以科研课题为中心PBL护理教育模式的研究及应用
摘要
目的
通过对国内15所护理院系护理科研及相关课程开设情况,以及对南方医科大学120名2005年级护理本科生护理科研知识掌握情况及态度进行调查,旨在了解学生对护理研究教育的态度及知识掌握程度,为护理科研教育研究提供理论依据。针对目前护理科研教育中存在的问题及基于问题的学习(problem-basedlearning,PBL)教学方法的局限性,在本科生教育中创建以科研课题为中心的PBL(project-based learning,PBL)护理教育模式。应用该护理教育模式,以循证护理(evidence-based nursing,EBN)理论为指导,指导本科生在对糖尿病前期及糖尿病病人、腹部手术病人健康教育现状系统综述的基础上,研制调查问卷,展开多中心健康教育需求调查研究,并研制南方健康教育网站,为实施糖尿病前期及糖尿病病人、腹部手术病人个性化健康教育服务奠定理论及实践基础。
方法
第一章第一部分:采用Email问卷调查法,对国内15所护理院系护理科研及相关课程开设情况进行调查,内容包括护理科研及相关课程6个维度:《护理科研》、《文献检索》、《护理科技论文写作》(以下简称“《写作》”)、《流行病学》、《医学统计学》、其他护理科研相关课程的开设情况。其中每一个维度中如果有开设上述课程,分别对学时数、开课时间、教材、师资队伍(包括数量、学历、职称、年龄、任教时间5个方面)4个方面进行开放式题目问答;第二部分:对南方医科大学120名2005年级护理本科生发放自行设计的调查问卷,当场回收,问卷内容包括2个部分:第一部分为护理科研知识试题,包括22道单项选择题;第二部分为护理科研态度,包括4道单项选择题;第二章以第一章调查数据为依据,设计教学计划及目标,对2个学习小组开展本研究PBL护理教育模式研究。采用小组讨论会、时时电子联络等教学方法,教学实施包括教师将研究课题分成2个方向,确定若干问题,介绍课题研究背景,指导科研思路,检索外文文献,筛选出难易适中的文献进行分类;确定教学目标及方法;制定分阶段考核目标;联系教学场地;进行经费预算。每个学生选择1个问题查阅文献,撰写总结报告,其中新进展部分撰写综述;在充分了解国内外研究现状基础上,研制糖尿病前期及糖尿病病人、腹部手术病人健康需求调查问卷并组织实施;师生共同设计与建设南方健康教育网站;第三章第一部分:以EBN理论为指导,在系统综述国内外糖尿病前期及糖尿病病人健康教育现状及研究成果的基础上,找出目前糖尿病健康教育存在的问题,多中心调研糖尿病前期及糖尿病病人健康教育需求。参考国内外相关文献,咨询心理学、统计学专家各1名,护理学专家3名,并参照预调查结果的基础上,自行设计及修订调查问卷。问卷分成3个部分:包括一般情况、健康教育需求以及健康教育方式需求。一般情况包括性别、年龄、民族、文化程度、医疗费用类型、劳动者类型、患病时间、诊断、并发症数量。其中,文化程度包括高中及以上、中专及初中、小学及以下文化程度3个层次;劳动者类型分为脑力劳动者、体力劳动者2种;医疗费用支出分为公费、自费2种。健康教育需求部分包括8个维度:一般糖尿病知识需求情况、营养、运动、健康教育、自我监测、并发症、药物及出院指导健康教育需求。其中第1个维度包括10个条目,第2个维度包括6个条目,第3个维度包括3个条目,第4、6个维度各包括2个条目,第5个维度包括3个条目,第7个维度包括6个条目,第9个维度包括1个条目。每一条目分成非常需要、需要、无所谓、不是很需要及不需要5个等级,采用单项选择法。健康教育需求方式调查包括14个条目,每一条目分成是和否2个选项,采用多项选择法。在国内首先以广东省专科护士(clinical nurse specialist,CNS)研究生课程班教育形式培养CNS,作为本调查员培训的师资。以南方医科大学糖尿病护理学选修课形式培养调查员。8名调查员分成4组,统一术语,讲解调查表内容及要求,对糖尿病前期及糖尿病病人进行问卷调查,没有文化者由调查员通过访谈记录调查结果,当场回收调查表。统计数据通过SPSS13.0软件包进行处理及分析,使用的统计方法包括问卷信效度检验、频数分布分析、描述性统计分析、等级资料使用等级Logistic全变量回归分析,二分类资料使用二分类Logistic回归分析,两相关样本的非参数检验方法为Wilcoxon两相关样本符号秩检验,多个相关样本的非参数检验方法为Friedman检验。在系统综述国内外糖尿病健康教育现状的基础上,以及针对糖尿病前期及糖尿病病人健康教育需求,研制糖尿病网络健康教育形式,开发糖尿病网络门诊;第二部分:以EBN理论为指导,在系统综述国内外腹部手术病人健康教育现状及研究成果的基础上,找出目前腹部手术病人健康教育存在的问题,多中心调研腹部手术病人健康教育需求。参考国内外相关文献,咨询心理学、统计学各1名,护理学专家3名,并参照预调查结果的基础上,自行设计及修订调查问卷。问卷分成6个部分:包括一般情况、腹部手术前、手术后、出院指导健康教育需求、病人喜欢的出院指导方式及获取健康信息的方式需求。一般情况包括性别、年龄、民族、文化程度、医疗费用类型、劳动者类型、术后时间、麻醉方式、疼痛等级。其中,文化程度包括高中及以上、中专及初中、小学及以下文化程度3个层次;劳动者类型分为脑力劳动者、体力劳动者2种;医疗费用支出分为公费、自费2种;麻醉方式分为全麻和局麻2种;疼痛等级分为0～7级。第2部分包括11个条目,第3部分包括3个条目,第4部分包括1个条目。每一条目分成非常需要、需要、无所谓、不是很需要及不需要5个等级,采用单项选择法。第5部分包括9个条目,第6部分包括8个条目,采用多项选择法。12名调查员分成6组,统一术语,讲解调查表内容及要求,对腹部手术后病人或家属进行问卷调查,行动不便、没有家属陪伴或没有文化者由调查员通过访谈记录调查结果,当场回收调查表。统计数据通过SPSS13.0软件包进行处理及分析,使用的统计方法包括问卷信效度检验、频数分布分析、描述性统计分析、等级Logistic全变量回归分析及二分类Logistic回归分析,两相关样本的非参数检验方法为Wilcoxon两相关样本符号秩检验,多个相关样本的非参数检验方法为Friedman检验。在系统综述国内外腹部手术病人健康教育现状的基础上,根据病人的健康教育需求,研制我国首个腹部手术专题护理网站,与糖尿病专科护理网站合二为一为南方健康教育网站。网站开发充分利用计算机的图像、动画、图形、声音的多媒体功能,研制过程介绍了网站的开发、应用环境、资料来源、设计思想及结构内容。
结果
第一章第一部分:15所护理院系中有13所开设了《护理科研》课程。学时数从30～64学时不等,平均(38.92±11.36)学时。师资以研究生学历水平为主,有独立的教材,而年龄梯队和职称等反映师资科研和教学经验的指标还不尽如人意。护理师资力量还不能独立胜任护理科研相关课程的教学任务。与本科生护理科研能力培养密切相关的《文献检索》课程,开设情况并不乐观。相比之下《医学统计学》更受到重视。护理科研及相关课程的教学计划显得混乱,具体该开设多少学时适合护理本科生教育,每个学校都不尽相同;第二部分:认为护理科研工作非常重要和重要的占大多数,学生对护理科研工作比较重视。大部分学生认为护理科研课程安排得一般或不好,对自己掌握护理科研知识程度也认为一般或不好。学生认为掌握护理科研方法的教育途径重要性(从高到低)排序为课堂讲授、参加研究团队、临床实践、申报课题、自学。22道题目中只有7道题正确率超过了60%,其余15道题正确率均在60%以下。最低分5分,最高分16分,平均(10.48±2.50)分,实际得分不足总分的一半。与学生的自评结果一致。护理科研中概念性的问题大部分学生还没搞明白;第二章:PBL护理教育模式中学生教学效果评价采取分阶段理论及实践考核的形式:包括论文撰写数量达标率、网站内容合格率及调查问卷合格率,这三部分各占总评分数(100分)的1/3。经过2年多的学习和研究,4名学生的论文在国家核心期刊上发表。20名学生已完成网站内容资料的汇总与录入,完成调查问卷1450份,网站内容合格率92.06%及调查问卷合格率为88.07%,均获得南方医科大学创新学分,本研究最后总结出以申报科研课题的方式提出问题,充分利用业余时间,弥补课堂教学形式的不足,结合灵活多样的教学方法,注重理论与实践相结合的PBL护理教育模式;第三章PBL护理教育模式在本科生健康教育研究中的应用。第一部分:糖尿病前期及糖尿病健康教育需求调查问卷的内部一致性信度(Cronbach's alpha为0.971,x~2=109.858,P=0.000)及结构效度均较好。一般健康教育需求中,病人最希望了解的是糖尿病治疗方案和糖尿病的危害,其次是糖尿病危险因素,糖尿病护理方案,临床表现,诊断标准,预防,糖尿病前期诊断标准,相关术语,临床分型(P=0.000);病人最希望了解的糖尿病营养健康教育需求内容是饮食治疗的意义,其次是食物选择方法,营养素分配与餐次,食物交换份法,热量计算方法,食物血糖生成指数(glucose index,GI)的概念(P=0.000);病人最希望了解的运动健康教育需求是运动疗法的意义,其次是运动疗法的注意事项,最后是运动处方的内容(P=0.000);病人最希望了解的自我监测教育需求内容是了解血糖的监测方法、次数,其次是了解尿糖的监测方法,最后是了解糖化血红蛋白(glycosylated hemoglobin,HbAlc)的监测意义及方法(P=0.000);病人最希望了解的药物治疗健康教育需求是了解低血糖反应的防治,其次是了解口服降糖药物的副作用,了解口服降糖药物使用方法,了解胰岛素(insulin,INS)的使用方法,了解INS使用的注意事项,了解口服降糖药物的种类(P=0.000)。与护士比较,病人更希望由医生提供健康教育(P=0.023)。糖尿病前期及糖尿病一般健康教育中“了解糖尿病相关术语”(P=0.010,R~2=0.037)、“了解糖尿病三级预防知识”(P=0.040,R~2=0.031)、“了解糖尿病的诊断标准”(P=0.003,R~2=0.043)、“了解糖尿病的临床分型”(P=0.006,R~2=0.039)、“了解糖尿病的治疗方案”(P=0.037,R~2=0.033),营养健康教育中“了解GI的概念”(P=0.013,R~2=0.036)、“了解食物选择方法”(P=0.005,R~2=0.042)、运动健康教育需求中“了解运动疗法的意义”(P=0.049,R~2=0.031)、“了解运动处方的内容”(P=0.019,R~2=0.035)及“了解运动疗法的注意事项”(P=0.035,R~2=0.032),健康教育者需求中“由护士提供健康教育”(P=0.030,R~2=0.033),自我监测健康教育中“了解血糖(P=0.018,R~2=0.036)、尿糖(P=0.038,R~2=0.031)、HbAlc的监测方法、次数(P=0.021,R~2=0.033)”,并发症健康教育需求中“了解糖尿病并发症的种类”(P=0.007,R~2=0.041)、“了解糖尿病并发症的护理”(P=0.002,R~2=0.046),药物治疗健康教育需求中“了解口服降糖药物的种类(P=0.003,R~2=0.045)、使用方法(P=0.038,R~2=0.032)及副作用(P=0.022,R~2=0.035)”、“了解低血糖反应的防治”(P=0.033,R~2=0.033)及“出院指导”(P=0.006,R~2=0.041)健康教育需求均与文化程度(P＜0.05)相关,高学历病人需求明显;一般需求中“了解糖尿病三级预防知识”(P=0.040,R~2=0.031)与年龄(P=0.045)相关,年龄越小需求越明显;一般需求中“了解糖尿病的治疗方案”(P=0.037,R~2=0.033)及药物治疗需求中“了解口服降糖药物的副作用”(P=0.022,R~2=0.035)与民族(P=0.014,P=0.011)相关,汉族病人需求更明显;营养需求中“了解食物选择方法”(P=0.005,R~2=0.042),运动需求中“了解运动疗法的意义”(P=0.049,R~2=0.031),健康教育者需求中“由医生提供健康教育”(P=0.024,R~2=0.035),药物治疗需求中“了解口服降糖药物的种类(P=0.003,R~2=0.045)、使用方法(P=0.038,R~2=0.032)及副作用(P=0.022,R~2=0.035)”、“了解低血糖反应的防治”(P=0.033,R~2=0.033)均与患病时间(P＜0.05)相关,除了“了解口服降糖药物的副作用”是患病时间越长需求越明显,其余6种需求都是患病时间短病人需求更明显;自我监测健康教育中“了解血糖(P=0.018,R~2=0.036)、尿糖的监测方法、次数(P=0.038,R~2=0.031)”均与劳动者类型(P=0.005,P=0.032)相关,脑力劳动者需求明显。