investigate the treatment for comprehensive evaluation of simulation training and advice.(3) Students practice a month later, using self-designed questionnaire, the clinical comprehensive ability of the students was evaluated by clinical teachers.4Statistical MethodA statistical analysis of research data is conducted by means of the statistical software called Graph Pad Prism5.0. Methods of statistical analysis adopted are mainly descriptive statistical analysis, two-sample t test, paired-sample t test and chi-square test. P<0.05is considered as the difference with statistical significance.RESULTS1Baseline information resultsThere was no significant difference in the age, gender, and professional courses average scores were not significantly different (P>0.05), comparable.2OSCE assessment results(1) Before intensive training, compared the two groups of students’ ability assessed by OSCE:By two independent sample t-test, intensive training before two groups of students’ ability of nursing assessment grade(t=0.1148, P=0.9088), the communication ability grade (t=0.4972, P=0.6202), analysis, decision-making ability grade (t=0.5424, P=0.5888), the technical operation ability score (t=0.5622, P=0.5735), health education ability grade (t=0.5736, P=0.5675), no statistically significant difference were observed in the five ability score (P>0.05), comparable.(2) After intensive training, compared the two groups of students’ ability assessed by OSCE:By two independent sample t-test, the experimental group after the intensive training in nursing ability to assess overall (t=12.3, P=0.000012), the communication ability grade (t=21.35, P=0.000024)), analysis, decision-making ability grade (t=14.28, P=0.000022), health education ability grade (t=16.64, P=0.000036) scores were higher than control group, the difference was statistically significant (P<0.05). In the technical operation ability score (t=0.7756, P=0.4398) has no statistically significant difference (P>0.05).(3) Before and after intensive training, compared the scores of experimental group students’ability assessed by OSCE:The paired samples t-test, comprehensive simulation training model after intensive training, the experimental group in nursing assessment, Ability grade (t=13.20, P=0.000041), the communication ability grade (t=17.18, P=0.000065), analysis, decision-making ability grade (t=14.86, P=0.000036), the technical operation ability score (t=11.24, P=0.000072), health education ability grade (t=14.93, P=0.000024) in the five ability scores were improved obviously before the training, the difference was statistically significant (P<0.05).(4) Before and after intensive training, compared the scores of control group students’ ability assessed by OSCE:The paired samples t-test, the traditional intensive training pattern after the training, the control on technical operation ability. Achievement on improving (t=11.29, P=0.00006), the difference was statistically significant (P<.05), while in nursing ability to assess overall (t=1.630, P=0.1063), communication ability grade (t=1.713, P=0.0898), analysis, decision-making ability grade (t=1.687, P=0.0947), health education ability score (t=1.464, P=0.1463) increase is not obvious, there was no statistically significant difference (P>0.05).3The comparison of evaluation to nursing skills enhancement training.Experimental group compared with control group, the indicators are better than the control group, the skill strengthening training effect difference was statistically significant (P<0.05), the students’ practice motivation, problem solving ability, skills, operation ability, training satisfaction were increased (P<0.05), participation, training effects are enhanced (P<0.01).4The comprehensive simulation training feedback results(1) Student to teacher’s comments and proposals for more than80%of the students hold a certain degree, teacher’s performance suggested that teachers can be more involved in, strengthen the interaction between teachers and students.(2) The students for their evaluation and suggested that50%of the students think they didn’t fully prepared before class, suggested that after the training, self-reflection.(3) Students’ comments and Suggestions to the method of comprehensive simulation training comprehensive simulation training for100%of the students think they found themselves disadvantages with the knowledge and skills to attend similar training again;80%of the students think that accumulated certain clinical experience from practice;40%of the students think simulation similar to clinical, have a sense of reality. Suggest the teacher wants to add realism to the simulation training closer to clinical.(4) The contents of the training evaluation, and suggested that more than90%of students satisfied with the training content, reasonable think school, training for their help;40%of the students think that training is difficult. Suggest that teachers adjust the difficulty of simulation according to situation, teachers should further strengthen clinical practice; enrich the content of the rich intensive training,(5) The student to the comprehensive simulation training effect evaluation of more than100%of the students said they prefer this way of teaching, to improve the comprehensive skills of deepened the understanding of theoretical knowledge memory at the same time, the benefit for the cultivation of team spirit and practice to adapt to the clinical work as soon as possible;90%of the students think can improve the observation ability, the clinical emergency response ability to deal with problems, improve the communication ability, active classroom atmosphere, stimulate interest in practice. It was suggested later that in the nursing skills enhancement training, even in various courses of operation sills training, engaged in more activities such as teaching skills.5Students clinical comprehensive ability evaluationStudents practice a month later, using self-designed questionnaire, the clinical comprehensive ability of the students was evaluated by clinical teachers. The experimental group students’ clinical comprehensive ability were increased significantly (P<0.01), and its skills, familiarity with operation, teamwork, communication, observation, emergency response, critical thinking and ability of health education were improved (P<0.01).CONCLUSION1. Establish an intensive training scheme of comprehensive simulation in combination of basics, professional knowledge and skills of medical science through conducting studies.2. Assessment of OSCE (Objective Structured Clinical Examination) shows that comprehensive simulation training improves students’ ability of nursing assessment, communication, analysis and decision and health education while enhancing the technical operation ability of students.3. Comprehensive simulation training can stimulate students’ interests’ in practice, raise awareness of participation and training effect, improve training satisfaction and deepen students’ understanding and memory of theoretical knowledge, which is beneficial for students to adapt to clinical work as quickly as possible and is greatly favored by students.4. Comprehensive simulation training changes the previous concept of intensive training, namely "take technical operation as the center" and yields significant achievements in improving students’ clinical comprehensive ability of teamwork, emergency response and critical thinking.5. In the process of implementing comprehensive simulation training, there are still a number of deficiencies. Many aspects including authenticity and difficulty of simulation and evaluation of the effects still remain to be continuously explored and gradually perfected. |
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