The Study On The Construction Of The Assessment Tool Of The Nurse Humanistic Practice Ability

BackgroundWith the return of medical humanities, the humanities enhance the medical staff and more attention. In 2003, Chinese Medical Association proposed to enhance the "physicians humanistic practice abilities", and launched trainings about physicians humanistic practice abilities. Experts on nursing education and management have not reach a consensus about the concept and the structure elements of nurse humanistic practice ability. And nursing training focused on the nursing clinical ability, trainings for nurse humanistic practice ability were few.At present, nurse humanistic practice ability is derived from physicians humanistic practice skills. Cao Yongfu,Shandong University professor of medical humanities,think physicians humanistic practice abilities is about communication, ethical decision-making, law practice, harmony practice, human services capabilities that a doctor need in diagnosis and treatment for patients. Many scholars proposed different opinions on humanistic, and the results show:nurse humanistic practice ability includes interpersonal communication skills, psychological adjustment, judge thinking ability, ethics decision-making ability, care aesthetic ability, the ability to care law, human care capacity.The training mode are also different at home and abroad. At abroad, the development of medicine are more mature. The study of humanistic practice ability focused on how to improve the basic element competence. Studies at home were more scattered because we have not a theoretical model to guide research. Although nursing researchers found the concept and training programs according to physicians humanistic practice abilities, but trainings for nurse humanistic practice ability were few.At present, the research on acessment tools of the nurse humanistic practice ability were few. So far, Wang Hefang in 2014 designed "humanistic nurse practitioner competency assessment tool (MIHPA)", which Cronbach’a is 0.933, but it still need expand the sample to test its effectiveness.Objectives1. Define the concept and structure elements of nurse humanistic practice ability,and develop a theoretical framework model;2. Build the acessment tool of nurse humanistic practice ability to evaluate the level of nurse humanistic practice ability;3. Analysis the factors of influencing nurse humanistic practice ability to improve the training modle.Methods1. Document and concept analysisThe researchers identify and organize the literature collected, find the discipline between the various component to analyse the objectivity of things.Our group use the school library, internet, electronic literature database to inqure the literature and knowledge, analysis the humane care nurse, nurses core competence, medical humanities practicing skills,psychosocial skills practice to define the concept of nurse humanistic practice ability.2.Delphi expert consultation2.1 Experts inclusion criteria(1) Bachelor degree or above; (2) The subtropical high and above titles; (3) more than 10 years in the field of nursing education, nursing management, clinical care, medical humanities and humanistic medicine; (4) being familiar with Medical Humanities, physicians and nurse nurse humanistic practice ability; (5) being interested and willing to participate.2.2 Expert consultation questionnaireEach expert consultation questionnaire consists of two parts:(1) basic information including name, gender, age, education, job title, supervisor, job, work experience, expert advice on judgment basis and familiarity etc.; (2) The concept of the nurse humanistic practice ability expert advisory table/the scale of nurse humanistic practice ability expert Advisory table. Expert Advisory table indexes were evaluated by Likert5 level,each indicator has a blank section for opening observations. After the first round of expert consultation, form a second round of expert consultation questionnaire by analysing the data and expert advice.2.3 Expert consultation. Use email distribution or paper version and recovery expert consultation questionnaire.3. Questionnaire3.1 Study ObjectsUse the stratified random cluster method, according to the hospital level, choose the nursing staff from 3 tertiary hospitals,6 secondary hospitals,12 basis hospital in Guangzhou,370 parts of the first, second 370, third part 1120.3.1.1 Inclusion criteria(1) clinical nurses and nursing managers who hold a certificate of qualification;(2) for six months or more in the hospital;(3) informed consent to participate in the voluntary survey.3.1.2 Exclusion criteria(1) non-hospital where nurses, including interns and visiting students;(2) not working at the hospital during the investigation, including migrant education, sick leave;(3) be reluctant to participate.3.2 Research tools and methods3.2.1 Research Tools(1) general information questionnaire, including age, gender, ethnicity, work hospital level, department name, work experience, job title, qualifications (first degree, and finally education), political affiliation, religion, marital status, whether received humanities practice or training.