Varapi vanofanirwa kuve nehunyanzvi hwekufunga kwekiriniki kuti vaite sarudzo dzakakodzera, dzakachengeteka dzekiriniki uye kudzivirira kukanganisa kwekuita.Unyanzvi hwekufunga husina kunaka hwekiriniki hunogona kukanganisa kuchengetedzwa kwemurwere uye kunonoka kutarisirwa kana kurapwa, kunyanya mukuchengetedza kwakanyanya uye madhipatimendi ekukurumidzira.Simulation-yakavakirwa kudzidzisa kunoshandisa inofungidzira yekudzidza nhaurirano ichitevera simulation senzira yekubvunzurudza yekuvandudza hunyanzvi hwekufunga kwekiriniki uchichengetedza kuchengeteka kwemurwere.Nekudaro, nekuda kwehuwandu hwakawanda hwekufunga kwekiriniki, njodzi inogona kuitika yekuziva kuwandisa, uye kushandiswa kwakasiyana kwekuongorora (hypothetico-deductive) uye isiri-analytical (intuitive) yekiriniki yekufunga maitiro nevatori vechikamu vepamberi uye vadiki simulation, zvakakosha kuti funga ruzivo, kugona, zvinhu zvine chekuita nekuyerera uye huwandu hweruzivo, uye kuomarara kwenyaya kuti uwedzere kufunga kwekiriniki nekuita muboka rinoratidzira hurukuro dzekudzidza mushure mekufananidza senzira yekubvunza.Chinangwa chedu ndechekutsanangura kugadzirwa kwemuenzaniso wepost-simulation reflective learning dialogue iyo inofunga zvinhu zvakawanda zvinopesvedzera kubudirira kwekiriniki kufunga optimization.
Boka rinoshanda redhizaini (N = 18), rinosanganisira vanachiremba, vanamukoti, vaongorori, vadzidzisi, uye vamiriri vevarwere, vakabatana kuburikidza nemisangano inoteedzana kubatanidza kugadzira mushure-yekutevedzera inoratidzira yekudzidza nhaurirano modhi kuti ipfupise iyo simulation.Iyo co-design inoshanda boka rakagadzira iyo modhi kuburikidza neinoretical uye conceptual process uye yakawanda-chikamu cheer wongororo.Iko kuwirirana kubatanidzwa kwekuwedzera / minus yekuongorora tsvakiridzo uye taxonomy yeBloom inotendwa kuti inogonesa vatori vechikamu kufunga kwekiriniki pavanenge vachitora chikamu muzviitiko zvekuedzesera.Content validity index (CVI) uye content validity ratio (CVR) nzira dzakashandiswa kumisa huso hwechokwadi uye huchokwadi hwezvinhu zvemuenzaniso.
A post-simulation reflective learning dialogue model yakagadzirwa uye yakaedzwa.Iyo modhi inotsigirwa nemienzaniso yakashanda uye nhungamiro yekunyora.Chiso uye chokwadi chemukati chemuenzaniso zvakaongororwa uye zvakasimbiswa.
Iyo itsva co-design model yakagadzirwa ichifunga nezveunyanzvi uye kugona kwevakasiyana-siyana vatori vechikamu, kuyerera uye kuwanda kweruzivo, uye kuoma kwenyaya dzekuenzanisira.Izvi zvinhu zvinofungidzirwa kuti zvigadzirise kufunga kwekiriniki kana uchitora chikamu mumabasa ekufananidza eboka.
Kufunga kwechipatara kunofungidzirwa kuti ndiyo nheyo yehutano hwehutano hwehutano [1, 2] uye chinhu chinokosha chehutano hwehutano [1, 3,4].Iyo inoratidzira nzira inoshandiswa nevashandi kuti vaone uye vashandise kupindira kwakakodzera kune imwe neimwe yekliniki mamiriro ezvinhu avanosangana nawo [5, 6].Kufunga kwekliniki kunotsanangurwa senzira yakaoma yekuziva iyo inoshandisa nzira dzakagadziriswa uye dzisina kurongeka dzekufunga kuunganidza nekuongorora ruzivo pamusoro pemurwere, kuongorora kukosha kwemashoko iwayo, uye kuona kukosha kwemamwe maitiro ekuita [7, 8].Zvinoenderana nekukwanisa kuunganidza zviratidzo, kugadzirisa ruzivo, uye kunzwisisa dambudziko remurwere kuitira kuti atore chiito chakanaka kune murwere akakodzera panguva yakakodzera uye nechikonzero chakanaka [9, 10].
