基于循证实践的儿科护理实习生临床决策能力指标体系的建立

常杰; 相琼; 周晓瑜; 张敏; 魏娟; 郭凤; 潘瑞

doi:10.3760/cma.j.cn116021-20250102-02116

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基于循证实践的儿科护理实习生临床决策能力指标体系的建立

护理教育研究 | 更新时间：2025-10-29

- 基于循证实践的儿科护理实习生临床决策能力指标体系的建立
- Establishment of a clinical decision-making ability indicator system for pediatric nursing interns based on evidence-based practice
- 中华医学教育探索杂志 2025年24卷第10期页码：1393-1399
- 作者机构：
  
  1.空军军医大学第一附属医院/西京医院儿科，西安 710032
  2.空军军医大学第一附属医院/西京医院骨科，西安 710032
- 作者简介：
  
  相琼，Email：Xiangqiong963852@163.com
- 基金信息：
  
  陕西省卫健委卫生健康科研项目(2022JQ-04)
- DOI：10.3760/cma.j.cn116021-20250102-02116
  中图分类号： R-05
- 收稿：2025-01-02，
  
  纸质出版：2025-10-20
- 稿件说明：
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常杰, 相琼, 周晓瑜, 等. 基于循证实践的儿科护理实习生临床决策能力指标体系的建立[J]. 中华医学教育探索杂志, 2025, 24(10): 1393-1399.

Chang Jie, Xiang Qiong, Zhou Xiaoyu, et al. Establishment of a clinical decision-making ability indicator system for pediatric nursing interns based on evidence-based practice[J]. Chinese journal of medical education research, 2025, 24(10): 1393-1399.
常杰, 相琼, 周晓瑜, 等. 基于循证实践的儿科护理实习生临床决策能力指标体系的建立[J]. 中华医学教育探索杂志, 2025, 24(10): 1393-1399. DOI： 10.3760/cma.j.cn116021-20250102-02116.

Chang Jie, Xiang Qiong, Zhou Xiaoyu, et al. Establishment of a clinical decision-making ability indicator system for pediatric nursing interns based on evidence-based practice[J]. Chinese journal of medical education research, 2025, 24(10): 1393-1399. DOI： 10.3760/cma.j.cn116021-20250102-02116.

摘要

目的

构建基于循证实践的儿科护理实习生临床决策能力指标体系，为临床教学与评价提供科学依据。

方法

采用文献分析、德尔菲专家咨询及实证研究相结合的方法。首先，系统检索中英文数据库（2018—2023年），依据PICO框架筛选文献，提取循证证据，初步形成包含4个一级指标、12个二级指标、39个三级指标的体系。随后，通过两轮德尔菲专家咨询（25名专家，工作年限19~27年）修订指标，专家权威系数（Cr）为0.898~0.907，肯德尔协调系数为0.351~0.420（

0.001）。最终采用层次分析法确定权重，并通过问卷调查验证信效度（样本量：预调查30人，正式调查58人）。

结果

构建的指标体系包含4个一级指标（权重）、13个二级指标和42个三级指标。一级指标权重分别为：知识整合能力（0.300）、循证实践能力（0.250）、临床判断能力（0.280）、伦理决策能力（0.170）。条目重要性评分均

4.0分（满分5分），变异系数

0.20。信效度检验显示，总量表Cronbach’s

系数为0.89，重测信度ICC=0.88；探索性因子分析累计方差解释率69.30%，验证性因子分析模型拟合良好（CFI=0.93，RMSEA=0.05）。

结论

该指标体系具有良好的科学性和实用性，可为儿科护理实习生临床决策能力的规范化培养与评价提供参考。未来需加强高级循证技能培训及长期应用效果追踪。

Abstract

Objective

To construct a clinical decision-making ability indicator system based on evidence-based practice for pediatric nursing interns

and to provide a scientific basis for clinical teaching and evaluation.

Methods

A method combining literature analysis

Delphi expert consultation

and empirical research was used. Firstly

a systematic search of Chinese and English databases (2018-2023) was conducted. Literature was screened based on the PICO framework and evidence-based data were extracted

resulting in a preliminary system consisting of 4 primary indicators

12 secondary indicators

and 39 tertiary indicators. Subsequently

the indicators were revised through two rounds of Delphi expert consultation (25 experts with 19-27 years of work experience). The expert authority coefficients (Cr) were 0.898-0.907 and the Kendall's concordance coefficients were 0.351-0.420 (

0.001). Finally

the analytic hierarchy process was used to determine the weights

and the reliability and validity were verified through a questionnaire survey (sample size: 30 participants in preliminary survey and 58 participants in formal survey).

Results

The constructed indicator system included 4 primary indicators (weights)

13 secondary indicators

and 42 tertiary indicators. The weights of the primary indicators were as follows: knowledge integration ability (0.300)

evidence-based practice ability (0.250)

clinical judgment ability (0.280)

and ethical decision-making ability (0.170). The importance scores of all items exceeded 4.0 points (out of 5 points)

and the coefficients of variation were less than 0.20. The reliability and validity tests showed that the Cronbach's

of the overall scale was 0.89

and the intraclass correlation coefficient was 0.88. The cumulative variance contribution rate of exploratory factor analysis was 69.30%. The confirmatory factor analysis demonstrated a good model fit with a comparative fit index of 0.93 and a root mean square error of approximation of 0.

05.

Conclusions

This indicator system has high scientificity and practicality

and can provide a reference for the standardized cultivation and evaluation of clinical decision-making ability of pediatric nursing interns. In the future

it is necessary to strengthen advanced evidence-based skills training and long-term application effectiveness tracking.

关键词

Keywords

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