(2) nurse humanistic practice ability Scale (Beta), contains 5 dimensions 49 entries. The scale is a self-rating scale, using Likert5 grade score.(3) nurse humanistic practice ability Scale (application), contains 5 dimensions 26 entries.(4) CAI, including 3 dimensions 37 entries. The study will use the CAI as a standard inspection.3.2.2 Research MethodsMembers of the task grant questionare. Recovered and excluding invalid questionnaires.4. Data Processing and AnalysisMembers of the task use EXCEL2007 and SPSS13.0/AMOS17.0 to analysis statistical. P<0.05 was considered statistically significant.(1) consultants using arithmetic mean, standard deviation, constituting to indicate the basic information. Calculate experts positive coefficient, the degree of authority coefficient, views and opinions degree of concentration coefficient coefficient level of coordination;(2) the survey:1) measurement data use the mean and standard deviation; count data use the frequency and composition ratio; 2) projects and screening analysis: discrete trend method, discrimination, correlation coefficient, Cronbach coefficient method, exploratory factor;3) Validity analysis:confirmatory factor analysis, content validity, effective and effective correlation; 4) reliability analysis:Cronbach’s Alpha, split-half reliability; 5) factors analysis:ANOVA, two independent samples t-test, LSD multiple comparisons, stepwise.Results1. Establish the concept of structural elements and connotation of nurse humanistic practice ability, including 5 primary structural element and 13 sub-elements. The effective recovery rates of the questionnaire were 81.8% and 100%. The authority coefficients were 0.924, and the total consistency coefficients were 0.307 and 0.409 with statistical significance. The average value of the first class was 3.94-5.00,the coefficients variation of was 0-0.20; the average value fo the second class was 3.89～5.00,the coefficient variation was 0-0.19.2. Establish the nurse humanistic practice ability Scale, including 5 dimensions 26 entries. The total Cronbach’s Alpha of the scale was 0.913, each dimension Cronbach’s Alpha were above 0.7, the validity is good. The effective recovery rates of the questionnaire were 100% and 100%. The authority coefficients were 0.924, and the total consistency coefficients were 0.244 and 0.334 with statistical significance. Average value of the entries was 3.94～5.00,the coefficient variation were 0～0.20. The variance contribution rate is 59.440% by cumulating 5 common factors, the load factor of each title belongs items were> 0.35.3. Analysis nurse humanistic practice ability of all levels hospital in Guangzhou(1)The total score of nurse humanistic practice ability of all levels of hospital in Guangzhou (3.66 ± 0.508)is at the middle level. Ethical and legal practice ability and psychological adjustment ability were better, interpersonal communication ability and humane care ability followed,and then self-management ability at last.(2) Analysis factors Affecting the nurse humanistic practice ability. The stepwise showed that:age, final education, hospitals rank, whether received training on the humanities, concern degree from family or colleague will have influence on nurse humanistic practice ability (P<0.05). LSD multiple comparison analysis showed that:1) The score of nurse humanistic practice ability rank:Tertiary hospitals> secondary hospitals> basic hospital; 2) The nurse of bachelor degree is better; 3) The score of age group 25-29 is highest; 4) Accepting more training indicate the nurse humanistic practice ability is better; 5) Receiving more family or colleagues caring indicate the nurse humanistic practice ability is better.Conclusions1. Define the concept and structure elements of nurse humanistic practice ability. Nurse humanistic practice ability is that an ability and skill which the nurse use humanistic in practice caring, reflecting the knowledge, idea, skill, spirit of the nurse, including 5 first-classes (humane care practice skills, interpersonal communication skills, self-management skills, ethical and legal practice ability, mental ability adaptation) and 13 sub-classes.2. Build the acessment tool of nurse humanistic practice ability with good reliability and validity,it can be used to evaluate the level of nurse humanistic practice ability3. Analysis the factors of influencing nurse humanistic practice ability to improve the training modle.