Advanced Nursing Practice Development in Mainland China Dr. Hu Yan School of Nursing, Fudan University
Outline: 1. Nursing Education System 2. Progress of Nursing Research 3. Nursing Care Delivery System 4. Nursing Management 5. Scope of Nursing Care 6. Evidence-base Nursing Practice
1 Nursing Education --moving from secondary nursing education to university-based education
Milestones of Nursing Education in Mainland China 1921 started undergraduate nursing program in PUMC 1952: national-wide secondary level nursing education 1979 proposal on promoting higher nursing education submitted to the National People's Congress 1980 started diploma nursing program in universities 1983 re-started undergraduate nursing program in medical universities 1992 started master program in nursing in Peking Uni 2003 started doctoral program in nursing in the Second Military Uni
Nursing Programs in Mainland China 2005 Doctoral program: 4 Master Program 30+ Undergraduate program 133 Diploma program 255 Certificate program: 400+
Educational Background of Nurses in Mainland China Educational Background Master and PhD Bachelor Diploma Certificate in 2004 (1.31 million) <0.1% 1.3% 24.3% 64.5% Aims in 2010 (2.32 million) 0.5% 19.5% 30% 50% Chinese Nursing Developmental Plan 2005 2010, from Health Ministry, 2005
Development of nursing curriculum Holistic and humanistic philosophy Health education role of nurse Client as a whole Nursing process System approach / developmental approach / functional pattern approach general knowledge medical knowledge nursing knowledge, skill, and lab practice clinical practice
Degree Two type of baccalaureate degree: Baccalaureate of Science: 4 years Baccalaureate of Medicine: 5 years Master of Medicine: 3 years ( 2 years)
2. Nursing Research -- quantity and quality
Nursing Journals 1995: 6 nursing journals Chinese Journal of Nursing Chinese J of Practical Nursing Chinese J of Nursing Science Chinese J of Nurse Training Shanxi Nursing J Oversea Medicine Series: Nursing 2005: increased to 27 nursing journals
Number of Research Papers in Nursing Journals (Chen Jinlian et al. The investigation on status of conducting nursing research. Chinese J of Nursing Research. 2004, 18(3): 457-461) 1994 1996: only 17 in 5 core nursing journals 2000 2002: increased to 239 (χ 2 =43.03, P<0.05) Research paper account for only 9.5% of papers
Methodology 1995: 1655 papers in 5 key nursing journals, inferential statistics 11, descriptive statistics 9.27%. 2002: 3046 papers inferential statistics 24.39%, descriptive statistics 9.39 (χ 2 =55.01, P<0.05) Chen Jinlian et al 2004 RCT papers: 0.8% in 1993~1995, increased to 7.7% during 1999~2000, 20.16% in 2003 Qualitative research: fewer Zhu Dan et al, 2002, Liu Yingchun et al 2005)
Methodology: comparison Yuan Changrong.. The analysis on trends of nursing papers. Chinese Military J of Nursing, 2005, 22(11):1-2 Methodology qualitative 6 SCI Nursing Journals year N of papers 40 % 45.46 3 core Chinese nursing journals/year N of papers 3 % 2.61 quantitative 35 39.77 survey 33 experimental 16 summary 38 Case analysis 7 28.69 13.91 80.44 33.04 6.08 triangulation 10 11.36 0 0 others total 3 88 3.41 100 review 10 others 8 115 8.69 6.95 100
Research collaboration authors of most papers were from same institutions 16.85% papers indicated authors from different institutions. Chen Jinlian et al 2004
Research Funding 1994~1999: 89 2410 papers 3.69% indicated research funding 2000~2002: 239 2460 papers 9.71% indicated research funding Source of funding National level research funding Municipal level research funding Project: CMB, HOPE Project University research funding Chen Jinlian et al 2004
Nursing Research: --Future Trends Expand topics in humanistic area and nursing policy study Increase number of prospective study Improve research design Initiate qualitative research
3. Nursing care delivery system --Functional nursing --Team nursing --Clinical pathway
Hospital System in Mainland China 3 Levels, 6 grades Primary Hospital: (community level, two grade) Secondary Hospital: two grade Tertiary Hospital: two grade
Nursing Care Delivery System in Mainland China Functional nursing: common in most secondary hospitals Team nursing: common in tertiary hospitals
The Exploration of Theoretical discussion: Clinical Pathway(CP) Yai MQ et al. The exploration of implementing CP in 21 century. Chinese J of Nurse Training, 2002, 17(4): 270-271 Clinical application Yin XJ et al. The application of CP in taking care of patients with cholecystectomy. Chinese Practical Nursing, 2002, 18(9): 27-29 Zhang WY et al. The application of CP in monitering patients in CCU. Nursing Journal of Chinese People's Liberation Army, 2003, 20(4): 45-47. Master thesis: Dai Hongxia (2003): The effectiveness of implementing clinical pathway for patients with kneescope Cao Hongxia (2003): Clinical Pathway for type II DM