Vese vatapi vehutano vanotarisana nekudiwa kwekuita sarudzo dzakaoma mumamiriro ekusava nechokwadi kwakanyanya [11].Mukutarisira kwakanyanya uye chiitiko chekukurumidzira, mamiriro ekiriniki nenjodzi dzinomuka apo mhinduro yekukurumidza uye kupindira kwakakosha kuponesa hupenyu uye kuve nechokwadi chekuchengetedzwa kwevarwere [12].Unyanzvi husina kunaka hwekufunga kwekiriniki uye kugona mukuita kwekuchengetedza kwakakosha kunobatanidzwa nemazinga epamusoro ekukanganisa kwekiriniki, kunonoka mukutarisira kana kurapwa [13] uye njodzi kune kuchengetedzwa kwemurwere [14,15,16].Kuti udzivise zvikanganiso zvinoshanda, varapi vanofanirwa kuve nehunyanzvi uye vane hunyanzvi hwekufunga kwekiriniki kuita sarudzo dzakachengeteka uye dzakakodzera [16, 17, 18].Iyo isiri-analytical (intuitive) yekufunga maitiro ndiyo nzira yekukurumidza inofarirwa nevarapi vehunyanzvi.Kusiyana neizvi, kuongorora (hypothetico-deductive) maitiro ekufunga anogara achinonoka, anonyanya kufunga, uye anowanzoshandiswa nevarapi vasina ruzivo [2, 19, 20].Tichifunga nezvekuoma kwehutano hwehutano hwehutano uye njodzi inogona kuitika yezvikanganiso zvekudzidzira [14,15,16], simulation-based education (SBE) inowanzoshandiswa kupa varapi mikana yekuvandudza unyanzvi uye unyanzvi hwekufunga kwekliniki.nzvimbo yakachengeteka uye kutarisana nemhando dzakasiyana-siyana dzematambudziko paunenge uchichengetedza kuchengetedzwa kwevarwere [21, 22, 23, 24].
Sosaiti yeSimulation muHutano (SSH) inotsanangura simulation se "tekinoroji inogadzira mamiriro kana nharaunda umo vanhu vanoona zvinomiririrwa zvezviitiko chaizvo zvehupenyu nechinangwa chekudzidzira, kudzidzisa, kuongorora, kuedza, kana kuwana kunzwisisa kwemaitiro evanhu kana maitiro."[23] Zvirongwa zvakanyatsorongeka zvekuenzanisira zvinopa vatori vechikamu mukana wekuzvinyudza muzviitiko zvinotevedzera mamiriro ekiriniki panguva yekuderedza njodzi dzekuchengetedza [24,25] uye kudzidzira kufunga kwekiriniki kuburikidza nemikana yekudzidza yakanangwa [21,24,26,27,28] SBE inokwidziridza zviitiko zvekiriniki yemumunda, kufumura vadzidzi kuzviitiko zvekiriniki izvo vangave vasina kumbosangana nazvo mumamiriro ekuchengeta varwere chaiwo [24, 29].Iyi inzvimbo isingatyisidzire, isina mhosva, inotariswa, yakachengeteka, isina njodzi yekudzidza.Inokurudzira kukura kwezivo, hunyanzvi hwekiriniki, kugona, kufunga kwakadzama uye kufunga kwekiriniki [22,29,30,31] uye inogona kubatsira vashandi vehutano kukunda kushushikana kwepfungwa kwemamiriro ezvinhu, nekudaro vachivandudza kugona kudzidza [22, 27, 28] ., 30, 32].
Kuti utsigire kubudirira kunobudirira kwekliniki yekufunga uye unyanzvi hwekuita sarudzo kuburikidza neSBE, kutarisa kunofanira kubhadharwa kune dhizaini, template, uye chimiro chemashure-simulation debriefing process [24, 33, 34, 35].Post-simulation reflective learning conversations (RLC) yakashandiswa senzira yekutsanangurira kubatsira vatori vechikamu kuratidza, kutsanangura zviito, uye kushandisa simba rekutsigirwa kwevezera uye boka rekufunga mumamiriro ekushanda pamwe chete [32, 33, 36].Kushandiswa kweboka reRLCs kunotakura njodzi inogona kuitika yekusagadziridzwa kwekiriniki kufunga, kunyanya maererano nekugona kwakasiyana uye huwandu hwehukuru hwevatori vechikamu.Iwo maviri maitiro emuenzaniso anotsanangura maitiro akasiyana-siyana emakiriniki ekufunga uye kusiyana kwemaitiro evakuru vevashandi kushandisa analytical (hypothetico-deductive) maitiro ekufunga uye varapi vadiki kuti vashandise zvisiri-analytical (intuitive) kufunga maitiro [34, 37].].Aya maitiro maviri ekufunga anosanganisira dambudziko rekugadzirisa nzira dzekufunga dzakakwana kumamiriro akasiyana, uye hazvina kujeka uye zvinopokana mashandisiro aungaita nzira dzekuongorora uye dzisiri dzekuongorora kana paine vatori vechikamu vakuru nevadiki muboka rimwechete rekuenzanisira.Vadzidzi vechikoro chesekondari uye vadiki vechikoro chesekondari vane hunyanzvi hwakasiyana uye mazinga ezviitiko vanotora chikamu mukuenzanisa mamiriro ekuoma kwakasiyana [34, 37].Izvo zvakasiyana-siyana zvehutano hwekufunga kwekliniki zvinosanganiswa nenjodzi inogona kuitika yekusagadziriswa kwekiriniki kufunga uye kuwedzeredza kwekuziva, kunyanya apo vashandi vanotora chikamu muboka reSBE rine nyaya dzakasiyana-siyana dzakaoma uye mazinga ehukuru [38].Izvo zvakakosha kuti uzive kuti kunyangwe paine akati wandei mamodheru ekubvunzurudza anoshandisa RLC, hapana kana imwe yemamodheru akagadzirwa aine tarisiro yekuvandudza kwehunyanzvi hwekufunga kwekiriniki, tichifunga nezveruzivo, kugona, kuyerera uye huwandu hweruzivo, uye kuenzanisira kuoma kwezvinhu [38].]., 39].Zvose izvi zvinoda kugadzirwa kwemuenzaniso wakarongeka unotarisa zvipo zvakasiyana-siyana uye zvinokurudzira zvinhu kuti zvigadzirise kufunga kwekliniki, uku uchibatanidza post-simulation RLC senzira yekubika.Isu tinotsanangudza dzidziso uye inotungamirwa maitiro ekubatana dhizaini uye kusimudzira kweiyo post-simulation RLC.Muenzaniso wakagadzirwa kuti uwedzere hunyanzvi hwekufunga kwekiriniki panguva yekutora chikamu muSBE, tichitarisa huwandu hwakasiyana hwekufambisa uye kupesvedzera zvinhu kuti uwane yakagadziridzwa yekiriniki yekufunga kufunga.