其他健康教育需求回归方程均P＞0.05。病人最喜欢的健康教育方式是返院糖尿病医生门诊咨询,其次是报纸、杂志,电话咨询,医院邮寄健康宣传册、图书,返院糖尿病护理门诊咨询,返院听专题讲座,医护人员上门服务,上网,返院参加定期组织的护患交流会,宣传栏,手机短信,观看录像带,光盘教育资料,最后是其他教育方式(P=0.000)。电话咨询方式(P=0.014,R~2=0.045)与年龄(P=0.013)、性别(P=0.029)相关,年龄小,男病人需求高;手机短信方式(P=0.022,R~2=0.062)与患病时间(P=0.007)相关,患病时间越短需求越高;上网方式(P=0.000,R~2=0.213)与年龄(P=0.000)、劳动者类型(P=0.008)及并发症数量(P=0.000)相关,年龄越小、并发症越少病人需求高,脑力劳动者病人需求高;医院邮寄健康宣传册(P=0.000,R~2=0.071)、图书方式与医疗费用类型(P=0.049)、劳动者类型(P=0.011)相关,公费、脑力劳动者需求高;观看录像带方式(P=0.022,R~2=0.062)与并发症数量(P=0.009)相关,并发症数量越多需求越高;光盘教育资料(P=0.000,R~2=0.109)、报纸、杂志方式(P=0.008,R~2=0.046)均与文化程度(P=0.014,P=0.000)及并发症数量(P=0.001,P=0.026)相关,文化程度越高、并发症数量越多需求越高;返院糖尿病医生门诊咨询方式(P=0.034,R~2=0.035)与患病时间(P=0.015)、并发症数量(P=0.049)相关,患病时间越长、并发症越多需求越高;返院听专题讲座方式(P=0.002,R~2=0.063)与性别(P=0.034)、年龄(P=0.012)及文化程度(P=0.051)相关,女病人需求高,年龄越大、文化程度越高病人需求越高;医护人员上门服务方式(P=0.003,R~2=0.060)与劳动者类型(P=0.000)相关,体力劳动病人需求高;其他健康教育方式回归方程均P＞0.05;第二部分:腹部手术病人在院各阶段(入院、术前、术后及出院指导)健康需求程度均较高。比较责任护士,病人更希望了解主管医生的姓名、职称及技术水平(P=0.000);与麻醉师相比,病人更希望了解主管医生的姓名、职称及技术水平(P=0.000);病人希望了解责任护士及麻醉师姓名、职称及技术水平两者之间差异没有显著性(P=0.124)。腹部手术前健康教育需求中“了解主管医生姓名、职称、技术水平”(P=0.026,R~2=0.056)、“了解麻醉师姓名、职称、技术水平”(P=0.000,R~2=0.124)、“了解医院有关规章制度”(P=0.001,R~2=0.072)、“了解术前检查的必要性”(P=0.005,R~2=0.066)、“了解术前准备的重要意义”(P=0.000,R~2=0.082)、“告知手术术式及程序”(P=0.000,R~2=0.096)均与性别(P＜0.03)相关,女病人需求明显;术前健康教育需求中“了解主管医生姓名、职称、技术水平”(P=0.026,R~2=0.056)、“了解麻醉师姓名、职称、技术水平”(P=0.000,R~2=0.124)、“了解医院有关规章制度”(P=0.001,R~2=0.072)、术后健康教育需求中“告知手术是否成功”(P=0.030,R~2=0.065)均与文化程度(P＜0.04)相关,高学历病人术前3个健康教育需求明显,低学历病人术后健康教育需求高;术前健康教育需求中“护士手术前对您的健康需求给予指导”(P=0.000,R~2=0.083)、“告知手术名称”(P=0.029,R~2=0.053)、术后健康教育需求中“告知手术是否成功”(P=0.030,R~2=0.065)以及“出院指导”(P=0.001,R~2=0.081)均与医疗费用类型(P＜0.05)相关,公费病人需求明显;术前健康教育需求中“了解医院有关规章制度”(P=0.001,R~2=0.072)、“了解术前准备的重要意义”(P=0.000,R~2=0.082)均与麻醉方式(P＜0.05)相关,全麻病人需求明显;术前健康教育需求中“介绍手术室环境”(P=0.000,R~2=0.119)与民族(P=0.043)相关,少数民族更关注。其他健康教育需求回归方程均P＞0.05。病人喜欢的出院指导方式中“出院时医生直接给予出院指导”[313(50.3%)]最受病人欢迎,“电话咨询”[230(37.0%)]方式排在第二位。在病人获取健康信息方式中,“护士专门介绍”[307(49.4%)]位列第一,提示病人更喜欢和护士面对面的交流。病人喜欢的出院指导方式中电话咨询方式(P=0.000,R~2=0.097)与性别(P=0.008)、年龄(P=0.045)、疼痛程度(P=0.046)及麻醉方式(P=0.000)相关,采用局麻方式、疼痛越轻、年龄越小的女病人需求越明显;出院时医生给予指导(P=0.000,R~2=0.071)与疼痛程度(P=0.000)及年龄(P=0.006)相关,疼痛越重、年龄越大需求越明显;病人获取健康信息的方式中护士专门介绍(P=0.000,R~2=0.108)与医疗费用类型(P=0.015)、性别(P=0.041)及疼痛程度(P=0.000)相关,疼痛轻、男性及自费病人需求明显;观看录像带方式(P=0.001,R~2=0.139)与性别(P=0.029)、麻醉方式(P=0.020)相关,全麻方式及女性病人需求明显;宣传栏方式(P=0.006,R~2=0.068)与性别(P=0.028)及劳动者类型(P=0.027)相关,女病人及脑力劳动病人需求明显;上网方式(P=0.000,R~2=0.085)与文化程度(P=0.011)相关,文化程度越高,病人需求越明显。南方健康教育网站网络运行结果显示,在WindowsXP操作系统、IE6.0浏览器上运行稳定,未出现程序运行出错或死机现象,未出现字符错误显示等问题。在网上发布,网站交互性显示良好,与相关网站链接未见出错。
结论
第一章第一部分:护理教育者应不断完善《护理科研》及相关课程教育,加强《护理科研》师资培养;开展护理科研及相关课程教学研究。第二部分:教师应激发学生学习兴趣,深化护理科研及相关课程改革;注重基础知识教育,丰富护理科研实践经历;实施师资队伍建设,历练护理科研及教学能力;第二章:本研究PBL护理教育模式能激发学生学习兴趣、强调学习个性化;小组成员相互学习,强调学习互动;设计成果目标,强调言传身教;构建多样化平台,强调信息共享;考核形式多元化,强调综合能力培养;第三章第一部分:问卷内容逻辑性强,题目数量合适,可用于不同类型糖尿病前期及糖尿病病人的健康教育需求评估。病人认为健康教育需求重要性排序是从易到难的,也就是说,容易理解的排在前面,而相对较难理解的排在后面。糖尿病健康教育中需要病人了解的重要术语及相关知识,很多病人还不清楚,医护人员的健康教育服务还不深入。在教育前CNS应充分评估病人病人掌握的专业知识情况及性别、年龄、民族、文化程度、医疗费用类型、劳动者类型、患病时间、诊断、并发症数量等影响因素,对处于不同疾病阶段的病人应该有针对性的给予教育服务,并应加强开放式教育方式(如看录像带、光盘教育资料、报纸、杂志、上网)病人管理研究,提高其依从性。健康教育形式以返院糖尿病医生门诊咨询最受病人欢迎,虽然糖尿病护理教育还不普及,但随着国内糖尿病专科护理教育不断发展,将具有非常广阔的前景。国内没有糖尿病专科护理网站。国外有糖尿病专科护理杂志及学会的网站,但网站中没有糖尿病护理门诊服务。本研究的糖尿病专科护理网络门诊是以广东省培养的全国首批糖尿病CNS为门诊护理专家,在广东省形成糖尿病专科护理网络,定期出诊为有健康教育需求的人群服务;第二部分:腹部手术病人的健康教育需求程度较高,护士应发挥其专业优势,健康教育前充分评估病人的性别、年龄、民族、文化程度、医疗费用类型、劳动者类型、疼痛程度、麻醉方式等影响因素,探索个性化的、全程的、优质的腹部手术病人健康教育服务模式,才能满足病人的健康需求。健康教育形式以能和医护人员直接交流的指导、电话咨询形式最受欢迎。护士应注重研制网络、光盘及录像等多媒体教育方式,以满足不同病人的需求。由于腹部手术涉及知识范围广泛,目前国内外尚未见独立的护理专题网站。腹部手术病人上网方式需求与文化程度相关,文化程度越高,病人需求越明显。开发研制腹部手术护理专题网站以满足文化程度高病人的健康教育需求具有重要意义。其他糖尿病前期及糖尿病、腹部手术病人健康教育方式也将是本研究的方向,本研究将根据循证结果及病人需求研制多种多样的健康教育方式。
Objectives
To know knowledge level and attitude of undergraduated students to nursing research education,and to offer theoretical basis to education study of nursing research,two investigations are conducted,the one is about nursing research and correlative curriculums of 15 nursing schools in China,the other one is about knowledge level and attitude of 2005 grade undergraduated students in Nanfang medical university to nursing research education.Aim at the problems of nursing research education and limits of problem-based learning,we have been built nursing education model of project-based learning(PBL) in undergraduated students education.Application of nursing education model of PBL,in the light of evidence-based nursing(EBN),the teachers conduct students to system review,study questionnaires,many-centers investigate to the patients of impaired glucose regulation(IGR),diabetes,and abdominal operation,and build website of Nanfang health education in order to supply theoretical and practical basis to personal health education of the patients of IGR,diabetes,and abdominal operation.