4. Nursing Management -- broader vision of nursing administrators
Milestones of Nursing Management in Mainland China 1. 1979-- Policy on Strength Nursing Management by Health Ministry: construct Nursing Service Department in hospitals 2. 1986-- the first National Nurse Congress, expanded responsibility of Nursing Service Department 3. 1993-- Measures for nursing administration in P.R.China, start RN system 4. 1998-- Act on Continuing Nursing Education 5. 2005-- Guideline for Evaluating Quality of Nursing Care 6. 2005-- the second National Nurse Congress, Chinese Nursing Developmental Plan 2005~2010
The national strategic plan in Nursing Profession Development 1. Issuing Nurse Law and Code of Nursing 2. Increasing number of first-line nurses 3. Adjusting the structure for educational background of nurses in different level of hospitals 4. Improving quality of care: holistic philosophy 5. Training clinical specialized nurses 6. Improving the management and leadership skills 7. Developing community nursing 8. Nursing education innovation in structure and curriculum 9. Developing TCM and nursing 10. Strengthing international collaboration
Career Development of Nurse Technical title: Administrative title: Charge Nurse Head Nurse Nurse superintendent Director of Nursing Service Department Should develop Professional Title: Level or grade system of Nurse? Professional Ladder?
Vision of nursing administrators: application of transformational leadership theory Transformational vision empowerment motivation change agent productiveness Transactional daily task oriented conservative follow order no change initiated predictive
Shanghai Study --Hu Yan,, Yang Yinghua,, Ma Mingzhi et al. Leadership behaviors of head nurses and work effectiveness of nursing: a study from Shanghai. Chinese J of Nursing,, 1999, 34(8): 453-457. 457. Objectives: To study the relationship among leadership behaviors of head nurses and work effectiveness of nurses in Shanghai. Design: A correlational-descriptive study 48 head nurses and 292 staff nurses were investigated in 8 firstlevel top-grade hospitals in Shanghai. Questionnaire: leadership behaviors --Leadership Practices Inventory for self and other, job satisfaction--job-in-gerenal scale, productivity scale work effectiveness organizational commitment--organizational commitment scale
Shanghai Study: results Leadership behaviors of head nurse ranked by staff nurses: 1. Encouraging the heart 2. Modeling the way 3. Enabling others to act 4. Inspiring a shared vision 5. Challenge the process Inspiring a shared vision from head nurses is the predictor of organization commitment and job satisfaction enabling others to act is the predictor of organizational commitment
Shanghai Study: result (cont) Challenging the process is the only predictor of productivity modeling the way and encouraging the heart are the top two leadership styles of head nurses, and it is highly correlated to job satisfaction but modeling the way and encouraging the heart can not predict productivity and organizational commitment
National Training Plan for Nursing Administrator 2006: develop National Training Program for nursing administrators By 2010: training all directors in NCD in tertiary hospitals Head nurse training program Chinese Nursing Developmental Plan 2005 2010, from Health Ministry, 2005
5. Expanded Scope of Nursing Community nursing Clinical Specialized Nurse
The Significance of Community Health Care in P.R.China new point for the development of health care system Community nursing is an important part of community health care P.R.China: community nurse account for 10% of RN in 2003
Community Health Care Practice in Shanghai Build network of community health care system by 2004 1998-2004 invested 964 million RMB for system re-construct and professional training City 98 community health center 422 community health stations 12 million citizen) suburb 127 community health center 2251 village health station 3 million farmers) Characteristics From hospital structure to community center structure From specialized clinic to general clinic, construct reference system Family-based health care Family-based bed Nursing rehabilitation center for elders
The Studies on Community Nursing Master thesis: Zhang Yumei 2001 Needs for community nursing and plan of training community nurse. Shen Huixia 2002 The study on curriculum of community nursing program (diploma level) Zhanghua 2002 Family-based rehabilitation program for community people with stroke. Zhang Shaoru 2003 Psychological distress and quality of life of caregivers for community elder people with dementia Jia Shoumei 2004 Psychosocial support program for community elder people with depression Lu Minmin (2005): A comprehensive diet and exercise intervention program on community people with metabolistic syndrome.
