爱尔兰国际硕士班学习心得（胡越神经重症监护病区）

发布时间：2024.05.15 来源部门：管理员

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2022年6月，在医院的支持和帮助下，在北京华通国康公益基金会（BHGF）的组织安排下，怀着对留学的向往和对护理科研的追求，我有幸参加了为期一年的爱尔兰芒斯特省理工大学国际护理硕士学习项目。因为疫情原因，此次学习上半学期是在国内通过线上学习的方式参加的，下半学期是前往爱尔兰线下学习的。时光飞逝，一年的时间转眼而过，回顾这一年的日子，经历多多，收获满满，感触颇丰。这一年的学习让我感受到了学习机会来之不易和持续学习的重要性，这都要归功于医院鼓励员工持续学习。通过这一年的研究生学习，我对护理和护理科研有了更深刻的认识和理解，学习了如何通过反思判断自己的临床实践，还学习了运用科研知识解决护理临床问题，而且知晓了如何运用科研知识指导我们临床实践，以及使用循证的方法为患者提供更高质量的护理。现将这一年学习期间的所见、所闻、所思、所想分享给大家，与大家共勉。

爱尔兰概况

爱尔兰是位于西欧的岛屿国家，教育体系完善，教育水平领先欧洲国家，得到国际的广泛认可。加之爱尔兰的官方语言为英语，前往爱尔兰学习的学生不用再单独学习其他小语种。爱尔兰的护理教育世界闻名。

在校学习情况

我们的学习分为两部分，英语语言学习和专业课程学习。虽然在参加课程之前已经通过了语言考试，但是学校还是在专业课之前安排了为期两个月的语言培训。老师都是来自语言学校的专职老师，其内容类似于雅思培训，包含听说读写，涉及日常沟通、饮食、人物、爱尔兰文化历史等，以及一些简单的护理专业情景对话。课堂形式多样，包括小组讨论、游戏、PPT演讲比赛等。课后还会有作业巩固课堂所学内容。通过这些学习，加深了我的语言能力，为后期的专业课做好准备。通过语言培训，使得学员之间有了更多的了解，建立了深厚的同学情谊。在专业课程开始之后，我们的语言课程由一周五天改为了一周两次。老师还会根据我们不同的学习要求而更改学习内容。

专业课程分为上、下两学期，一共有八门课程，此外，还有一门课程为学术指导，旨在帮助我们解答关于课程的任何问题，帮助完成学业。与国内教育不同，老师没有固定的教材，所有的PPT内容均从经典书籍或者文献中截取的篇章。为了帮助我们更好地理解老师课堂所讲的内容，老师还会推荐很多文献和专业书籍供我们阅读。每门课程都以论文为考评标准，字数从1500到10000字。

第一学期的四门课程为护理理论（Nursing Theory）、研究方法学和设计（Research Methodology and Project Design）、领导力（Leadership）和反思实践（Transforming Practice through Reflection）。因为疫情的原因，我们这学期的课程全部采用线上教学。每门课程均由两名老师负责，虽然通过了语言考试和语言培训，但是对于母语非英语的我来说还是很难一下子跟上老师的语速，因此还是借助了一些实时翻译软件帮助理解。第二学期的四门课程为循证实践（Evidence-Based Practice）、伦理决策力（Ethical Judgment In Professional Leadership）、护理信息学（Healthcare Informatics）和毕业论文（Dissertation Project）。幸运的是，第二学期我们去到了爱尔兰，可以真切感受课堂教学。以下是八门课程的详细讲解：