Methods
ChapterⅠsectionⅠ:Investigation by email,about nursing research and correlative curriculums of 15 nursing schools in China,its questionnaire include 6 factors:curriculums teaching about nursing research,bibliography search,nursing papers writing,epidemiology,medical statistics,others correlative curriculums of nursing research.Each factor includes 4 items need answer if this course has been conducted,the number of course hours,the time of course begin,teaching books, teachers(include number,education certificate,the title of a technical post,age and teaching time);sectionⅡ:the questionnaire to 120 nursing undergraduated students of 2005 grade in Southern medical university,include two sections:the one is 22 test questions need to single choice of nursing research knowledge,the other one is 4 test questions need to single choice of nursing research attitude;ChapterⅡ:base on investigative data of chapterⅠ,we plan teaching program and objectives,study nursing education model of project-based learning of two learning groups of undergraduated students.Teaching methods have symposium,timely email,QQ etc. Teaching program include the project divided into two domains,the questions confirmed,study background of the project introduced,research thinking directed, English bibliographies searched and selected if those are middle difficulty,teaching objectives and methods planed,test objectives different period established,teaching fields communicated,teaching outlay budgeted by teacher.Each student chooses a question,search and read papers,writes concluding report,and reviews the new development about the question,based on the review and concluding report,studies questionnaires and investigates about health demands of patients of IGR,diabetes, and abdominal operation,plans and builds website of the Nanfang health education together teachers;ChapterⅢsectionⅠ:under the EBN thesis directing,in the light of system review about condition and research outcomes of the health education of IGR and diabetes patients,we find the questions about the health education of them, many-centers investigate the health education demands to them.After reading foreign and Chinese references,consulting a psychologist,a statistician and three nursing specialists,investigating in advance,we plan and revise questionnaire by oneself.The questionnaire includes three sections,general condition,the health education demands and the methods of health education demand of IGR and diabetes patients. The general condition of IGR and diabetes patients include gender,age,nationality (the Han nationality and minority),culture level(high culture level,middle culture level,and primary culture level),classification of medical expenditure(expenditure by oneself and not by self) and occupation(the worker of physical strength and brainworker),illness time,diagnose,the number of complications.The health education demands of IGR and diabetes patients include eight factors:general(have ten items),dietary(have six items),sportive(have three items),health educative (have two items),inspective by oneself(have three items),complications of(have two items),pharmic(have six items) and directive leaving hospital(have an item) knowledge demand of diabetes.Each item need single choice divides into five grades: need very much,need,not at all,no need very much,no need.The methods of health education demand of IGR and diabetes patients include fourteen items.Each item not need single choice have two choices:yes and no.The teachers educating investigators are the first group CNS in China,their graduation being from graduated student's refresher course of the CNS in southern medical university of Guangdong province. The investigators are teached by diabetes nursing,the choice major course in southern medical university.Eight investigators having been unified terms and divided into four groups explain the content and requirement of the questionnaires to IGR and diabetes patients,the questionnaires are filled in.If the patients are illiteracy,the investigators record the investigative result according to statement of the patients.The investigators receive the questionnaires after the patients on the ground have filled them out.The statistical data are analyzed by SPSS13.0 software,statistical methods include reliability of homogeneity and construct-related validity analysis,frequencies and descriptive statistics,ordinal logistic regression,binary logistic regression, Wilcoxon nonparametric test of 2 related samples,Friedman nonparametric test of K related samples.In term of system review about condition and research outcomes and investigation of the health education of IGR and diabetes patients,we study the internet means of health education and nursing clinics of network serving them; sectionⅡ:under the EBN thesis directing,in the light of system review about condition of the health education of abdominal operation patients,we find the questions about the health education of them,many-centers investigate the health education demands to them.After reading foreign and Chinese references,consulting a psychologist,a statistician and three nursing specialists,investigating in advance, we plan and revise questionnaire by oneself.The questionnaire includes six sections: general condition,the preoperational health education demands,post-operation,and direction of leaving hospital and the fondest methods of health education demand and leaving hospital of abdominal operation patients.The general condition of abdominal operation patients includes gender,age,nationality(the Han nationality and minority), culture level(high culture level,middle culture level,and primary culture level), classification of medical expenditure(expenditure by oneself and not by self) and occupation(the worker of physical strength and brainworker),post-operative time, anaesthetic patterns(local and systemic anaesthesia),the grades of pain(0～7 grades). The second section includes eleven items.The third section includes 3 items.The forth section includes 1 item.Each item need single choice divides into five grades: need very much,need,not at all,no need very much,no need.The fondest methods of health education demand and leaving hospital of abdominal operation patients includes respectively 8 and 9 items.Each item not need single choice have two choices:yes and no.Twelve investigators having been unified terms and divided into six groups,explain the content and requirement of the questionnaires to abdominal operation patients,the questionnaires are filled in.If the patients are single or illiteracy or activity inconvenienced,the investigators record the investigative result according to statement of the patients or their family numbers.The investigators receive the questionnaires after they have filled them out on the ground.The statistical data are analyzed by SPSS13.0 software;statistical methods include reliability of homogeneity and construct-related validity analysis,frequencies and descriptive statistics,ordinal logistic regression,binary logistic regression,Wilcoxon nonparametric test of 2 related samples,Friedman nonparametric test of K related samples.In term of system review about condition and investigation of the health education of abdominal operation patients,we study the Internet means of health education serving them,combining nursing website of the diabetes to form a network of Nanfang health education.We apply adequately multimedia functions(images, graphics,actions,radios,etc) to website building,and introduce the surrounding of exploring and application,materials source,plan thinking,framework and contents of the web.
Results
ChapterⅠsectionⅠ:there are 13 nursing schools to have conducted nursing research curriculum in 15 nursing schools of this study.The number of course hours is 30～64;mean course hours are(38.92±11.36).The teacher is mainly graduated student.There is the teaching book.However,the age and the title of a technical post of teachers,the index reflect research and education experience,are not very good. The nursing teachers are not competent for correlative curriculums of nursing research.The bibliography search is not conducted very well;however,it is correlative with nursing research ability of undergraduated students.Compare to it, medical statistics is attached importance to.The teaching program of nursing research and correlative courses is confusional.It is very different how many courses fitted nursing undergraduated students' educations for every nursing school;SectionⅡ:it are the great number of the students thinking the work of nursing research of being very important and important.It is explained that the students think much of the work of nursing research.A majority of students think arrangement of nursing research course and knowledge level of nursing research being held is common or not very well.The order of importance of educative methods about nursing research from high to low is lecture,taking part in research group,clinical practice,application for research project and self-study.In 22 test questions,there are only 7 questions,their correct rate exceeds 60 percent,and the correct rate of the other 15 questions is under 60 percent.The lowest scores are 5,and the highest scores are 16,mean scores are (10.48±2.50),it does not reach the half of total scores.It is consistent with results of the students self-judge.A great deal of the students is not plain to conception of nursing research;ChapterⅡ:in the nursing education model of project based learning, we use theoretical and practical test different period to teaching effective evaluation of students.The test include eligible rate of the number of writing paper,contents of the website,investigative questionnaires.One of scores of these three sections is 1/3 of the total scores.Through our study more than two years,there are six students to have published paper on core journals in China.Twenty students have finished conclusion and entrance of the materials of website(regulative rate is 92.06%),and 1450 investigative questionnaires(regulative rate is 88.07%).All they attain the critical credits of southern medical university.Therefore,our study conclude the nursing education model of project based learning which teachers and students enough use part time and many kinds of and active teaching methods,emphasize combination theory with practice,it is importantly complementary teaching model to regular lecture in class room;ChapterⅢ:application the nursing education model of project based learning in undergraduated student's study about health education. SectionⅠ:The reliability of homogeneity(Cronbach's alpha is 0.971,x~2=109.858, P=0.000) and construct-related validity of the questionnaire about health education demands of IGR and diabetes patients are very good.In general health education demands,those order of the patient hoping to know from high to low is therapy program,harm,dangerous effects,nursing plan,clinical findings,diagnosis regulation, prevention of diabetes,diagnosis regulation of IGR,terms and clinical classification of diabetes(P=0.000);Order of dietary health education demands the patient hoping to know from high to low is meaning of food therapy,methods selecting food, distribution of nutrition elements and eating frequence,method of food exchanging, means of caloric calculation,conception of GI(P=0.000);Order of sportive health education demands the patient hoping to know from high to low is meaning,key points of sportive therapy,and content of sportive prescription(P=0.000);Order of inspective by oneself health education demands the patient hoping to know from high to low is inspective method and frequence of plasma glucose,urine glucose,and inspective aim and method of HbAlc(P=0.000);Order of pharmic health education demands the patient hoping to know from high to low is prevention and therapy of action to low plasma glucose,side effect and using method of oral medicines decreasing plasma glucose,using method and key points of INS,kind of oral medicines decreasing plasma glucose(P=0.000).Compare to nurse,the patient is more hopeful to be offered health education by doctors(P=0.023).These demands of health education of the IGR and diabetes patient hoping to know are correlative with culture level(P＜0.05) to the terms(P=0.010,R~2=0.037),knowledges of three grades prevention(P=0.040,R~2=0.031),diagnosis(P=0.003,R~2=0.043),clinical classification(P=0.006,R~2=0.039),therapy program(P=0.037,R~2=0.033) of diabetes in general health education;conception of GI(P=0.013,R~2=0.036),methods selecting food(P=0.005,R~2=0.042) in dietary health