| Objective1.To explore the current situation of ICU nurses’ core competence in county hospitals and their needs and expectations for tele-nursing teaching ward round,combined with questionnaire survey and qualitative interview.2.To construct a tele-nursing teaching and ward round program suitable for ICU nurses in county hospitals,and run it on a trial basis to explore the effects of the plan.Methods(1)Status of ICU nurses’ core competence in county hospitalsAnalyze the literature at home and abroad and refer to the intensive care nurse training textbook of the Chinese Nursing Association,initially construct the "ICU Nurse Specialist Theoretical Skills Questionnaire",and carry out a pre-survey to determine its credibility and validity.It is convenient to select 173 ICU nurses from county-level hospitals for questionnaire surveys,in-depth understanding of their core competencies,the current status of theoretical skills level of intensive care specialties and influencing factors,and provide reference for the construction of distance nursing teaching rounds programs.(2)Study on the expectation of ward round of ICU nurses’ tele-nursing teaching in county hospitalsPurpose sampling method was adopted to select 12 ICU nurses and nursing managers from county-level hospitals to conduct semi-structured interviews,and explore their expectations for tele-nursing teaching ward round,so as to provide corresponding basis for further supplementing case selection and key contents of ward round in tele-nursing teaching mode.(3)Construction and revision of ICU tele-nursing teaching ward round program in county hospitalsCombined with the literature analysis,the current situation of the core competencies of ICU nurses in county-level hospitals and their expectations for distance nursing teaching rounds,the first draft of the county-level hospital ICU distance nursing teaching rounds plan was formulated,and delphi expert consultation was carried out to improve,forming the final draft of the county-level hospital ICU distance care teaching rounds plan.(4)Effect evaluation of ICU remote nursing teaching and ward round program pilot operation in county hospitalsIn this part,a 12-week pilot study was carried out using a kind of experimental study.ICU nurses from two county-level hospitals were recruited on a voluntary basis and divided into control group and intervention group.The intervention group implemented the tele-nursing teaching ward round program,and the control group received the same case learning materials as the intervention group by establishing a wechat group.Before and after the intervention,ICU nurses’ theoretical skills questionnaire and ICU nurses’ core competence questionnaire were used to collect the data of ICU nurses in the two groups of county-level hospitals,and the intervention effect was evaluated.Objective sampling method was used to select 15 ICU nurses from county-level hospitals and 4 ICU nurses from grade-THREE hospitals to conduct semi-structured interviews,and analyze their experience and thinking in tele-nursing teaching ward rounds.Results(1)The score of core competence of ICU nurses in county-level hospitals was(206.27±39.77),and the average score was(3.68±0.71),with the highest score of nursing practice ability and the lowest score of clinical inquiry ability.ICU nurses in county-level hospitals all scored(3.11±0.75)points for theoretical items and(3.66±0.65)points for technical items.They still lacked knowledge of theoretical knowledge such as "ICU research and sepsis management" and emerging skills such as "ECMO".ICU nurses’ specialized theory,skill level,weekly autonomous learning time and whether they participate in teaching and scientific research were the important influencing factors of their core competence(P<0.05).(2)Through analyzing the needs and expectations of ICU nurses in county-level hospitals for tele-nursing teaching ward rounds,four themes and nine sub-themes are extracted: Distance nursing teaching rounds target expectations(improve the core ability of county-level hospital ICU nurses,increase communication with tertiary hospitals),distance care teaching rounds content expectations(case selection close to the grassroots,rounds content with the times,independent learning method introduction),distance care teaching rounds form expectations(high-qualification team guidance,teaching rounds convenient and not negative),distance care teaching rounds effect guarantee expectations(establish an effective supervision and evaluation mechanism,information technology guarantee).(3)Combined with the results of the previous research,the county-level hospital ICU distance care teaching rounds program was preliminarily constructed,and after12 experts in related fields conducted two rounds of Delphi expert consultation,a total of 12 county-level hospital ICU distance care teaching rounds were finally constructed.Including pre-round preparation: introduction to distance nursing teaching rounds,literature retrieval special training;Remote nursing teaching rounds:respiratory failure,cerebral hemorrhage,coronary heart disease complicated by serious arrhythmias,myocardial infarction with heart failure,head injury,cerebral infarction,sepsis,severe pancreatitis 8 typical cases,case introduction,bedside examination,remote case discussion,knowledge link four major processes;Reflection on telemedicine teaching after rounds: Design scientific research lectures and PICC workshops based on post-round feedback.(4)The baseline data of ICU nurses in county hospitals in the two groups before intervention was balanced(P>0.05)and comparable.12 weeks after the intervention,rank-sum test analysis of two independent samples showed that the theoretical skills scores of ICU nurses in the intervention group were higher than those in the control group,the difference was statistically significant(P<0.05),and the core ability scores of ICU nurses in the intervention group were higher than those in the control group,the difference was statistically significant(P<0.05).T-test of paired samples showed that the core competence scores of ICU nurses in the intervention group were improved,and the difference was statistically significant(P<0.05),while the specialty theory and skills scores of ICU nurses in the intervention group were improved,and the difference was statistically significant(P<0.05).The remote nursing teaching rounds experience of the ICU nurses of the county-level hospitals of the intervention group were excavated,and the advantages of distance care teaching rounds,the effects of distance care teaching rounds,and the limitations of distance care teaching rounds were extracted,and the advantages of distance care teaching rounds were:expanding the way of continuing education,accurate remote interactive guidance,and clear content forms;The effect of distance nursing teaching rounds: attitude change(enhancing professional identity,enhancing work enthusiasm),ability improvement(increasing theoretical knowledge reserve,changing clinical nursing concept,standardizing clinical nursing skills,and improving comprehensive professional literacy),behavior change(strengthening knowledge application,increasing active learning,and active medical and nursing communication);Limitations of distance nursing teaching rounds(lack of multidisciplinary cooperative rounds,cumbersome rounds,and difficulty in guaranteeing on-site rounds).ConclusionICU remote nursing teaching round mode in county hospitals can improve the core ability,specialty theory and skills of ICU nurses in county hospitals,expand the learning path of ICU nurses in county hospitals,improve their clinical nursing concept and professional identity,which provides a new way and measure for the cultivation of core ability of ICU nurses in county hospitals in China.It is recommended to further carry out remote nursing teaching rounds in county-level hospitals within the medical federation to promote the linkage of intensive care education resources. |
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