Iyo RLC post-simulation modhi yakagadziridzwa zvakabatana zvichibva pane iripo mamodheru uye dzidziso dzekiriniki kufunga, kufungidzira kudzidza, dzidzo, uye simulation.Kuti vagadzirise modhi iyi pamwe chete, boka rinoshanda rakabatana (N = 18) rakaumbwa, rine vanamukoti gumi vanochengeta zvakanyanya, mumwe anosimbisa moyo, uye vamiriri vatatu vevarwere vakambopinzwa muchipatara vemazinga akasiyana, ruzivo, uye murume kana mukadzi.Imwe imba yevanorwara zvakanyanya, 2 vabatsiri vekutsvagisa uye 2 vakuru mukoti vadzidzisi.Iyi co-design innovation inogadzirwa uye inogadzirwa kuburikidza nekubatana kwevezera pakati pevatambi vane ruzivo rwepasi rose mune zvehutano, vangave vashandi vehutano vanobatanidzwa mukugadzirwa kwemuenzaniso wakarongwa kana vamwe vanobatana vakadai sevarwere [40,41,42].Kusanganisira vamiririri vevarwere muhutano hwekugadzirisa-design vanogona kuwedzera kuwedzera kukosha kuhutano, sezvo chinangwa chikuru chepurogiramu ndechekuvandudza kutarisira kwevarwere nekuchengeteka [43].
Boka rekushanda rakaita nhanhatu 2-4 awa maworkshops kugadzira chimiro, maitiro uye zvirimo zvemuenzaniso.Musangano uyu unosanganisira nhaurirano, kudzidzira uye kutevedzera.Zvinhu zvemuenzaniso zvakabva pahuwandu hwehuchapupu-hwakavakirwa zviwanikwa, mamodheru, dzidziso uye zvimiro.Izvi zvinosanganisira: constructivist kudzidza dzidziso [44], iyo mbiri loop pfungwa [37], kiriniki yekufunga loop [10], iyo yekutenda yekubvunza (AI) nzira [45], uye yekushuma plus/delta nzira [46].Iyo modhi yakagadziridzwa pamwe chete zvichibva paInternational Nurses Association's INACSL debriefing process standards yekiriniki uye yekuenzanisa dzidzo [36] uye yakasanganiswa nemienzaniso yakashanda kugadzira modhi inotsanangura.Iyo modhi yakagadziridzwa mumatanho mana: kugadzirira yekufungisisa yekudzidza nhaurirano mushure mekuenzanisa, kutangwa kweinofungidzira yekudzidza nhaurirano, kuongorora / kufungidzira uye kubvunzurudza (Mufananidzo 1).Tsanangudzo yedanho rega rega inokurukurwa pazasi.