education;meaning(P=0.049,R~2=0.031), key points(P=0.035,R~2=0.032) of sportive therapy,and content of sportive prescription(P=0.019,R~2=0.035) in sportive health education;offered health education by nurse(P=0.030,R~2=0.033) in health education;inspective method and frequence of plasma glucose(P=0.018,R~2=0.036),urine glucose(P=0.038, R~2=0.031),and inspective aim and method of HbAlc(P=0.021,R~2=0.033) in inspective by oneself health education;classification(P=0.007,R~2=0.041)and nursing (P=0.002,R~2=0.046) in complications health education;kind(P=0.003,R~2=0.045), using method(P=0.038,R~2=0.032) and side effect(P=0.022,R~2=0.035)of oral medicines decreasing plasma glucose,prevention and therapy of action to low plasma glucose(P=0.033,R~2=0.033) in pharmic health education and direction leaving hospital(P=0.006,R~2=0.041),the higher culture level,the most demand.Knowledges of three grades prevention of diabetes(P=0.040,R~2=0.031) in general health education demand is correlation with age(P=0.045),the less age,the more demand. These demands of health education of the IGR and diabetes patient hoping to know are correlative with nationality(P=0.014,P=0.011 respectively) to therapy program of diabetes(P=0.037,R~2=0.033) in general health education and side effect of oral medicines decreasing plasma glucose(P=0.022,R~2=0.035) in pharmic health education,Han nationality patients have more demand.These demands of health education of the IGR and diabetes patient hoping to know are correlative with illness time(P＜0.05)to methods selecting food(P=0.005,R~2=0.042) in dietary health education,meaning of sportive therapy(P=0.049,R~2=0.031) in sportive health education,offered health education by doctors(P=0.024,R~2=0.035) in health education,kind(P=0.003,R~2=0.045),using method(P=0.038,R~2=0.032) and side effect(P=0.022,R~2=0.035)of oral medicines decreasing plasma glucose,prevention and therapy of action to low plasma glucose(P=0.033,R~2=0.033) in pharmic health education,besides the more illness time,the more demand to know side effect of oral medicines decreasing plasma glucose,the less illness time,the more demand to know other six demands.Patients demands to inspective method and frequence of plasma glucose(P=0.018,R~2=0.036),and urine glucose(P=0.038,R~2=0.031 respectively) in inspective by oneself health education are correlation with occupation(P=0.005, P=0.032 respectively),the brainworker have more demands.Others regression equation of health education demand are P＞0.05.Order of the fondest means of health education to patient from high to low is clinics consultation of diabetes doctor, newspaper,journal,phone consultation,brochures and books posted from hospital, clinics consultation of diabetes nurse,lecture in hospital,medical and nursing home serve,Internet,communicative meet between nurse and patient,poster,the mobile phone short message service(SMS),video,CD-ROM,others(P=0.000).Demand to telephone consultation(P=0.014,R~2=0.045) of patients is correlation with age (P=0.013),gender(P=0.029),the less age,the more demand,and the male patient has more demands;Demand to SMS(P=0.022,R~2=0.062) is correlation with illness time, the shorter illness time,the more demand.Demand to Internet(P=0.000,R~2=0.213) is correlation with age(P=0.000),occupation(P=0.008) and the number of complications(P=0.000),the less age and complications,the more demand,and the brainworker have more demand to Internet.Demand to brochures and books posted from hospital(P=0.000,R~2=0.071) is correlation with the classification of medical expense(P=0.049) and occupation(P=0.011),the patients of expenditure not by self or brainworker have more demand.Demand to video(P=0.022,R~2=0.062) is correlation with the number of complications(P=0.009),the more complications,the more demand.Demands to CD-ROM(P=0.000,R~2=0.109),newspaper and journals (P=0.008,R~2=0.046) are correlation with culture level(P=0.014,P=0.000) and the number of complications(P=0.001,P=0.026),the high culture level,the more complications,the more demand.Demand to clinics consultation of diabetes doctor (P=0.034,R~2=0.035) is correlation with illness time(P=0.015),the number of complications(P=0.049),the longer illness time,the more complications,the more demand.Demand to lecture in hospital(P=0.002,R~2=0.063) is correlation with gender(P=0.034),age(P=0.012) and culture level(P=0.051),the bigger age,the higher culture level,the more demand,and the female patient has more demand. Demand to medical and nursing home serve(P=0.003,R~2=0.060) is correlation with occupation(P=0.000),the worker of physical strength has more demand.Others regression equation of health education demand are P＞0.05;SectionⅡ:Health requirement level of abdominal operation patients is very high at different period in hospital(entering hospital,preoperation,post-operation and direction leaving hospital).Contrast to charge nurse(P=0.000) and anesthetist(P=0.000),patients hope to most know the name,the title of a technical post,skill level of charge doctor.There is not deviation(P=0.124) between charge nurse and anesthetist of which patients hope to know the name,the title of a technical post,skill level.These demands of health education of the abdominal operation patient hoping to know are correlative with gender(P＜0.03) to the name,the title of a technical post,skill level of charge doctor(P=0.026,R~2=0.056) and anesthetist(P=0.000,R~2=0.124),regulation of the hospital(P=0.001,R~2=0.072),importance of preoperative examinations(P=0.005, R~2=0.066),important meaning of preoperative preparation(P=0.000,R~2=0.082), operative methods and procedure(P=0.000,R~2=0.096) in preoperational health education,the female patient has more demand.These demands of health education of the abdominal operation patient hoping to know are correlative with culture level (P＜0.04) to the name,the title of a technical post,skill level of charge doctor (P=0.026,R~2=0.056) and anesthetist(P=0.000,R~2=0.124),regulation of the hospital in preoperational health education(P=0.001,R~2=0.072) and operative patients about being noted if operative success(P=0.030,R~2=0.065),the higher culture level,the more demand to the three preoperational patient,and the lower culture level,the more demand to the post-operative patient.These demands of health education of the abdominal operation patient hoping to know are correlative with the classification of medical expense(P＜0.05) to nurse's direction to preoperative patients(P=0.000, R~2=0.083),operative name(P=0.029,R~2=0.053) in preoperational health education and operative patients about being noted if operative success(P=0.030,R~2=0.065) and direction leaving hospital(P=0.001,R~2=0.081),the patient of expenditure not by self has more demand.Two demands are correlation with anaesthetic patterns(P＜0.05) to regulation of the hospital(P=0.001,R~2=0.072) and important meaning of preoperative preparation(P=0.000,R~2=0.082) in preoperational health education,the patient of systemic anaesthesia has more demand.Preoperative demand to introduce surrounding of operation room(P=0.000,R~2=0.119) is correlation with nationality (P=0.043),the minority has more attention.Others regression equation of health education demand are P＞0.05.The fondest direction out hospital of patients is directly conducted by doctor[313(50.3%)].The telephone[230(37.0%)]was arranged second.The fondest means of acquiring health information by patients is introduced by nurse[307(49.4%)].Thus it can be seen,patients were fonder of communication with nurse face to face.Demand to telephone consultation(P=0.000, R~2=0.097) in direction out hospital of patients is correlation with gender(P=0.008), age(P=0.045),pain level(P=0.046) and anaesthetic patterns(P=0.000),local anaesthesia or female patient has more demand,the milder pain,or the less age,the more demand.Demand to directly conducted by doctor(P=0.000,R~2=0.071) in direction out hospital of patients is correlation with pain level(P=0.000) and age (P=0.006),the more serious or the bigger age,the more demand.In means of acquiring health information by patients,demand to introduced by nurse(P=0.000, R~2=0.108) is correlation with classification of medical expense(P=0.015),gender (P=0.041) and pain level(P=0.000),the milder pain,the more demand,the male patient or the patient of expenditure by self has more demand;demand to video (P=0.001,R~2=0.139) is correlation with gender(P=0.029) and anaesthetic patterns (P=0.020),systemic anaesthesia or female patient has more demand;demand to poster(P=0.006,R~2=0.068) is correlation with gender(P=0.028) and occupation (P=0.027),the female patient or brainworker has more demand;demand to Internet (P=0.000,R~2=0.085) is correlation with culture level(P=0.011),the higher culture level,the more demand.Result of website of Nanfang health education running show, it is stabilizing run on the WindowsXP operating system and IE6.0 browser,no run error or stoppable and character error.Put it out Internet,alternation of the website is good,no link error.
Conclusions
ChapterⅠsectionⅠ:the nursing teacher should perfect education about nursing research and correlative course in the future,strengthen teacher's trainability,and conduct teaching study of nursing research course.SectionⅡ:the teacher should inspire student's learning interest,deeply reform nursing research and correlative course,practice nursing research and education ability.SectionⅡ:nursing education model of project based learning can inspire student's learning interest for study individuation;group members can study each other for learning inter-influence;the teacher plans objectives of the outcomes for teaching by personal example as well as verbal instruction;the teacher builds diversified stage for information communication; the teacher multiform tests for cultivating synthesis ability to students.ChapterⅢsectionⅠ:because content has strong logicality and the number is suitable,the questionnaire can use evaluation the demands of health education to different IGR and diabetes patients.The patient considers importance order of the demand of health education is from easy to difficult,videlicet the patient arranges intelligible demand to ahead and indigestible those to back.Many patients are unaware of important terms and correlative knowledge and services of the doctors and nurses still are not deep in health education of IGR and diabetes patient.CNS should pertinently serve the demands of patients' health education to different disease stage;enough evaluate professional knowledge held by the patient and the effect factors,such as gender,age, nationality,culture lever,classification of medical expense,occupation,illness time, diagnose and the number of the complications before education,and stress management study of the patients to application of opening education patterns,such as video,CD-ROM,newspaper,journal and Internet,so that the nurse can improve compliance of the patients.Although nursing health education of diabetes patients still is not prevalent,with development of nursing education to CNS of diabetes,it has very expansively outlook.There is not website of diabetes specialty nursing. Although there are the Journal of diabetes specialty nursing and the institutional website,there is not a web clinic of diabetes nursing.In our study,the web clinic of diabetes nursing periodically serves to diabetes patients.The nursing specialists are the first group diabetes CNS in China brought up by us.SectionⅡ:because there are higher demands to abdominal operative patients,the nurses should pertinently serve the demands of patients' health education to different disease stage and explore personal,full-stage,excellent health education model;enough evaluate the effect factors,such as gender,age,nationality,culture lever,classification of medical expense,occupation,pain level,and anaesthetic patterns before education.Although demand to directly conducted by doctor and nurse and telephone consultation are fond,the nurses should study multimedia education methods,such as website, CD-ROM and video etc so that satisfying the demand of different patients.Because of expansively knowledge domain of abdominal operation,so far,there is not an absolute nursing website about abdominal operation.In terms of this study,demand to Internet is correlation with culture level,the higher culture level,the more demand, thus,it is very important to study and build nursing website about abdominal operation.Direction of this study will research more others methods of health education about IGR,diabetes,and abdominal operation in the light of evidence based result.