护理理论Nursing Theory（5学分）：一方面，老师们让我从理论的角度重新理解了护理学。也让我知晓了护理理论在护理学科的重要性。这门课也解答了困惑我很久的疑惑，医院众多中标课题项目的理论来自于哪里。但是在开始学习的时候，我一头雾水，自己还在B站上找了一些视频帮助我理解护理理论。最终，通过这门课程，我知道了什么是广域理论、中域理论，也正是这些理论，支撑着护理作为一门学科的发展。通过阅读相关书籍，我也知晓了中域理论的运用范围，不同于广域理论，它们可以直接指导护理临床实践和研究。另一方面，此门课程旨在通过对某一护理问题的前因后果的分析，对其促成因素的详细剖析，从而形成概念，最后这些概念融合形成护理理论。在这门课程中，通过使用护理概念分析的八大步骤，完成了关于“道德困境”的概念分析。
研究方法学和设计Research Methodology and Project Design（5学分）：该课程从方法学的角度讲解了如何完成一个研究设计，但又不仅仅是方法学。因为追其根源是世界观，不同的世界观确定了不同的研究类型。在研究设计方面，老师特别强调理论对研究的重要性，因为质性研究有助于构建护理知识，帮助一个理论的发展；而量性研究又可以对理论进行验证。两位老师分别从质性研究和量性研究的角度为我们讲解了如何完成一个研究设计，其主要内容包括了文献检索、科研设计、伦理审核、抽样、文献写作等。通过学习，我完成了一篇关于ICU护士对于临终护理态度的文献回顾，这些内容也是为了下学期的毕业论文做准备。
领导力Leadership（10学分）：这门课程帮助我区分了管理和领导力，并且详细讲解了四类领导力：仆人式领导力、真实领导力、变革型领导力和集体领导力。每一种领导力风格各有所长，不同的领导力对领导者的能力和要求均不一样。该课程作业分为两部分，第一个作业是批判性分析“leadership involves the use of interpersonal skills to influence others to accomplish specific goals.”这句话。老师为了让我们更好地完成作业，进行了小组讨论，让大家发表自己的看法，激发出我们的灵感。第二个作业是关于领导如何面对当今社会的机遇和挑战，以便该组织的成员感到自己是受到重视和授权的。通过该课程的学习，我知道了每一种领导力方式在组织实践中扮演的角色和作用均不同，我们需要根据组织的现状采用不同的领导方式，帮助每个成员积极投入到工作中，从而促进组织的变革与发展，以面临当今社会的机遇与挑战。
反思实践Transforming Practice through Reflection（10学分）：看到课程名字时，我以为这个反思和我们平时的反思是一样的，但是通过学习后发现大有不同。这门课程通过讲解批判性解放性反思在护理实践中的重要作用，并使用了泰勒模型帮助自己对以往实践进行反思。该课程通过老师讲课、研讨会和PPT汇报等形式开展。通过这些方式的学习，我完成了“NCU护士可持续发展的解放性反思”的论文。泰勒模型让我认识到自己的行为不仅受到我自己的影响，还受到我身处的环境、社会和文化的影响。

5.循证实践Evidence-Based Practice（5学分）：是指将最佳研究证据与临床专业知识和患者价值相结合，帮助患者做出最佳决策的能力。该课程需要对某专业问题进行全面的检索并评价文献的质量。为了进行全面的检索，老师教导我们使用PICO检索原则来构建一个可回答的问题，并推荐和讲解了一些不同的文献质量评价工具。这门课程需要进行PPT汇报，因此，通过系统地检索，我发现护理学生的考试焦虑较其他专业的学生更高，但是缺乏有效减轻考试焦虑的证据总结，并在这之后完成了“芳香疗法是否可减轻护理学生考试焦虑”的论文。以前看文章，都不知道从哪些角度去评价文章质量的高低，通过对五篇文章的质量评价，了解了众多评价工具，自己知道了可以从哪些方面去评价一篇文章，从哪些角度去判断一篇文章的好坏。此外，通过循证，我们可以去寻找对临床问题最好的解决办法，发现哪些干预措施有效或无效，从而减少医疗成本，使病人得到最好的护理，提高护理质量。以后还需要继续学习，在有一定的输入后能做到输出一些内容。

