目的 构建病区疼痛护士阿片类药物临床危机管理仿真模拟课程,并评价其应用效果。方法 参考国际护理临床模拟教学协会最佳实践标准,从情景编制、师资准备、设施配备、场景布置和学生准备5个维度构建阿片类药物临床危机管理仿真模拟课程。2019年11月—12月,便利选取浙江省某三级甲等综合医院的61名病区疼痛护士,在麻醉手术部模拟教学中心应用仿真模拟课程。采用评判性思维倾向问卷、对阿片类药物引发的过度镇静和呼吸抑制的临床决策自信测评等进行教学评价。结果 培训后评判性思维能力总分为（264.57±2.77）分,与培训前得分比较,差异均具有统计学意义（P<0.05）;培训后对阿片类药物引发的过度镇静和呼吸抑制的临床决策自信得分分别为（3.89±0.82）分、（3.89±0.80）分,与培训前得分比较,差异均具有统计学意义（P<0.001）;病区疼痛护士对仿真模拟课程的满意度较高。结论 仿真模拟课程有助于提高病区疼痛护士的阿片类药物临床危机管理能力和临床决策自信,可为疼痛护士综合应急能力培训提供参考。
Objective To construct a simulation course of opioid-induced clinical crisis management for pain nurse in ward and evaluate its effects. Methods Following the best practice standards of International Nursing Association for Clinical Simulation and Learning,according to the five basic dimensions of scenario development,facilitator preparation,equipment preparation,environmental preparation and pre-course student preparation,a opioid-induced clinical crisis management simulation course was constructed. From November to December 2019,a group of 61 pain nurses in wards from a tertiary general hospital in Zhejiang Province were selected for training in the simulation teaching center of the Anesthesia-Operation Department of the hospital. The teaching evaluation was carried out by using the questionnaire of Critical Thinking Disposition Inventory and clinical decision-making self-confidence assessment of excessive sedation and respiratory depression caused by opioids. Results After training,the total score of critical thinking was （264.57± 2.77）. There were statistical differences before and after the training（P< 0.05）. After training,the clinical decision-making self-confidence of the trainees in the excessive sedation and respiratory depression caused by opioids was（3.89± 0.82） and（3.89± 0.80） respectively,which were statistically different compared with those before the training（P< 0.001）. Pain nurses in wards were highly satisfied with the simulation teaching course. Conclusion The simulation course can effectively improve the clinical crisis management ability and clinical decision-making confidence of pain nurses in wards,and can provide reference for the training of comprehensive emergency response ability of pain nurses.
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