Lechthaler Filippo, Arigoni Michele, Khamidova Mohira, Davlyatova Dilbar, Prytherch Helen, Wyss Kaspar
1Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, 4002, Basel, Switzerland.
2University of Basel, Basel, Switzerland.
BMC Nurs. 2020 Feb 11;19:11. doi: 10.1186/s12912-020-0405-4. eCollection 2020.
A well-functioning education system for family nurses is a priority of the primary health care reform in Tajikistan. In 2015/2016, a baseline study was carried out to measure the educational environment at two nursing colleges, in Kulob and Dushanbe. Building on the study's recommendations, the educational reform has addressed several key issues to improve the educational environment among nursing students with a focus on strengthening competency-based learning and clinical skills. A follow-up study was carried out in late 2018 to comparatively analyse progress in the educational environment against the baseline and assess potential impacts of tailored interventions.
A repeated cross-sectional survey involving 1239 students was applied to measure changes in the educational environment between 2015/2016 (baseline) and 2018 (endline) using the Dundee Ready Education Environment Measure (DREEM). We compared mean scores over time using Welch's two sample t-test and the Wilcoxon-Mann-Whitney test. Single items have additionally been analysed using critical threshold (flags) for mean scores, and the percentage of answers falling above or below predefined values. A multivariate non-parametric regression was applied to control for confounding factors. Internal consistency was examined using Cronbach's α.
Cronbach's α for overall scores ranged between 0.87 and 0.89. Between 2015/2016 and 2018 the perceived educational environment improved with an increase of the mean total DREEM score from 131.8 to 146.9 in Dushanbe and from 134.9 to 151.2 in Kulob. Mean comparisons and multivariate regression revealed a significant increase of all sub-scores between 2015/2016 and 2018 with students' social self-perception exhibiting the smallest progress. Despite the general improvements observed, analysis at the level of single items revealed persistent weaknesses including a lack of competency-based learning and stress.
The education environment has improved in several important ways between 2015/2016 and 2018 which points to a likely positive contribution of the nursing education reform. This progress notwithstanding, there is still notable room for further improvement. Targeted efforts aimed at a better organization of practical trainings, improved didactical competences of teachers, and support structures for lonely and stressed students still seem to be lacking for the achievement of a good nursing education system in Tajikistan.
建立一个运转良好的家庭护士教育体系是塔吉克斯坦初级卫生保健改革的一项优先任务。2015/2016年，开展了一项基线研究，以衡量库洛布和杜尚别两所护理学院的教育环境。基于该研究的建议，教育改革解决了几个关键问题，以改善护理专业学生的教育环境，重点是加强基于能力的学习和临床技能。2018年末进行了一项后续研究，以对比分析教育环境相对于基线的进展情况，并评估针对性干预措施的潜在影响。
采用重复横断面调查，涉及1239名学生，使用邓迪良好教育环境量表（DREEM）来衡量2015/2016年（基线）和2018年（终线）之间教育环境的变化。我们使用韦尔奇两样本t检验和威尔科克森-曼-惠特尼检验来比较不同时间的平均得分。还使用平均得分的临界阈值（标志）以及高于或低于预定义值的答案百分比对单个项目进行了分析。应用多元非参数回归来控制混杂因素。使用克朗巴哈α系数检验内部一致性。
总体得分的克朗巴哈α系数在0.87至0.89之间。在2015/2016年至2018年期间，感知到的教育环境有所改善，杜尚别DREEM总平均分从131.8提高到146.9，库洛布从134.9提高到151.2。均值比较和多元回归显示，2015/2016年至2018年期间所有子得分均显著提高，学生的社会自我认知进展最小。尽管观察到总体有所改善，但单个项目层面的分析显示仍存在持续的薄弱环节，包括缺乏基于能力的学习和压力问题。
2015/2016年至2018年期间，教育环境在几个重要方面有所改善，这表明护理教育改革可能做出了积极贡献。尽管取得了这一进展，但仍有显著的改进空间。为实现塔吉克斯坦良好的护理教育体系，似乎仍缺乏针对性的努力，即更好地组织实践培训、提高教师的教学能力以及为孤独和压力大的学生提供支持结构。