6. 伦理决策力Ethical Judgment in Professional Leadership（5学分）：伦理决策力的课程是由两名老师教授的，一名负责从哲学的角度告知我们关于患者人权的内容，一位老师则负责将这些抽象的哲学内容从行为准则等方面具体化。这门课程让我对问题的思考角度更广阔。也就是说我不再是仅仅是从护士或医疗的角度去看待一些临床问题，而是从患者和家属的角度去思考他们对于医疗和护理的选择，而且会更加尊重患者和家属的决定。此外，通过该学习，我发现中国护理人员在伦理方面的行为准则要求并不详细且侧重点不一样。爱尔兰护理及助产士管理委员会颁布的《Code of Professional Conduct and Ethics For Registered Nurses and Registered Midwives》则对护士的行为从伦理方面进行了规范，也详细指导了护士及助产士关于伦理问题在临床上如何做出决策，促进了护士职业能力的发展。

7. 护理信息学Healthcare Informatics（5学分）：这门课程向我们展示了电子健康的发展和在医疗环境中的重要性，也告诉了我护士在电子健康的发展和管理中的现况和角色。作为一名护士，我们不仅仅是电子健康的使用者，我们还可以是开发者。因为这门课程分为理论和实践两部分，其作业任务分为小组作业和个人作业。小组作业要求我们以小组为单位设计一个APP。我们小组由五名同学组成，其中包括一名来自印度的同学，通过大家的合作和配合，我们完成了“术前访视APP”项目。通过这个项目，我了解了APP的制作过程，虽然我们遇到了很多问题，但是通过我们的合作和密切的沟通，最终解决了那些困难。此外，这门课程使我对护理信息化建设有了兴趣，觉得自己能通过更多的方法去提高护理工作效率，解决临床护理问题。

8. 毕业论文Dissertation Project（15学分）：毕业论文则是大综合，是对我们整个学年内容的总结，因为其要求是写一份研究计划书，包含了两部分：文献回顾和对研究问题提出可操作的详细方案，字数要求为10000字。而且老师在新学期一开始就公布了这门课程的进度要求，我们每个人需要按照这个进度去完成这个作业。在这份计划书里，我需要考虑以下几个方面：①研究设计：包括研究方法、抽样等；②理论框架；③伦理考虑。虽然要求高，内容多，但是学校为我们每位学生安排了一名指导老师协助我们完成这门作业。经过与我指导老师的商量，确定了我的毕业论文主题为“探讨西南某三级医院重症监护病房护士心理赋权与工作倦怠的关系：横断面调查”。在完成毕业论文的过程中，每周我和指导老师会保持密切的联系，除了每次的单独讨论，我们还会在邮件里沟通写作情况。老师也会根据我的完成进度对我的草稿进行修改并给出建议，并安排下一周的写作任务。我需要阅读大量的文献，让我对横断面研究有了深入的了解，对我以后的工作有很大的帮助。

三、总结和展望

在学习之余，我看完了《精益医疗》这本书，它虽然不厚，但是内容很丰富。让我知道了医疗是一个追求精益的职业。此外，尊重员工，让员工主动参与变革也是其中很重要的内容。这也就要求我们要持续学习，接受变化才能不被时代淘汰。

在学习最后，我们有幸参观了Kerry郡的医院，但是为了保护病人的隐私，我们只能进入空的病房。即使这样，我们也了解了他们的医院布局和相关科室的设备设施情况，以及感受到了他们对病人保护的强烈意识，这是非常值得我们学习的地方。