通过对国内15所护理院系护理科研及相关课程开设情况,以及对南方医科大学120名2005年级护理本科生护理科研知识掌握情况及态度进行调查,旨在了解学生对护理研究教育的态度及知识掌握程度,为护理科研教育研究提供理论依据。针对目前护理科研教育中存在的问题及基于问题的学习(problem-basedlearning,PBL)教学方法的局限性,在本科生教育中创建以科研课题为中心的PBL(project-based learning,PBL)护理教育模式。应用该护理教育模式,以循证护理(evidence-based nursing,EBN)理论为指导,指导本科生在对糖尿病前期及糖尿病病人、腹部手术病人健康教育现状系统综述的基础上,研制调查问卷,展开多中心健康教育需求调查研究,并研制南方健康教育网站,为实施糖尿病前期及糖尿病病人、腹部手术病人个性化健康教育服务奠定理论及实践基础。
方法
第一章第一部分:采用Email问卷调查法,对国内15所护理院系护理科研及相关课程开设情况进行调查,内容包括护理科研及相关课程6个维度:《护理科研》、《文献检索》、《护理科技论文写作》(以下简称“《写作》”)、《流行病学》、《医学统计学》、其他护理科研相关课程的开设情况。其中每一个维度中如果有开设上述课程,分别对学时数、开课时间、教材、师资队伍(包括数量、学历、职称、年龄、任教时间5个方面)4个方面进行开放式题目问答;第二部分:对南方医科大学120名2005年级护理本科生发放自行设计的调查问卷,当场回收,问卷内容包括2个部分:第一部分为护理科研知识试题,包括22道单项选择题;第二部分为护理科研态度,包括4道单项选择题;第二章以第一章调查数据为依据,设计教学计划及目标,对2个学习小组开展本研究PBL护理教育模式研究。采用小组讨论会、时时电子联络等教学方法,教学实施包括教师将研究课题分成2个方向,确定若干问题,介绍课题研究背景,指导科研思路,检索外文文献,筛选出难易适中的文献进行分类;确定教学目标及方法;制定分阶段考核目标;联系教学场地;进行经费预算。每个学生选择1个问题查阅文献,撰写总结报告,其中新进展部分撰写综述;在充分了解国内外研究现状基础上,研制糖尿病前期及糖尿病病人、腹部手术病人健康需求调查问卷并组织实施;师生共同设计与建设南方健康教育网站;第三章第一部分:以EBN理论为指导,在系统综述国内外糖尿病前期及糖尿病病人健康教育现状及研究成果的基础上,找出目前糖尿病健康教育存在的问题,多中心调研糖尿病前期及糖尿病病人健康教育需求。参考国内外相关文献,咨询心理学、统计学专家各1名,护理学专家3名,并参照预调查结果的基础上,自行设计及修订调查问卷。问卷分成3个部分:包括一般情况、健康教育需求以及健康教育方式需求。一般情况包括性别、年龄、民族、文化程度、医疗费用类型、劳动者类型、患病时间、诊断、并发症数量。其中,文化程度包括高中及以上、中专及初中、小学及以下文化程度3个层次;劳动者类型分为脑力劳动者、体力劳动者2种;医疗费用支出分为公费、自费2种。健康教育需求部分包括8个维度:一般糖尿病知识需求情况、营养、运动、健康教育、自我监测、并发症、药物及出院指导健康教育需求。其中第1个维度包括10个条目,第2个维度包括6个条目,第3个维度包括3个条目,第4、6个维度各包括2个条目,第5个维度包括3个条目,第7个维度包括6个条目,第9个维度包括1个条目。每一条目分成非常需要、需要、无所谓、不是很需要及不需要5个等级,采用单项选择法。健康教育需求方式调查包括14个条目,每一条目分成是和否2个选项,采用多项选择法。在国内首先以广东省专科护士(clinical nurse specialist,CNS)研究生课程班教育形式培养CNS,作为本调查员培训的师资。以南方医科大学糖尿病护理学选修课形式培养调查员。8名调查员分成4组,统一术语,讲解调查表内容及要求,对糖尿病前期及糖尿病病人进行问卷调查,没有文化者由调查员通过访谈记录调查结果,当场回收调查表。统计数据通过SPSS13.0软件包进行处理及分析,使用的统计方法包括问卷信效度检验、频数分布分析、描述性统计分析、等级资料使用等级Logistic全变量回归分析,二分类资料使用二分类Logistic回归分析,两相关样本的非参数检验方法为Wilcoxon两相关样本符号秩检验,多个相关样本的非参数检验方法为Friedman检验。在系统综述国内外糖尿病健康教育现状的基础上,以及针对糖尿病前期及糖尿病病人健康教育需求,研制糖尿病网络健康教育形式,开发糖尿病网络门诊;第二部分:以EBN理论为指导,在系统综述国内外腹部手术病人健康教育现状及研究成果的基础上,找出目前腹部手术病人健康教育存在的问题,多中心调研腹部手术病人健康教育需求。参考国内外相关文献,咨询心理学、统计学各1名,护理学专家3名,并参照预调查结果的基础上,自行设计及修订调查问卷。问卷分成6个部分:包括一般情况、腹部手术前、手术后、出院指导健康教育需求、病人喜欢的出院指导方式及获取健康信息的方式需求。一般情况包括性别、年龄、民族、文化程度、医疗费用类型、劳动者类型、术后时间、麻醉方式、疼痛等级。其中,文化程度包括高中及以上、中专及初中、小学及以下文化程度3个层次;劳动者类型分为脑力劳动者、体力劳动者2种;医疗费用支出分为公费、自费2种;麻醉方式分为全麻和局麻2种;疼痛等级分为0～7级。第2部分包括11个条目,第3部分包括3个条目,第4部分包括1个条目。每一条目分成非常需要、需要、无所谓、不是很需要及不需要5个等级,采用单项选择法。第5部分包括9个条目,第6部分包括8个条目,采用多项选择法。12名调查员分成6组,统一术语,讲解调查表内容及要求,对腹部手术后病人或家属进行问卷调查,行动不便、没有家属陪伴或没有文化者由调查员通过访谈记录调查结果,当场回收调查表。统计数据通过SPSS13.0软件包进行处理及分析,使用的统计方法包括问卷信效度检验、频数分布分析、描述性统计分析、等级Logistic全变量回归分析及二分类Logistic回归分析,两相关样本的非参数检验方法为Wilcoxon两相关样本符号秩检验,多个相关样本的非参数检验方法为Friedman检验。在系统综述国内外腹部手术病人健康教育现状的基础上,根据病人的健康教育需求,研制我国首个腹部手术专题护理网站,与糖尿病专科护理网站合二为一为南方健康教育网站。网站开发充分利用计算机的图像、动画、图形、声音的多媒体功能,研制过程介绍了网站的开发、应用环境、资料来源、设计思想及结构内容。
结果
第一章第一部分:15所护理院系中有13所开设了《护理科研》课程。学时数从30～64学时不等,平均(38.92±11.36)学时。师资以研究生学历水平为主,有独立的教材,而年龄梯队和职称等反映师资科研和教学经验的指标还不尽如人意。护理师资力量还不能独立胜任护理科研相关课程的教学任务。与本科生护理科研能力培养密切相关的《文献检索》课程,开设情况并不乐观。相比之下《医学统计学》更受到重视。护理科研及相关课程的教学计划显得混乱,具体该开设多少学时适合护理本科生教育,每个学校都不尽相同;第二部分:认为护理科研工作非常重要和重要的占大多数,学生对护理科研工作比较重视。大部分学生认为护理科研课程安排得一般或不好,对自己掌握护理科研知识程度也认为一般或不好。学生认为掌握护理科研方法的教育途径重要性(从高到低)排序为课堂讲授、参加研究团队、临床实践、申报课题、自学。22道题目中只有7道题正确率超过了60%,其余15道题正确率均在60%以下。最低分5分,最高分16分,平均(10.48±2.50)分,实际得分不足总分的一半。与学生的自评结果一致。护理科研中概念性的问题大部分学生还没搞明白;第二章:PBL护理教育模式中学生教学效果评价采取分阶段理论及实践考核的形式:包括论文撰写数量达标率、网站内容合格率及调查问卷合格率,这三部分各占总评分数(100分)的1/3。经过2年多的学习和研究,4名学生的论文在国家核心期刊上发表。20名学生已完成网站内容资料的汇总与录入,完成调查问卷1450份,网站内容合格率92.06%及调查问卷合格率为88.07%,均获得南方医科大学创新学分,本研究最后总结出以申报科研课题的方式提出问题,充分利用业余时间,弥补课堂教学形式的不足,结合灵活多样的教学方法,注重理论与实践相结合的PBL护理教育模式;第三章PBL护理教育模式在本科生健康教育研究中的应用。第一部分:糖尿病前期及糖尿病健康教育需求调查问卷的内部一致性信度(Cronbach's alpha为0.971,x~2=109.858,P=0.000)及结构效度均较好。一般健康教育需求中,病人最希望了解的是糖尿病治疗方案和糖尿病的危害,其次是糖尿病危险因素,糖尿病护理方案,临床表现,诊断标准,预防,糖尿病前期诊断标准,相关术语,临床分型(P=0.000);病人最希望了解的糖尿病营养健康教育需求内容是饮食治疗的意义,其次是食物选择方法,营养素分配与餐次,食物交换份法,热量计算方法,食物血糖生成指数(glucose index,GI)的概念(P=0.000);病人最希望了解的运动健康教育需求是运动疗法的意义,其次是运动疗法的注意事项,最后是运动处方的内容(P=0.000);病人最希望了解的自我监测教育需求内容是了解血糖的监测方法、次数,其次是了解尿糖的监测方法,最后是了解糖化血红蛋白(glycosylated hemoglobin,HbAlc)的监测意义及方法(P=0.000);病人最希望了解的药物治疗健康教育需求是了解低血糖反应的防治,其次是了解口服降糖药物的副作用,了解口服降糖药物使用方法,了解胰岛素(insulin,INS)的使用方法,了解INS使用的注意事项,了解口服降糖药物的种类(P=0.000)。与护士比较,病人更希望由医生提供健康教育(P=0.023)。糖尿病前期及糖尿病一般健康教育中“了解糖尿病相关术语”(P=0.010,R~2=0.037)、“了解糖尿病三级预防知识”(P=0.040,R~2=0.031)、“了解糖尿病的诊断标准”(P=0.003,R~2=0.043)、“了解糖尿病的临床分型”(P=0.006,R~2=0.039)、“了解糖尿病的治疗方案”(P=0.037,R~2=0.033),营养健康教育中“了解GI的概念”(P=0.013,R~2=0.036)、“了解食物选择方法”(P=0.005,R~2=0.042)、运动健康教育需求中“了解运动疗法的意义”(P=0.049,R~2=0.031)、“了解运动处方的内容”(P=0.019,R~2=0.035)及“了解运动疗法的注意事项”(P=0.035,R~2=0.032),健康教育者需求中“由护士提供健康教育”(P=0.030,R~2=0.033),自我监测健康教育中“了解血糖(P=0.018,R~2=0.036)、尿糖(P=0.038,R~2=0.031)、HbAlc的监测方法、次数(P=0.021,R~2=0.033)”,并发症健康教育需求中“了解糖尿病并发症的种类”(P=0.007,R~2=0.041)、“了解糖尿病并发症的护理”(P=0.002,R~2=0.046),药物治疗健康教育需求中“了解口服降糖药物的种类(P=0.003,R~2=0.045)、使用方法(P=0.038,R~2=0.032)及副作用(P=0.022,R~2=0.035)”、“了解低血糖反应的防治”(P=0.033,R~2=0.033)及“出院指导”(P=0.006,R~2=0.041)健康教育需求均与文化程度(P＜0.05)相关,高学历病人需求明显;一般需求中“了解糖尿病三级预防知识”(P=0.040,R~2=0.031)与年龄(P=0.045)相关,年龄越小需求越明显;一般需求中“了解糖尿病的治疗方案”(P=0.037,R~2=0.033)及药物治疗需求中“了解口服降糖药物的副作用”(P=0.022,R~2=0.035)与民族(P=0.014,P=0.011)相关,汉族病人需求更明显;营养需求中“了解食物选择方法”(P=0.005,R~2=0.042),运动需求中“了解运动疗法的意义”(P=0.049,R~2=0.031),健康教育者需求中“由医生提供健康教育”(P=0.024,R~2=0.035),药物治疗需求中“了解口服降糖药物的种类(P=0.003,R~2=0.045)、使用方法(P=0.038,R~2=0.032)及副作用(P=0.022,R~2=0.035)”、“了解低血糖反应的防治”(P=0.033,R~2=0.033)均与患病时间(P＜0.05)相关,除了“了解口服降糖药物的副作用”是患病时间越长需求越明显,其余6种需求都是患病时间短病人需求更明显;自我监测健康教育中“了解血糖(P=0.018,R~2=0.036)、尿糖的监测方法、次数(P=0.038,R~2=0.031)”均与劳动者类型(P=0.005,P=0.032)相关,脑力劳动者需求明显。