Nhanho yekugadzirira yemuenzaniso yakagadzirirwa kugadzirira mupfungwa vatori vechikamu chechikamu chinotevera uye kuwedzera kutora kwavo kushingaira uye kuisa mari pavanenge vachichengetedza kuchengeteka mupfungwa [36, 47].Danho iri rinosanganisira sumo yechinangwa nezvinangwa;inotarisirwa nguva yeRLC;zvinotarisirwa nemufambisi uye vatori vechikamu panguva yeRLC;kutaridzika kwesaiti uye kuenzanisa kumisikidza;kuve nechokwadi chekuvanzika munzvimbo yekudzidza, uye kuwedzera nekusimudzira kuchengetedzwa kwepfungwa.Mhinduro dzinotevera dzemumiririri kubva ku-co-design working group dzakatariswa panguva ye-pre-development phase yeRLC model.Mutori wechikamu 7: "Semukoti anotarisira mukoti, dai ndanga ndiri kutora chikamu mukuenzanisa pasina mamiriro emamiriro ezvinhu uye vakuru vakuru vaivapo, ndingadai ndakadzivisa kutora chikamu mukukurukurirana kwepashure kunze kwekunge ndanzwa kuti kuchengeteka kwangu mupfungwa kwaiva. kuremekedzwa.uye kuti ndaizodzivisa kutora chikamu muhurukuro mushure mekuenzanisa."Dzivirirwa uye hapazove nemhedzisiro."Mutori wechikamu 4: "Ini ndinotenda kuti kutarisisa uye kumisa mitemo yekutanga kuchabatsira vadzidzi mushure mekuenzanisa.Kutora chikamu mune fungidziro yehurukuro dzekudzidza. "
Matanho ekutanga eRLC modhi anosanganisira kuongorora manzwiro emutori wechikamu, kutsanangura maitiro ari pasi uye kuongorora mamiriro, uye kunyora zviitiko zvakanaka nezvakaipa zvemutori wechikamu, asi kwete kuongorora.Muenzaniso padanho rino unogadzirwa kuitira kukurudzira vavhoti kuti vazvitarise uye vatarise basa, pamwe nekugadzirira mupfungwa kuongororwa kwakadzama uye kufungisisa kwakadzama [24, 36].Chinangwa ndechekuderedza njodzi inogona kuitika yekuziva kuwandisa [48], kunyanya kune avo vatsva kune chinyorwa chekuenzanisira uye vasina ruzivo rwekare rwekiriniki neunyanzvi / musoro [49].Kukumbira vatori vechikamu kuti vatsanangure muchidimbu nyaya yakafananidzirwa uye kuita mazano ekuongorora zvirwere zvichabatsira mufambisi kuona kuti vadzidzi vari muboka vane ruzivo rwekutanga uye rwese rwenyaya vasati vaenda kune imwe nhanho yekuongorora / yekufungisisa.Pamusoro pezvo, kukoka vatori vechikamu padanho rino kuti vataure manzwiro avo mumienzaniso yezviitiko zvinovabatsira kukunda kushushikana kwepfungwa kwemamiriro ezvinhu, nekudaro vachiwedzera kudzidza [24, 36].Kugadzirisa nyaya dzemupfungwa kunozobatsirawo mufambisi weRLC kunzwisisa kuti manzwiro evatori vechikamu anokanganisa sei kuita kwemunhu neboka, uye izvi zvinogona kukurukurwa zvakadzama panguva yekufungisisa/kuongorora.Iyo Plus/Delta nzira yakavakirwa muchikamu ichi chemuenzaniso segadziriro yekugadzirira uye yakasarudzika nhanho yekuratidzira / yekuongorora chikamu [46].Uchishandisa nzira yePlus/Delta, vese vatori vechikamu nevadzidzi vanogona kugadzirisa/kunyora zvavanoona, manzwiro uye zviitiko zvekufananidza, izvo zvinozogona kukurukurwa pfungwa nepoint panguva yekufungisisa/yekuongorora chikamu chemuenzaniso [46].Izvi zvichabatsira vatori vechikamu kuti vawane metacognitive mamiriro kuburikidza nemikana yekudzidza yakanangwa uye yakakosha kukwirisa kufunga kwekiriniki [24, 48, 49].Mhinduro dzinotevera dzemumiririri kubva ku-co-design working group dzakatariswa panguva yekugadzirwa kwekutanga kweRLC model.Mutori wechikamu 2: "Ini ndinofunga kuti semurwere akambogamuchirwa kuICU, isu tinofanirwa kufunga nezvemanzwiro uye manzwiro evadzidzi vakaedzerwa.Ini ndinosimudza nyaya iyi nekuti panguva yekubvumidzwa kwangu ndakaona yakanyanya kushushikana uye kunetsekana, kunyanya pakati pevarapi vanochengeta.uye mamiriro ekukurumidzira.Iyi modhi inofanirwa kufunga nezvekushushikana uye manzwiro ane chekuita nekutevedzera chiitiko. "Mutori wechikamu 16: "Kwandiri semudzidzisi, ndinoona zvakakosha kushandisa nzira yePlus/Delta kuitira kuti vadzidzi vakurudzirwe kutora chikamu nekutaura zvinhu zvakanaka nezvavanoda zvavakasangana nazvo panguva yekufananidza.Nzvimbo dzekuvandudza. "
Kunyange zvazvo matanho ekare emuenzaniso akakosha, nhanho yekuongorora / yekufungisisa ndiyo inonyanya kukosha pakuwana optimization yekliniki kufunga.Yakagadzirirwa kupa ongororo yepamusoro / synthesis uye ongororo yakadzama inoenderana neruzivo rwekiriniki, kugona, uye kukanganisa kwemisoro yakaenzanisirwa;RLC maitiro uye chimiro;huwandu hweruzivo rwakapihwa kuti udzivise kuwandisa kwekuziva;kushandisa zvakanaka mibvunzo yekufungisisa.nzira dzekuwana kudzidza kwakanangana nemudzidzi uye kushingaira.Panguva ino, ruzivo rwekiriniki uye kujairana nemisoro yekunyepedzera yakakamurwa kuita zvikamu zvitatu kuti zvigadzirise mazinga akasiyana echiitiko uye kugona: chekutanga: hapana yapfuura kiriniki yehunyanzvi ruzivo / hapana kuratidzwa kwekare kumisoro yekufananidza, chechipiri: ruzivo rwekiriniki yehunyanzvi, ruzivo uye hunyanzvi / hapana.kuratidzwa kwekare kumisoro yekuenzanisira.Chechitatu: Kliniki yehunyanzvi ruzivo, ruzivo uye hunyanzvi.Nyanzvi / yakapfuura kuratidzwa kune yekuenzanisira misoro.Kurongeka kwacho kunoitwa kuti kugadzirise zvinodiwa nevanhu vane ruzivo rwakasiyana uye nhanho dzekugona mukati meboka rimwe chete, nekudaro kuenzanisa tsika yevasina ruzivo rwakanyanya kushandisa kufunga kwekuongorora nekatsika yevakawanda vane ruzivo rwekushandisa hunyanzvi hwekufunga husiri hwekuongorora [19, 20, 34]., 37].Iyo RLC maitiro akarongedzerwa akatenderedza kiriniki yekufunga kutenderera [10], inofungidzira yemuenzaniso chimiro [47], uye ruzivo rwekudzidza dzidziso [50].Izvi zvinowanikwa kuburikidza nemaitiro akati wandei: kududzira, kusiyanisa, kutaurirana, kufungidzira uye synthesis.
