杨　依，刘华平



高仿真模拟教学对护理学生临床能力影响的系统评价

杨依，刘华平

摘要：[目的]评价高仿真模拟(HFS)教学对护生临床能力等方面的影响。[方法]采用Cochrane系统评价方法，检索2000年—2014年CNKI、VIP、Cochrane图书馆、CINAHL、PubMed、 EMBASE、PROQUEST中关于高仿真模拟教学对护生临床能力影响的随机对照试验以及类实验性研究，对纳入文献进行文献质量评价后，采用RevMan5.1软件进行数据合并与分析。[结果]共纳入12项研究,包括686名护生，其中2篇为随机对照研究，10篇为类实验性研究。Meta分析结果显示，高仿真模拟教学有助于提高护生的知识水平(SMD=0.48,95%CI为0.06～0.90,P<0.01)和临床技能(SMD=0.68,95%CI为0.46～0.91,P<0.01),但对评判性思维能力的培养无显著影响(SMD=-0.28,95%CI为-0.64～0.08,P>0.05)。[结论]高仿真模拟教学在提高护生知识水平和临床技能上显示出优越性，尤其在知识的长期维持方面，显著高于传统教学方法，但其对护生评判性思维无明显改善作用，仍有待更多的高质量证据来证实其在护生临床能力整体水平上的确切效果。

关键词：高仿真模拟；护理学生；临床能力；传统教学法；知识水平；评判性思维；Meta分析

Systematic evaluation influence of high-fidelity simulation teaching on clinical competence of nursing students

Yang Yi，Liu Huaping

(Nursing College of Peking Union Medical College，Beijing 100144 China)

AbstractObjective:In order to evaluate the influence of high simulation(HFS) teaching on the clinical competence of nursing students.Methods:It used Cochrane system evaluation method.It retrieved CNKI,VIP,Cochrane library,CINAHL,PubMed,EMBASE，PROQUEST on randomized controlled trials and experimental research on the influence of high simulation teaching on nursing students’ clinical competence from 2000 to 2014.After the literature quality evaluation,the data were combined and by analyzed using RevMan5.1 software.Results:A total of 12 studies were included,including 686 nursing students.Among them，two papers were randomized controlled studies,and ten papers were experimental studies.Meta analysis showed that high simulation teaching was helpful to improve the knowledge level of nursing students(SMD=0.48,95%CIwas 0.06～0.90，P<0.01) and clinical skills (SMD=0.68，95%CIwas 0.46～0.91，P<0.01).But there was no significant effect on the cultivation of critical thinking (SMD=-0.28,95%CIwas -0.64～0.081,P<0. 05).Conclusion:High simulation teaching in improving the knowledge level of nursing students and clinical skills showed superiority.Especially in the long-term maintenance of knowledge,significantly higher than the traditional teaching methods.But it had no significant improvement effect on the critical thinking of nursing students,and still need more high quality evidence to confirm its exact effect on the overall level of nursing students’ clinical ability.

Key wordshigh-fidelity simulation；nursing students；clinical competence；traditional teaching method；knowledge level；critical thinking；Meta analysis

作为一门实践应用型学科，护理教育的重点在于培养学生的临床能力，使其在未来特定的临床情境中能够整合并运用相应的临床知识、技能等为病人提供安全、有效的照护[1-2]。尽管目前尚缺乏对护生临床能力概念的统一认识，但多数研究认为，临床知识、技能和评判性思维是临床能力的核心内容，亦是评价护理教育质量的重要指标[3-4]。就临床能力的培养方式而言，传统的课堂讲授及临床实践是最常见的教学策略，但随着病人安全理念的日渐深入以及临床资源短缺，越来越多的教育者和研究者开始探索模拟教学在护理领域的应用效果。……