其他健康教育需求回归方程均P＞0.05。病人最喜欢的健康教育方式是返院糖尿病医生门诊咨询,其次是报纸、杂志,电话咨询,医院邮寄健康宣传册、图书,返院糖尿病护理门诊咨询,返院听专题讲座,医护人员上门服务,上网,返院参加定期组织的护患交流会,宣传栏,手机短信,观看录像带,光盘教育资料,最后是其他教育方式(P=0.000)。电话咨询方式(P=0.014,R~2=0.045)与年龄(P=0.013)、性别(P=0.029)相关,年龄小,男病人需求高;手机短信方式(P=0.022,R~2=0.062)与患病时间(P=0.007)相关,患病时间越短需求越高;上网方式(P=0.000,R~2=0.213)与年龄(P=0.000)、劳动者类型(P=0.008)及并发症数量(P=0.000)相关,年龄越小、并发症越少病人需求高,脑力劳动者病人需求高;医院邮寄健康宣传册(P=0.000,R~2=0.071)、图书方式与医疗费用类型(P=0.049)、劳动者类型(P=0.011)相关,公费、脑力劳动者需求高;观看录像带方式(P=0.022,R~2=0.062)与并发症数量(P=0.009)相关,并发症数量越多需求越高;光盘教育资料(P=0.000,R~2=0.109)、报纸、杂志方式(P=0.008,R~2=0.046)均与文化程度(P=0.014,P=0.000)及并发症数量(P=0.001,P=0.026)相关,文化程度越高、并发症数量越多需求越高;返院糖尿病医生门诊咨询方式(P=0.034,R~2=0.035)与患病时间(P=0.015)、并发症数量(P=0.049)相关,患病时间越长、并发症越多需求越高;返院听专题讲座方式(P=0.002,R~2=0.063)与性别(P=0.034)、年龄(P=0.012)及文化程度(P=0.051)相关,女病人需求高,年龄越大、文化程度越高病人需求越高;医护人员上门服务方式(P=0.003,R~2=0.060)与劳动者类型(P=0.000)相关,体力劳动病人需求高;其他健康教育方式回归方程均P＞0.05;第二部分:腹部手术病人在院各阶段(入院、术前、术后及出院指导)健康需求程度均较高。比较责任护士,病人更希望了解主管医生的姓名、职称及技术水平(P=0.000);与麻醉师相比,病人更希望了解主管医生的姓名、职称及技术水平(P=0.000);病人希望了解责任护士及麻醉师姓名、职称及技术水平两者之间差异没有显著性(P=0.124)。腹部手术前健康教育需求中“了解主管医生姓名、职称、技术水平”(P=0.026,R~2=0.056)、“了解麻醉师姓名、职称、技术水平”(P=0.000,R~2=0.124)、“了解医院有关规章制度”(P=0.001,R~2=0.072)、“了解术前检查的必要性”(P=0.005,R~2=0.066)、“了解术前准备的重要意义”(P=0.000,R~2=0.082)、“告知手术术式及程序”(P=0.000,R~2=0.096)均与性别(P＜0.03)相关,女病人需求明显;术前健康教育需求中“了解主管医生姓名、职称、技术水平”(P=0.026,R~2=0.056)、“了解麻醉师姓名、职称、技术水平”(P=0.000,R~2=0.124)、“了解医院有关规章制度”(P=0.001,R~2=0.072)、术后健康教育需求中“告知手术是否成功”(P=0.030,R~2=0.065)均与文化程度(P＜0.04)相关,高学历病人术前3个健康教育需求明显,低学历病人术后健康教育需求高;术前健康教育需求中“护士手术前对您的健康需求给予指导”(P=0.000,R~2=0.083)、“告知手术名称”(P=0.029,R~2=0.053)、术后健康教育需求中“告知手术是否成功”(P=0.030,R~2=0.065)以及“出院指导”(P=0.001,R~2=0.081)均与医疗费用类型(P＜0.05)相关,公费病人需求明显;术前健康教育需求中“了解医院有关规章制度”(P=0.001,R~2=0.072)、“了解术前准备的重要意义”(P=0.000,R~2=0.082)均与麻醉方式(P＜0.05)相关,全麻病人需求明显;术前健康教育需求中“介绍手术室环境”(P=0.000,R~2=0.119)与民族(P=0.043)相关,少数民族更关注。其他健康教育需求回归方程均P＞0.05。病人喜欢的出院指导方式中“出院时医生直接给予出院指导”[313(50.3%)]最受病人欢迎,“电话咨询”[230(37.0%)]方式排在第二位。在病人获取健康信息方式中,“护士专门介绍”[307(49.4%)]位列第一,提示病人更喜欢和护士面对面的交流。病人喜欢的出院指导方式中电话咨询方式(P=0.000,R~2=0.097)与性别(P=0.008)、年龄(P=0.045)、疼痛程度(P=0.046)及麻醉方式(P=0.000)相关,采用局麻方式、疼痛越轻、年龄越小的女病人需求越明显;出院时医生给予指导(P=0.000,R~2=0.071)与疼痛程度(P=0.000)及年龄(P=0.006)相关,疼痛越重、年龄越大需求越明显;病人获取健康信息的方式中护士专门介绍(P=0.000,R~2=0.108)与医疗费用类型(P=0.015)、性别(P=0.041)及疼痛程度(P=0.000)相关,疼痛轻、男性及自费病人需求明显;观看录像带方式(P=0.001,R~2=0.139)与性别(P=0.029)、麻醉方式(P=0.020)相关,全麻方式及女性病人需求明显;宣传栏方式(P=0.006,R~2=0.068)与性别(P=0.028)及劳动者类型(P=0.027)相关,女病人及脑力劳动病人需求明显;上网方式(P=0.000,R~2=0.085)与文化程度(P=0.011)相关,文化程度越高,病人需求越明显。南方健康教育网站网络运行结果显示,在WindowsXP操作系统、IE6.0浏览器上运行稳定,未出现程序运行出错或死机现象,未出现字符错误显示等问题。在网上发布,网站交互性显示良好,与相关网站链接未见出错。
结论
第一章第一部分:护理教育者应不断完善《护理科研》及相关课程教育,加强《护理科研》师资培养;开展护理科研及相关课程教学研究。第二部分:教师应激发学生学习兴趣,深化护理科研及相关课程改革;注重基础知识教育,丰富护理科研实践经历;实施师资队伍建设,历练护理科研及教学能力;第二章:本研究PBL护理教育模式能激发学生学习兴趣、强调学习个性化;小组成员相互学习,强调学习互动;设计成果目标,强调言传身教;构建多样化平台,强调信息共享;考核形式多元化,强调综合能力培养;第三章第一部分:问卷内容逻辑性强,题目数量合适,可用于不同类型糖尿病前期及糖尿病病人的健康教育需求评估。病人认为健康教育需求重要性排序是从易到难的,也就是说,容易理解的排在前面,而相对较难理解的排在后面。糖尿病健康教育中需要病人了解的重要术语及相关知识,很多病人还不清楚,医护人员的健康教育服务还不深入。在教育前CNS应充分评估病人病人掌握的专业知识情况及性别、年龄、民族、文化程度、医疗费用类型、劳动者类型、患病时间、诊断、并发症数量等影响因素,对处于不同疾病阶段的病人应该有针对性的给予教育服务,并应加强开放式教育方式(如看录像带、光盘教育资料、报纸、杂志、上网)病人管理研究,提高其依从性。健康教育形式以返院糖尿病医生门诊咨询最受病人欢迎,虽然糖尿病护理教育还不普及,但随着国内糖尿病专科护理教育不断发展,将具有非常广阔的前景。国内没有糖尿病专科护理网站。国外有糖尿病专科护理杂志及学会的网站,但网站中没有糖尿病护理门诊服务。本研究的糖尿病专科护理网络门诊是以广东省培养的全国首批糖尿病CNS为门诊护理专家,在广东省形成糖尿病专科护理网络,定期出诊为有健康教育需求的人群服务;第二部分:腹部手术病人的健康教育需求程度较高,护士应发挥其专业优势,健康教育前充分评估病人的性别、年龄、民族、文化程度、医疗费用类型、劳动者类型、疼痛程度、麻醉方式等影响因素,探索个性化的、全程的、优质的腹部手术病人健康教育服务模式,才能满足病人的健康需求。健康教育形式以能和医护人员直接交流的指导、电话咨询形式最受欢迎。护士应注重研制网络、光盘及录像等多媒体教育方式,以满足不同病人的需求。由于腹部手术涉及知识范围广泛,目前国内外尚未见独立的护理专题网站。腹部手术病人上网方式需求与文化程度相关,文化程度越高,病人需求越明显。开发研制腹部手术护理专题网站以满足文化程度高病人的健康教育需求具有重要意义。其他糖尿病前期及糖尿病、腹部手术病人健康教育方式也将是本研究的方向,本研究将根据循证结果及病人需求研制多种多样的健康教育方式。
Objectives
To know knowledge level and attitude of undergraduated students to nursing research education,and to offer theoretical basis to education study of nursing research,two investigations are conducted,the one is about nursing research and correlative curriculums of 15 nursing schools in China,the other one is about knowledge level and attitude of 2005 grade undergraduated students in Nanfang medical university to nursing research education.Aim at the problems of nursing research education and limits of problem-based learning,we have been built nursing education model of project-based learning(PBL) in undergraduated students education.Application of nursing education model of PBL,in the light of evidence-based nursing(EBN),the teachers conduct students to system review,study questionnaires,many-centers investigate to the patients of impaired glucose regulation(IGR),diabetes,and abdominal operation,and build website of Nanfang health education in order to supply theoretical and practical basis to personal health education of the patients of IGR,diabetes,and abdominal operation.