Kuti udzivise kuwandisa kwenjere, kusimudzira nzira yekutaura yakanangana nemudzidzi ine nguva yakakwana nemikana yekuti vatori vechikamu varatidze, kuongorora, uye kubatanidza kuti vawane kuzvivimba kwakatariswa.Maitiro ekuziva panguva yeRLC anotariswa kuburikidza nekubatanidza, kusimbisa, kuumba, uye kubatanidza maitiro akavakirwa paviri-loop chimiro [37] uye cognitive mutoro dzidziso [48].Kuva nehurongwa hwekukurukurirana kwakarongeka uye kubvumira nguva yakakwana yekufungisisa, tichifunga nezvevose vane ruzivo uye vasina ruzivo rwevatori vechikamu, zvichaderedza njodzi inogona kuitika yekuziva mutoro, kunyanya mukuenzanisa kwakaoma kune zvakasiyana-siyana zvakaitika kare, kuratidzwa uye kukwanisa kwevatori vechikamu.Mushure mechiitiko.Maitiro ekubvunzurudza emuenzaniso anoenderana neBloom's taxonomic modhi [51] uye yekutenda yekubvunza (AI) nzira [45], umo mufambisi wemuenzaniso anosvika pachidzidzo nhanho-ne-nhanho, Socratic, uye inofungidzira maitiro.Bvunza mibvunzo, uchitanga nemibvunzo yakavakirwa pazivo.uye kugadzirisa hunyanzvi uye nyaya dzine chekuita nekufunga.Iyi nzira yekubvunzurudza inovandudza kukwenenzverwa kwekufunga kwekiriniki nekukurudzira vatori vechikamu vanoshingaira kutora chikamu uye kufunga kunofambira mberi nengozi shoma yekuziva kuwandisa.Mhinduro dzinotevera dzemumiririri kubva ku-co-design working group dzakatariswa panguva yekuongorora / kuratidzira chikamu cheRLC model development.Mutori wechikamu 13: "Kuti tidzivise kuwandisa kwekuziva, isu tinofanirwa kufunga nezvehuwandu uye kuyerera kweruzivo patinenge tichiita hurukuro dzemashure-yekutevedzera, uye kuita izvi, ndinofunga zvakakosha kupa vadzidzi nguva yakakwana yekufungisisa uye kutanga nekutanga. .Zivo.inotanga nhaurirano nehunyanzvi, yozoenda kumazinga epamusoro eruzivo nehunyanzvi kuti uwane metacognition. "Mutori wechikamu 9: "Ini ndinotenda zvakasimba kuti nzira dzekubvunza dzinoshandisa nzira dzeAppreciative Inquiry (AI) uye kubvunza mibvunzo uchishandisa Bloom's Taxonomy modhi inosimudzira kushingaira kudzidza uye kutarisisa kwevadzidzi uku ichideredza mukana wengozi yekuwandisa kwekuziva."Chikamu chekubvunza chemuenzaniso chine chinangwa chekupfupisa pfungwa dzekudzidza dzakasimudzwa panguva yeRLC uye kuona kuti zvinangwa zvekudzidza zvazadzikiswa.Mutori wechikamu 8: "Zvakakosha kuti vese mudzidzi nemudzidzisi vabvumirane papfungwa dzakanyanya kukosha uye zvinhu zvakakosha zvekufunga nezvazvo pakuita maitiro."