The Progressive of Community Nursing Community nursing is integrated in the curriculum of diploma and undergraduate nursing programs: theory and practice Training program for current community nurses No specialized degree/diploma program for community nursing Community nursing is put in one of the ten focus of Chinese Nursing Developmental Plan 2005 2010
About Specialized Nurse in Mainland China Exploration the role of Specialized Nurse (SN) in China You Liming. Role of CNS in nursing profession. Chinese J of Nursing, 2002, 37(2):85-88. Practice Clinical specialized nurses in DM and Wound Care Feng JE. et al. The practice of clinical specialized nurse. Chinese J of Nursing 2004, 39(2):115-117 Wound Care Nurse Training Program in Sun Yat-Sen University and other cities Wound Care Clinic, PICC Clinic What we need to do: registration and accreditation system for SN
About Clinical Specialized Nurse in Mainland China Develop Clinical Specialized Nurse System 2005 2010 ICU Emergency Nursing Organ transplantation Operation room Nursing Cancer Nursing et al Chinese Nursing Developmental Plan 2005 2010, from Health Ministry, 2005
Nurse Practitioner, NP No start yet, as: Right for prescription Education requirement, registration criteria, auditing system
6. Evidence-based Nursing in Mainland China
EBN a hot topic in nursing Paper: 195 papers with EBN in title in CNKI ( ), 295 papers in VIP Information database ( ), 213 papers in Wangfang Data ( ),.., 2001, 36(4):245-248.. :., 2001,17(6):1-2. Studies:,.., 2004, 19(12): 1082-1083.,,... 2004, 10(1):3-4...,2004,10(10):159-160. EBN Center: Fudan JBI Center for Evidence-based Nursing: launched in Nov 2004
http://www.joannabriggs.edu.au
http://nursing.fudan.edu.cn JBI
Barriers in implementing EBN results from pilot study Li Tianya,2005 1 Do not have enough knowledge about EBN (47.0%) Nurses don t have the right to change the procedure. (33.4% rank as the first barrier) Do not recognized the significance in changing, believe the routine way 2 Do not have enough ability of applying EBN (44.2%) Don t know how to evaluate quality of research paper. Difficult in reading nursing journals in English Don t understand statistics 43.9% rank as the 3rd barrier)
Barriers in implementing EBN results from pilot study Li Tianya,2005,2005 3 Do not have enough external recourse required for EBN (60.1%) Don t have enough time in searching research papers Don t have enough time to use research result Don t have the support from administrators Don t have enough time to follow the suggestion from research results (30.1% rank as the 2 nd barrier
Barriers in implementing EBN results from pilot study Li Tianya,2005,2005 4 Do not have enough nursing researches with good quality in Chinese (38.7%) Unclear description Result can not be tested and repeated Researches are not relevant to practice Research results are contradictive with each other Research results are not updated The value of research is not obviously indicated Some research results are not acceptable
Misunderstandings of EBN in mainland China A new nursing model? Ignore individualization Evidence = RCT result? EBN= systematic review and meta analysis? EBN= conducting research? EBN= literature review?
Nurses, a caring team Start from evidence-base Practice!
School of Nursing, Fudan University
nursing