Methods
ChapterⅠsectionⅠ:Investigation by email,about nursing research and correlative curriculums of 15 nursing schools in China,its questionnaire include 6 factors:curriculums teaching about nursing research,bibliography search,nursing papers writing,epidemiology,medical statistics,others correlative curriculums of nursing research.Each factor includes 4 items need answer if this course has been conducted,the number of course hours,the time of course begin,teaching books, teachers(include number,education certificate,the title of a technical post,age and teaching time);sectionⅡ:the questionnaire to 120 nursing undergraduated students of 2005 grade in Southern medical university,include two sections:the one is 22 test questions need to single choice of nursing research knowledge,the other one is 4 test questions need to single choice of nursing research attitude;ChapterⅡ:base on investigative data of chapterⅠ,we plan teaching program and objectives,study nursing education model of project-based learning of two learning groups of undergraduated students.Teaching methods have symposium,timely email,QQ etc. Teaching program include the project divided into two domains,the questions confirmed,study background of the project introduced,research thinking directed, English bibliographies searched and selected if those are middle difficulty,teaching objectives and methods planed,test objectives different period established,teaching fields communicated,teaching outlay budgeted by teacher.Each student chooses a question,search and read papers,writes concluding report,and reviews the new development about the question,based on the review and concluding report,studies questionnaires and investigates about health demands of patients of IGR,diabetes, and abdominal operation,plans and builds website of the Nanfang health education together teachers;ChapterⅢsectionⅠ:under the EBN thesis directing,in the light of system review about condition and research outcomes of the health education of IGR and diabetes patients,we find the questions about the health education of them, many-centers investigate the health education demands to them.After reading foreign and Chinese references,consulting a psychologist,a statistician and three nursing specialists,investigating in advance,we plan and revise questionnaire by oneself.The questionnaire includes three sections,general condition,the health education demands and the methods of health education demand of IGR and diabetes patients. The general condition of IGR and diabetes patients include gender,age,nationality (the Han nationality and minority),culture level(high culture level,middle culture level,and primary culture level),classification of medical expenditure(expenditure by oneself and not by self) and occupation(the worker of physical strength and brainworker),illness time,diagnose,the number of complications.The health education demands of IGR and diabetes patients include eight factors:general(have ten items),dietary(have six items),sportive(have three items),health educative (have two items),inspective by oneself(have three items),complications of(have two items),pharmic(have six items) and directive leaving hospital(have an item) knowledge demand of diabetes.Each item need single choice divides into five grades: need very much,need,not at all,no need very much,no need.The methods of health education demand of IGR and diabetes patients include fourteen items.Each item not need single choice have two choices:yes and no.The teachers educating investigators are the first group CNS in China,their graduation being from graduated student's refresher course of the CNS in southern medical university of Guangdong province. The investigators are teached by diabetes nursing,the choice major course in southern medical university.Eight investigators having been unified terms and divided into four groups explain the content and requirement of the questionnaires to IGR and diabetes patients,the questionnaires are filled in.If the patients are illiteracy,the investigators record the investigative result according to statement of the patients.The investigators receive the questionnaires after the patients on the ground have filled them out.The statistical data are analyzed by SPSS13.0 software,statistical methods include reliability of homogeneity and construct-related validity analysis,frequencies and descriptive statistics,ordinal logistic regression,binary logistic regression, Wilcoxon nonparametric test of 2 related samples,Friedman nonparametric test of K related samples.In term of system review about condition and research outcomes and investigation of the health education of IGR and diabetes patients,we study the internet means of health education and nursing clinics of network serving them; sectionⅡ:under the EBN thesis directing,in the light of system review about condition of the health education of abdominal operation patients,we find the questions about the health education of them,many-centers investigate the health education demands to them.After reading foreign and Chinese references,consulting a psychologist,a statistician and three nursing specialists,investigating in advance, we plan and revise questionnaire by oneself.The questionnaire includes six sections: general condition,the preoperational health education demands,post-operation,and direction of leaving hospital and the fondest methods of health education demand and leaving hospital of abdominal operation patients.The general condition of abdominal operation patients includes gender,age,nationality(the Han nationality and minority), culture level(high culture level,middle culture level,and primary culture level), classification of medical expenditure(expenditure by oneself and not by self) and occupation(the worker of physical strength and brainworker),post-operative time, anaesthetic patterns(local and systemic anaesthesia),the grades of pain(0～7 grades). The second section includes eleven items.The third section includes 3 items.The forth section includes 1 item.Each item need single choice divides into five grades: need very much,need,not at all,no need very much,no need.The fondest methods of health education demand and leaving hospital of abdominal operation patients includes respectively 8 and 9 items.Each item not need single choice have two choices:yes and no.Twelve investigators having been unified terms and divided into six groups,explain the content and requirement of the questionnaires to abdominal operation patients,the questionnaires are filled in.If the patients are single or illiteracy or activity inconvenienced,the investigators record the investigative result according to statement of the patients or their family numbers.The investigators receive the questionnaires after they have filled them out on the ground.The statistical data are analyzed by SPSS13.0 software;statistical methods include reliability of homogeneity and construct-related validity analysis,frequencies and descriptive statistics,ordinal logistic regression,binary logistic regression,Wilcoxon nonparametric test of 2 related samples,Friedman nonparametric test of K related samples.In term of system review about condition and investigation of the health education of abdominal operation patients,we study the Internet means of health education serving them,combining nursing website of the diabetes to form a network of Nanfang health education.We apply adequately multimedia functions(images, graphics,actions,radios,etc) to website building,and introduce the surrounding of exploring and application,materials source,plan thinking,framework and contents of the web.
Results
ChapterⅠsectionⅠ:there are 13 nursing schools to have conducted nursing research curriculum in 15 nursing schools of this study.The number of course hours is 30～64;mean course hours are(38.92±11.36).The teacher is mainly graduated student.There is the teaching book.However,the age and the title of a technical post of teachers,the index reflect research and education experience,are not very good. The nursing teachers are not competent for correlative curriculums of nursing research.The bibliography search is not conducted very well;however,it is correlative with nursing research ability of undergraduated students.Compare to it, medical statistics is attached importance to.The teaching program of nursing research and correlative courses is confusional.It is very different how many courses fitted nursing undergraduated students' educations for every nursing school;SectionⅡ:it are the great number of the students thinking the work of nursing research of being very important and important.It is explained that the students think much of the work of nursing research.A majority of students think arrangement of nursing research course and knowledge level of nursing research being held is common or not very well.The order of importance of educative methods about nursing research from high to low is lecture,taking part in research group,clinical practice,application for research project and self-study.In 22 test questions,there are only 7 questions,their correct rate exceeds 60 percent,and the correct rate of the other 15 questions is under 60 percent.The lowest scores are 5,and the highest scores are 16,mean scores are (10.48±2.50),it does not reach the half of total scores.It is consistent with results of the students self-judge.A great deal of the students is not plain to conception of nursing research;ChapterⅡ:in the nursing education model of project based learning, we use theoretical and practical test different period to teaching effective evaluation of students.The test include eligible rate of the number of writing paper,contents of the website,investigative questionnaires.One of scores of these three sections is 1/3 of the total scores.Through our study more than two years,there are six students to have published paper on core journals in China.Twenty students have finished conclusion and entrance of the materials of website(regulative rate is 92.06%),and 1450 investigative questionnaires(regulative rate is 88.07%).All they attain the critical credits of southern medical university.Therefore,our study conclude the nursing education model of project based learning which teachers and students enough use part time and many kinds of and active teaching methods,emphasize combination theory with practice,it is importantly complementary teaching model to regular lecture in class room;ChapterⅢ:application the nursing education model of project based learning in undergraduated student's study about health education. SectionⅠ:The reliability of homogeneity(Cronbach's alpha is 0.971,x~2=109.858, P=0.000) and construct-related validity of the questionnaire about health education demands of IGR and diabetes patients are very good.In general health education demands,those order of the patient hoping to know from high to low is therapy program,harm,dangerous effects,nursing plan,clinical findings,diagnosis regulation, prevention of diabetes,diagnosis regulation of IGR,terms and clinical classification of diabetes(P=0.000);Order of dietary health education demands the patient hoping to know from high to low is meaning of food therapy,methods selecting food, distribution of nutrition elements and eating frequence,method of food exchanging, means of caloric calculation,conception of GI(P=0.000);Order of sportive health education demands the patient hoping to know from high to low is meaning,key points of sportive therapy,and content of sportive prescription(P=0.000);Order of inspective by oneself health education demands the patient hoping to know from high to low is inspective method and frequence of plasma glucose,urine glucose,and inspective aim and method of HbAlc(P=0.000);Order of pharmic health education demands the patient hoping to know from high to low is prevention and therapy of action to low plasma glucose,side effect and using method of oral medicines decreasing plasma glucose,using method and key points of INS,kind of oral medicines decreasing plasma glucose(P=0.000).Compare to nurse,the patient is more hopeful to be offered health education by doctors(P=0.023).These demands of health education of the IGR and diabetes patient hoping to know are correlative with culture level(P＜0.05) to the terms(P=0.010,R~2=0.037),knowledges of three grades prevention(P=0.040,R~2=0.031),diagnosis(P=0.003,R~2=0.043),clinical classification(P=0.006,R~2=0.039),therapy program(P=0.037,R~2=0.033) of diabetes in general health education;conception of GI(P=0.013,R~2=0.036),methods selecting food(P=0.005,R~2=0.042) in dietary health education;meaning(P=0.049,R~2=0.031), key