Mvumo yetsika yakawanikwa pasi penhamba dzeprotocol (MRC-01-22-117) uye (HSK/PGR/UH/04728).Iyo modhi yakaedzwa mumatatu ehunyanzvi ekuchengetedza ekutevedzera makosi kuti aongorore kushandiswa uye kushanda kweiyo modhi.Chiso chechokwadi chemuenzaniso chakaongororwa neboka rekushanda-dhizaini (N = 18) uye nyanzvi dzedzidzo dzinoshanda sevatungamiriri vedzidzo (N = 6) kugadzirisa nyaya dzine chekuita nechitarisiko, girama, uye maitiro.Mushure mekutendeseka kwechiso, kutendeseka kwemukati kwakatemwa nevakuru mukoti vadzidzisi (N = 6) vakapihwa zvitupa neAmerican Nurses Credentialing Center (ANCC) uye vakashanda sevarongi vedzidzo, uye (N = 6) vaive nemakore anopfuura gumi edzidzo uye ruzivo rwekudzidzisa.Chiitiko Chebasa Kuongorora kwakaitwa nevatungamiriri vedzidzo (N = 6).Kuenzanisira ruzivo.Kushanda kwezvirimo kwakatemwa pachishandiswa Content Validity Ratio (CVR) uye Content Validity Index (CVI).Nzira yeLawshe [52] yakashandiswa kufungidzira CVI, uye nzira yaWaltz naBausell [53] yakashandiswa kufungidzira CVR.CVR mapurojekiti anodiwa, anobatsira, asi kwete madikanwa kana sarudzo.Iyo CVI inopihwa pachiyero-mapoinzi mana zvichienderana nekukoshera, nyore, uye kujeka, ne1 = haina basa, 2 = zvakati zvine basa, 3 = yakakodzera, uye 4 = yakakosha.Mushure mekuona huso nehuchokwadi hwemukati, pamusoro pemawekishopu anoshanda, dzidziso uye dzidziso dzakaitirwa vadzidzisi vachashandisa modhi.
Boka rebasa rakakwanisa kukudziridza uye kuedza muenzaniso we-post-simulation RLC kuti uwedzere unyanzvi hwekufunga kwekliniki panguva yekutora chikamu muSBE mumakamuri ekuchengetedza zvakanyanya (Mifananidzo 1, 2, uye 3).CVR = 1.00, CVI = 1.00, inoratidza chiso chakakodzera uye kugutsikana kwemukati [52, 53].
Iyo modhi yakagadzirirwa boka reSBE, uko zvinonakidza uye zvinonetsa zviitiko zvinoshandiswa kune vatori vechikamu vane zvakafanana kana akasiyana mazinga echiitiko, ruzivo uye hukuru.Iyo RLC conceptual modhi yakagadziridzwa zvinoenderana neINACSL ndege simulation yekuongorora zviyero [36] uye yakanangana nevadzidzi uye inotsanangura yega, kusanganisira yakashanda mienzaniso (Mifananidzo 1, 2 uye 3).Iyo modhi yakagadziridzwa zvine chinangwa uye yakakamurwa kuita nhanho ina kuti isangane nemiyero yekuenzanisira: kutanga nepfupiso, ichiteverwa neinofungidzira kuongorora / kusanganisa, uye kupera neruzivo uye pfupiso.Kuti udzivise njodzi inogona kuitika yekuziva kuwandisa, nhanho imwe neimwe yemuenzaniso yakagadzirirwa nemaune sechinhu chinodiwa padanho rinotevera [34].
Kurudziro yehukuru uye kuwirirana kweboka zvinhu pakutora chikamu muRLC haina kumbodzidzwa [38].Tichifunga nezve pfungwa dzinoshanda dzekaviri loop uye cognitive overload theory mukuenzanisa kudzidzira [34, 37], zvakakosha kufunga kuti kutora chikamu muboka reSBE nezviitiko zvakasiyana uye kukwanisa mazinga evatori vechikamu muboka rimwechete rekufananidza idambudziko.Kuregeredza vhoriyamu yeruzivo, kuyerera uye chimiro chekudzidza, pamwe nekushandisa panguva imwe chete yekukurumidza uye inononoka yekurangarira maitiro nevadzidzi vechikoro chesekondari uye vadiki vechikoro chesekondari kunoisa njodzi inogona kuitika yekuziva kuwandisa [18, 38, 46].Izvi zvinhu zvakaverengerwa pakugadzira iyo RLC modhi kudzivirira kusakudziridzwa uye / kana suboptimal kliniki kufunga [18, 38].Zvakakosha kufunga kuti kuitisa RLC ine mazinga akasiyana ehukuru uye kugona kunokonzera kutonga pakati pevatori vechikamu vakuru.Izvi zvinoitika nekuti vatori vechikamu vepamusoro vanowanzo dzivirira kudzidza pfungwa dzekutanga, izvo zvakakosha kune vadiki vatori vechikamu kuti vawane metacognition uye kupinda yepamusoro-level yekufunga uye kufunga maitiro [38, 47].Iyo RLC modhi yakagadzirirwa kubata vanamukoti vakuru uye vadiki kuburikidza nekutenda kubvunza uye delta maitiro [45, 46, 51].Uchishandisa nzira idzi, maonero evatori vechikamu vakuru uye vadiki vane kugona kwakasiyana uye mazinga echiitiko acharatidzwa chinhu nechinhu uye anokurukurwa achifungisisa neanoongorora moderator uye co-moderator [45, 51].Pamusoro pemipimo yevatori vechikamu vekuenzanisa, mufambisi wenhaurirano anowedzera zvaanoita kuti ave nechokwadi chekuti zvese zvakaunganidzwa zvinofukidza zvizere nguva yega yega yekudzidza, nekudaro ichisimudzira metacognition kuti ikwidzise kufunga kwekiriniki [10].
