基于案例的学习和模拟：增强护士教育的有用工具？非随机对照试验。

Case-based learning and simulation: useful tools to enhance nurses' education? Nonrandomized controlled trial.

机构信息

Lecturer, School of Nursing, University of Girona, Girona, Spain.

出版信息

J Nurs Scholarsh. 2015 Jan;47(1):34-42. doi: 10.1111/jnu.12113. Epub 2014 Oct 25.

DOI:10.1111/jnu.12113

PMID:25346329

Abstract

PURPOSE

To compare skills acquired by undergraduate nursing students enrolled in a medical-surgical course. To compare skills demonstrated by students with no previous clinical practice (undergraduates) and nurses with clinical experience enrolled in continuing professional education (CPE).

DESIGN

In a nonrandomized clinical trial, 101 undergraduates enrolled in the "Adult Patients 1" course were assigned to the traditional lecture and discussion (n = 66) or lecture and discussion plus case-based learning (n = 35) arm of the study; 59 CPE nurses constituted a comparison group to assess the effects of previous clinical experience on learning outcomes.

METHODS

Scores on an objective structured clinical examination (OSCE), using a human patient simulator and cases validated by the National League for Nursing, were compared for the undergraduate control and intervention groups, and for CPE nurses (Student's t test).

FINDINGS

Controls scored lower than the intervention group on patient assessment (6.3 ± 2.3 vs 7.5 ± 1.4, p = .04, mean difference, -1.2 [95% confidence interval (CI) -2.4 to -0.03]) but the intervention group did not differ from CPE nurses (7.5 ± 1.4 vs 8.8 ± 1.5, p = .06, mean difference, -1.3 [95% CI -2.6 to 0.04]). The CPE nurses committed more "rules-based errors" than did undergraduates, specifically patient identifications (77.2% vs 55%, p = .7) and checking allergies before administering medication (68.2% vs 60%, p = .1).

CONCLUSIONS

The intervention group developed better patient assessment skills than the control group. Case-based learning helps to standardize the process, which can contribute to quality and consistency in practice: It is essential to correctly identify a problem in order to treat it. Clinical experience of CPE nurses was not associated with better adherence to safety protocols.

CLINICAL RELEVANCE

Case-based learning improves the patient assessment skills of undergraduate nursing students, thereby preparing them for clinical practice.

摘要

目的

比较参加医学外科课程的本科护理学生获得的技能。比较没有先前临床实践（本科生）的学生和参加继续教育（CPE）的有临床经验的护士所展示的技能。

设计

在一项非随机临床试验中，101 名参加“成人患者 1”课程的本科生被分配到传统讲座和讨论（n = 66）或讲座和讨论加基于案例的学习（n = 35）组；59 名 CPE 护士构成对照组，以评估先前临床经验对学习结果的影响。

方法

使用经过国家护理联盟验证的人体患者模拟器和病例对客观结构化临床考试（OSCE）的分数进行比较，比较本科生对照组和干预组以及 CPE 护士的分数（学生 t 检验）。

结果

对照组在患者评估方面的得分低于干预组（6.3 ± 2.3 与 7.5 ± 1.4，p =.04，平均差异，-1.2 [95%置信区间（CI）-2.4 至-0.03]），但干预组与 CPE 护士没有差异（7.5 ± 1.4 与 8.8 ± 1.5，p =.06，平均差异，-1.3 [95% CI -2.6 至 0.04]）。CPE 护士比本科生犯了更多的“基于规则的错误”，特别是在患者识别方面（77.2% 与 55%，p =.7）和在给药前检查过敏情况（68.2% 与 60%，p =.1）。