points(P=0.035,R~2=0.032) of sportive therapy,and content of sportive prescription(P=0.019,R~2=0.035) in sportive health education;offered health education by nurse(P=0.030,R~2=0.033) in health education;inspective method and frequence of plasma glucose(P=0.018,R~2=0.036),urine glucose(P=0.038, R~2=0.031),and inspective aim and method of HbAlc(P=0.021,R~2=0.033) in inspective by oneself health education;classification(P=0.007,R~2=0.041)and nursing (P=0.002,R~2=0.046) in complications health education;kind(P=0.003,R~2=0.045), using method(P=0.038,R~2=0.032) and side effect(P=0.022,R~2=0.035)of oral medicines decreasing plasma glucose,prevention and therapy of action to low plasma glucose(P=0.033,R~2=0.033) in pharmic health education and direction leaving hospital(P=0.006,R~2=0.041),the higher culture level,the most demand.Knowledges of three grades prevention of diabetes(P=0.040,R~2=0.031) in general health education demand is correlation with age(P=0.045),the less age,the more demand. These demands of health education of the IGR and diabetes patient hoping to know are correlative with nationality(P=0.014,P=0.011 respectively) to therapy program of diabetes(P=0.037,R~2=0.033) in general health education and side effect of oral medicines decreasing plasma glucose(P=0.022,R~2=0.035) in pharmic health education,Han nationality patients have more demand.These demands of health education of the IGR and diabetes patient hoping to know are correlative with illness time(P＜0.05)to methods selecting food(P=0.005,R~2=0.042) in dietary health education,meaning of sportive therapy(P=0.049,R~2=0.031) in sportive health education,offered health education by doctors(P=0.024,R~2=0.035) in health education,kind(P=0.003,R~2=0.045),using method(P=0.038,R~2=0.032) and side effect(P=0.022,R~2=0.035)of oral medicines decreasing plasma glucose,prevention and therapy of action to low plasma glucose(P=0.033,R~2=0.033) in pharmic health education,besides the more illness time,the more demand to know side effect of oral medicines decreasing plasma glucose,the less illness time,the more demand to know other six demands.Patients demands to inspective method and frequence of plasma glucose(P=0.018,R~2=0.036),and urine glucose(P=0.038,R~2=0.031 respectively) in inspective by oneself health education are correlation with occupation(P=0.005, P=0.032 respectively),the brainworker have more demands.Others regression equation of health education demand are P＞0.05.Order of the fondest means of health education to patient from high to low is clinics consultation of diabetes doctor, newspaper,journal,phone consultation,brochures and books posted from hospital, clinics consultation of diabetes nurse,lecture in hospital,medical and nursing home serve,Internet,communicative meet between nurse and patient,poster,the mobile phone short message service(SMS),video,CD-ROM,others(P=0.000).Demand to telephone consultation(P=0.014,R~2=0.045) of patients is correlation with age (P=0.013),gender(P=0.029),the less age,the more demand,and the male patient has more demands;Demand to SMS(P=0.022,R~2=0.062) is correlation with illness time, the shorter illness time,the more demand.Demand to Internet(P=0.000,R~2=0.213) is correlation with age(P=0.000),occupation(P=0.008) and the number of complications(P=0.000),the less age and complications,the more demand,and the brainworker have more demand to Internet.Demand to brochures and books posted from hospital(P=0.000,R~2=0.071) is correlation with the classification of medical expense(P=0.049) and occupation(P=0.011),the patients of expenditure not by self or brainworker have more demand.Demand to video(P=0.022,R~2=0.062) is correlation with the number of complications(P=0.009),the more complications,the more demand.Demands to CD-ROM(P=0.000,R~2=0.109),newspaper and journals (P=0.008,R~2=0.046) are correlation with culture level(P=0.014,P=0.000) and the number of complications(P=0.001,P=0.026),the high culture level,the more complications,the more demand.Demand to clinics consultation of diabetes doctor (P=0.034,R~2=0.035) is correlation with illness time(P=0.015),the number of complications(P=0.049),the longer illness time,the more complications,the more demand.Demand to lecture in hospital(P=0.002,R~2=0.063) is correlation with gender(P=0.034),age(P=0.012) and culture level(P=0.051),the bigger age,the higher culture level,the more demand,and the female patient has more demand. Demand to medical and nursing home serve(P=0.003,R~2=0.060) is correlation with occupation(P=0.000),the worker of physical strength has more demand.Others regression equation of health education demand are P＞0.05;SectionⅡ:Health requirement level of abdominal operation patients is very high at different period in hospital(entering hospital,preoperation,post-operation and direction leaving hospital).Contrast to charge nurse(P=0.000) and anesthetist(P=0.000),patients hope to most know the name,the title of a technical post,skill level of charge doctor.There is not deviation(P=0.124) between charge nurse and anesthetist of which patients hope to know the name,the title of a technical post,skill level.These demands of health education of the abdominal operation patient hoping to know are correlative with gender(P＜0.03) to the name,the title of a technical post,skill level of charge doctor(P=0.026,R~2=0.056) and anesthetist(P=0.000,R~2=0.124),regulation of the hospital(P=0.001,R~2=0.072),importance of preoperative examinations(P=0.005, R~2=0.066),important meaning of preoperative preparation(P=0.000,R~2=0.082), operative methods and procedure(P=0.000,R~2=0.096) in preoperational health education,the female patient has more demand.These demands of health education of the abdominal operation patient hoping to know are correlative with culture level (P＜0.04) to the name,the title of a technical post,skill level of charge doctor (P=0.026,R~2=0.056) and anesthetist(P=0.000,R~2=0.124),regulation of the hospital in preoperational health education(P=0.001,R~2=0.072) and operative patients about being noted if operative success(P=0.030,R~2=0.065),the higher culture level,the more demand to the three preoperational patient,and the lower culture level,the more demand to the post-operative patient.These demands of health education of the abdominal operation patient hoping to know are correlative with the classification of medical expense(P＜0.05) to nurse's direction to preoperative patients(P=0.000, R~2=0.083),operative name(P=0.029,R~2=0.053) in preoperational health education and operative patients about being noted if operative success(P=0.030,R~2=0.065) and direction leaving hospital(P=0.001,R~2=0.081),the patient of expenditure not by self has more demand.Two demands are correlation with anaesthetic patterns(P＜0.05) to regulation of the hospital(P=0.001,R~2=0.072) and important meaning of preoperative preparation(P=0.000,R~2=0.082) in preoperational health education,the patient of systemic anaesthesia has more demand.Preoperative demand to introduce surrounding of operation room(P=0.000,R~2=0.119) is correlation with nationality (P=0.043),the minority has more attention.Others regression equation of health education demand are P＞0.05.The fondest direction out hospital of patients is directly conducted by doctor[313(50.3%)].The telephone[230(37.0%)]was arranged second.The fondest means of acquiring health information by patients is introduced by nurse[307(49.4%)].Thus it can be seen,patients were fonder of communication with nurse face to face.Demand to telephone consultation(P=0.000, R~2=0.097) in direction out hospital of patients is correlation with gender(P=0.008), age(P=0.045),pain level(P=0.046) and anaesthetic patterns(P=0.000),local anaesthesia or female patient has more demand,the milder pain,or the less age,the more demand.Demand to directly conducted by doctor(P=0.000,R~2=0.071) in direction out hospital of patients is correlation with pain level(P=0.000) and age (P=0.006),the more serious or the bigger age,the more demand.In means of acquiring health information by patients,demand to introduced by nurse(P=0.000, R~2=0.108) is correlation with classification of medical expense(P=0.015),gender (P=0.041) and pain level(P=0.000),the milder pain,the more demand,the male patient or the patient of expenditure by self has more demand;demand to video (P=0.001,R~2=0.139) is correlation with gender(P=0.029) and anaesthetic patterns (P=0.020),systemic anaesthesia or female patient has more demand;demand to poster(P=0.006,R~2=0.068) is correlation with gender(P=0.028) and occupation (P=0.027),the female patient or brainworker has more demand;demand to Internet (P=0.000,R~2=0.085) is correlation with culture level(P=0.011),the higher culture level,the more demand.Result of website of Nanfang health education running show, it is stabilizing run on the WindowsXP operating system and IE6.0 browser,no run error or stoppable and character error.Put it out Internet,alternation of the website is good,no link error.
Conclusions
ChapterⅠsectionⅠ:the nursing teacher should perfect education about nursing research and correlative course in the future,strengthen teacher's trainability,and conduct teaching study of nursing research course.SectionⅡ:the teacher should inspire student's learning interest,deeply reform nursing research and correlative course,practice nursing research and education ability.SectionⅡ:nursing education model of project based learning can inspire student's learning interest for study individuation;group members can study each other for learning inter-influence;the teacher plans objectives of the outcomes for teaching by personal example as well as verbal instruction;the teacher builds diversified stage for information communication; the teacher multiform tests for cultivating synthesis ability to students.ChapterⅢsectionⅠ:because content has strong logicality and the number is suitable,the questionnaire can use evaluation the demands of health education to different IGR and diabetes patients.The patient considers importance order of the demand of health education is from easy to difficult,videlicet the patient arranges intelligible demand to ahead and indigestible those to back.Many patients are unaware of important terms and correlative knowledge and services of the doctors and nurses still are not deep in health education of IGR and diabetes patient.CNS should pertinently serve the demands of patients' health education to different disease stage;enough evaluate professional knowledge held by the patient and the effect factors,such as gender,age, nationality,culture lever,classification of medical expense,occupation,illness time, diagnose and the number of the complications before education,and stress management study of the patients to application of opening education patterns,such as video,CD-ROM,newspaper,journal and Internet,so that the nurse can improve compliance of the patients.Although nursing health education of diabetes patients still is not prevalent,with development of nursing education to CNS of diabetes,it has very expansively outlook.There is not website of diabetes specialty nursing. Although there are the Journal of diabetes specialty nursing and the institutional website,there is not a web clinic of diabetes nursing.In our study,the web clinic of diabetes nursing periodically serves to diabetes patients.The nursing specialists are the first group diabetes CNS in China brought up by us.SectionⅡ:because there are higher demands to abdominal operative patients,the nurses should pertinently serve the demands of patients' health education to different disease stage and explore personal,full-stage,excellent health education model;enough evaluate the effect factors,such as gender,age,nationality,culture lever,classification of medical expense,occupation,pain level,and anaesthetic patterns before education.Although demand to directly conducted by doctor and nurse and telephone consultation are fond,the nurses should study multimedia education methods,such as website, CD-ROM and video etc so that satisfying the demand of different patients.Because of expansively knowledge domain of abdominal operation,so far,there is not an absolute nursing website about abdominal operation.In terms of this study,demand to Internet is correlation with culture level,the higher culture level,the more demand, thus,it is very important to study and build nursing website about abdominal operation.Direction of this study will research more others methods of health education about IGR,diabetes,and abdominal operation in the light of evidence based result.
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