Kuyerera kweruzivo uye chimiro chekudzidza uchishandisa iyo RLC modhi zvinogadziriswa kuburikidza nehurongwa uye hwakawanda-nhanho maitiro.Izvi ndezvekubatsira vafambisi venhaurirano uye kuona kuti vatori vechikamu vataura zvakajeka uye nechivimbo padanho rega rega vasati vaenda padanho rinotevera.Mutevedzeri achakwanisa kutanga nhaurirano dzekufungisisa umo vatori vechikamu vose vanotora chikamu, uye kusvika pane imwe nguva apo vatori vechikamu vehukuru hwakasiyana uye mazinga ekugona vanobvumirana pane zvakanakisisa maitiro ehurukuro yega yega vasati vaenda kune inotevera [38].Kushandisa nzira iyi kuchabatsira vatori vechikamu vane ruzivo uye vane ruzivo kugovera mipiro yavo / kucherechedza, nepo mipiro / kucherechedzwa kwevasina ruzivo uye vanokwanisa vatori vechikamu kuchaongororwa nekukurukurwa [38].Zvisinei, kuti vazadzikise chinangwa ichi, vafambisi vanofanira kutarisana nedambudziko rekuenzanisa nhaurirano uye kupa mikana yakaenzana kune vakuru nevaduku vanotora chikamu.Kuti izvi zviitike, nzira yekuongorora yekuenzanisira yakagadzirwa nemaune uchishandisa Bloom's taxonomic modhi, iyo inosanganisa ongororo yekuongorora uye yekuwedzera / delta nzira [45, 46, 51].Kushandisa hunyanzvi uhu nekutanga neruzivo nekunzwisisa kwemibvunzo yakakosha/nhaurirano dzekufungisisa zvinokurudzira vatori vechikamu vane ruzivo rushoma kuti vatore chikamu uye vatore chikamu munhaurirano, mushure mezvo mufambisi anozoenda padanho repamusoro rekuongorora nekuumbwa kwemibvunzo/nhaurirano. umo mapato ese ari maviri anofanirwa kupa Vakuru neVadiki vatori vechikamu vane mukana wakaenzana wekutora chikamu zvichienderana neruzivo rwavo rwekare uye ruzivo nehunyanzvi hwekiriniki kana mamiriro akateedzerwa.Iyi nzira ichabatsira vatori vechikamu vasina ruzivo kuti vatore chikamu nekubatsirikana kubva kune zvakaitika zvakagoverwa nevatori vechikamu vane ruzivo rwakanyanya pamwe nemhinduro yemufambisi wehurukuro.Kune rimwe divi, modhi haina kugadzirwa chete kune maSBE ane hunyanzvi hwakasiyana hwevatori vechikamu uye mazinga echiitiko, asiwo kune vatori vechikamu veboka reSBE vane ruzivo rwakafanana uye mazinga ekugona.Mutevedzeri wakagadzirirwa kufambisa kufamba kwakanaka uye kwakarongeka kweboka kubva pakutarisa paruzivo nekunzwisisa kusvika pakutarisa kusanganisa uye kuongorora kuti uwane zvinangwa zvekudzidza.Chimiro chemuenzaniso uye maitiro akagadzirirwa kuti aenderane nemapoka ekuenzanisira ezvipo zvakasiyana uye zvakaenzana uye mazinga echiitiko.
Mukuwedzera, kunyange zvazvo SBE muhutano hwehutano pamwe chete neRLC inoshandiswa kukudziridza kufunga kwekliniki uye kukwanisa mune vashandi [22,30,38], zvisinei, zvinhu zvakakosha zvinofanira kutorwa maererano nekuoma kwenyaya uye njodzi dzinogona kuitika dzekuziva kuwandisa, kunyanya. apo Vatori vechikamu vaisanganisira zviitiko zveSBE zvakafananidzira zvakanyanya kuoma, varwere vanorwara zvakanyanya vanoda kupindira nekukurumidza uye kuita sarudzo dzakakomba [2,18,37,38,47,48].Kuti izvi zviitike, zvakakosha kuti titarise maitiro evatori vechikamu vane ruzivo uye vasina ruzivo panguva imwe chete kuchinja pakati peanoongorora uye asiri-analytic masisitimu ekufunga pavanenge vachitora chikamu muSBE, uye kugadzira humbowo-hwakavakirwa nzira inobvumira vese vakuru nevadiki. vadzidzi kuti vatore chikamu nesimba mukudzidza.Nokudaro, muenzaniso wakagadzirwa nenzira yokuti, pasinei nekuoma kwenyaya yakafananidzirwa yakaratidzwa, mufambisi anofanira kuona kuti zvikamu zvezivo uye kunzwisisa kwemashure evatori vechikamu vakuru uye vaduku zvinotanga kuvharwa uye zvishoma nezvishoma uye zvinogadziriswa kuti zvigadziriswe. fambisa kuongorora.synthesis uye kunzwisisa.evaluative aspect.Izvi zvichabatsira vadzidzi vadiki kuvaka nekubatanidza zvavakadzidza, uye kubatsira vadzidzi vakura kusanganisa nekuvandudza ruzivo rutsva.Izvi zvinosangana nezvinodiwa zvehurongwa hwekufunga, tichifunga nezve chiitiko chekare uye kugona kwemutori wechikamu wega wega, uye kuve nefomati yakajairwa inotarisana nekatsika kevadzidzi vechikoro chesekondari nevadiki vechikoro chesekondari kuti panguva imwe chete vafambe pakati pekuongorora uye neanonalytic masisitimu ekufunga, nekudaro. kuve nechokwadi chekugadzirisa kwekufunga kwekiriniki.
Pamusoro pezvo, vafambisi vekuenzanisa / vanoongorora vanogona kunetseka kugona kugona hunyanzvi hwekunyepedzera.Kushandiswa kweruzivo rwekubvunzurudza zvinyorwa zvinotendwa kuti zvinobudirira mukuvandudza ruzivo rwekuwana ruzivo uye hunyanzvi hwekuita hwevanofambisa zvichienzaniswa nevasingashandisi zvinyorwa [54].Zviitiko chishandiso chekuziva chinogona kufambisa basa revadzidzisi rekuenzanisira uye kuvandudza hunyanzvi hwekubvunza, kunyanya kuvadzidzisi vachiri kubatanidza ruzivo rwavo rwekuongorora [55].kuwana hukuru hwekushandisa uye gadzira mamodheru-ane hushamwari.(Mufananidzo 2 uye Mufananidzo 3).
Iko kuwirirana kubatanidzwa kweplus/delta, ongororo yekutenda, uye nzira dzeBloom's Taxonomy ongororo haisati yagadziriswa muongororo iripo yekufananidza uye inotungamirwa yekuratidzira modhi.Kubatanidzwa kwemaitiro aya kunoratidza hutsva hweRLC modhi, umo nzira idzi dzakabatanidzwa mune imwechete fomati kuti iwane optimization yekiriniki kufunga uye mudzidzi-centeredness.Vadzidzisi vezvokurapa vanogona kubatsirwa neboka rekuenzanisira SBE vachishandisa iyo RLC modhi kuvandudza uye kugonesa vatori vechikamu kugona kufunga kwekiriniki.Mamiriro emuenzaniso uyu anogona kubatsira vadzidzisi kugona maitiro ekuratidzira uye kusimbisa hunyanzvi hwavo kuti vave vane chivimbo uye vanokwanisa kufambisa nhaurirano.
SBE inogona kusanganisira nzira dzakawanda dzakasiyana-siyana uye maitiro, kusanganisira asi asina kuganhurirwa kune mannequin-based SBE, basa simulators, murwere simulators, vakamira varwere, chaiwo uye augmented chokwadi.Tichifunga nezvekuti kushuma ndeimwe yeakakosha maitiro ekuenzanisira, iyo yakateedzeredzwa RLC modhi inogona kushandiswa seyekuzivisa modhi kana uchishandisa aya modhi.Uyezve, kunyangwe iyo modhi yakagadziridzwa yekuranga vanamukoti, ine mukana wekushandiswa mune interprofessional healthcare SBE, ichiratidza kudikanwa kwematanho ekutsvagisa emangwana kuyedza iyo RLC modhi ye interprofessional dzidzo.
Kuvandudza uye kuongororwa kwemashure-simulation RLC modhi yekuchengeta mukoti muSBE intensive care units.Kuongororwa kweramangwana / kusimbiswa kwemuenzaniso kunokurudzirwa kuwedzera kuwirirana kwemuenzaniso wekushandiswa mune mamwe maitiro ehutano hwehutano uye interprofessional SBE.
Muenzaniso wakagadzirwa neboka rekushanda rakabatana rinobva pane dzidziso uye pfungwa.Kuti uvandudze kutendeseka uye kugoneka kweiyo modhi, kushandiswa kweakakwidziridzwa kuvimbika matanho ekuenzanisa zvidzidzo anogona kutariswa mune ramangwana.
Kuti kuderedze zvikanganiso zvekudzidzira, varapi vanofanirwa kuve nehunyanzvi hwekufunga kwekiriniki kuti vave nechokwadi chekuchengetedza uye kwakakodzera kuita sarudzo yekiriniki.Kushandisa SBE RLC senzira yekubvunzurudza inosimudzira kuvandudzwa kwezivo uye hunyanzvi hunoshanda hunodiwa kukudziridza kufunga kwekiriniki.Zvisinei, maitiro akawanda ekufungidzira kwekliniki, ane chokuita nezvakaitika kare uye kuratidzwa, kuchinja kwehutano, huwandu uye kuyerera kwemashoko, uye kuoma kwezviitiko zvekufananidza, zvinoratidzira kukosha kwekugadzira mushure-simulation RLC mienzaniso kuburikidza nekliniki yekufungidzira inogona kushingaira. uye inoitwa zvinobudirira.unyanzvi.Kuregeredza zvinhu izvi kunogona kukonzera kusakudziridzwa uye kusakwana kwekiriniki kufunga.Iyo RLC modhi yakagadziridzwa kugadzirisa zvinhu izvi kuti ikwidzise kufunga kwekiriniki kana uchitora chikamu mumapoka ekuenzanisa zviitiko.Kuzadzisa chinangwa ichi, modhi panguva imwe chete inosanganisa plus/minus evaluative kubvunza uye kushandiswa kweBloom's taxonomy.
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Nguva yekutumira: Jan-08-2024