在这一年的学习过程中，我时刻提醒自己要珍惜机会，不能浪费时间，努力学习，与老师和同学们建立了深厚的感情，并顺利通过了所有课程，取得了毕业证书。通过一年的脱产学习，让我对护理和护理科研知识有了较系统的了解。让我明白了护理科研与临床实践是相同重要的，他们都是为了促进护理学科的发展，为了给患者提供更好地护理服务，也提升护理人员的满意度。通过这一年的学习，我掌握了文献检索策略，文献管理工具和文献评价工具的使用，知晓了护理理论的相关知识，这些都为我以后的临床和科研工作提供了帮助。此外，作为科室科研小组的一员，我将所学的科研理论知识分享给大家，促进大家科研知识的储备。我将从以下几方面开展工作：①护理理论相关知识的培训：护理理论是支撑护理为护理学科的一个重要方面，了解护理理论可以更好地指导我们的护理实践。基于此，我将为大家介绍一些护理理论，供科室科研小组老师学习，为我们的科研发展提供理论支持，也给大家提供一些资源，让大家在写标书时不再为找不到理论支撑而烦恼。②循证护理培训：这一年的学习让我对循证护理知识有了掌握和了解，循证护理也是护理实践和科研的重要组成部分。因此，我将给大家分享不同文章类型的评价工具，帮助他们如何阅读和评价一篇文章。③在科室成立英语角，为大家英语学习提供帮助，提升大家的英语水平。④将对我们科室的护士进行伦理决策能力的提升培训，提高他们的伦理警觉，更富有同理心，做到尊重患者，从他们的角度思考问题，提升护理满意度。

The learning experience of the International Master's Program in Ireland

Deyang People's Hospital Neurological Intensive Care Ward Hu Yue

In June 2022, with the support and help of the hospital and the organization and arrangement of Beijing Huatong Guokang Foundation (BHGF), with the yearning for studying abroad and pursuit of nursing research, I had the honor to participate in the one-year International Master of Nursing study program at Munster Technological University, Ireland. Due to the epidemic, the first half of the study was online in China, and the second half of the study was offline in Ireland. Time flies, a year of time in a twinkling of an eye, looking back on the days of this year, a lot of experience, full of harvest, a lot of feelings. This year's study made me feel the hard-won learning opportunities and the importance of continuous learning, which is thanks to the hospital's encouragement of employees to continue learning. Through this one-year postgraduate study, I have gained a deeper understanding of nursing and nursing research, learned how to judge my clinical practice through reflection, learned to use scientific research knowledge to solve nursing clinical problems, and learned how to use scientific research knowledge to guide our clinical practice, and use evidence-based methods to provide higher quality care for patients. I would like to share with you what I saw, heard, and thought during this year's study.

一、Overview of Ireland

Ireland is an island country located in Western Europe, has a complete education system, leading European countries in terms of education level, and has been widely recognized internationally. In addition, the official language of Ireland is English, so students who travel to Ireland to study do not have to learn other minor languages separately. Nursing education in Ireland is world-renowned.

二、Study in school

Our study was divided into English language learning and professional courses. Although I had passed the language exam before taking the course, the school still arranged a two-month language training before the professional course. The teachers are all full-time teachers from language schools, and the content was similar to IELTS training, including listening, speaking, reading and writing, covering daily communication, food, people, Irish culture and history, and some simple nursing professional situational dialogues. The classes were in a variety of formats, including group discussions, games, PPT speech contests, etc. After class, there would also be homework to consolidate what you learned in class. Through these studies, I deepened my language skills and prepared for later professional courses. Through the language training, I had more understanding and established a deep friendships with classmates. After the start of the professional course, our language course was changed from five days a week to twice a week. Teachers would also change the learning content according to our different learning requirements.

The professional program was divided into two semesters, a total of eight courses. In addition, there was another course called academic support to help us answer any questions about the course and help us complete our studies. Different from Chinese education, teachers had no fixed textbooks, and all the PPT content was intercepted from classic books or literature. In order to help us better understand what the teacher said in class, the teacher would also recommend a lot of literature and professional books for us to read. Each course was judged on a thesis basis and had a word count ranging from 1,500 to 10,000 words.

The four courses in the first semester were nursing Theory, Research Methodology and Project Design, Leadership, and Transforming Practice through Reflection. Due to the epidemic, all of our courses for this semester were online. Two teachers were in charge of each course. Although I passed the language test and language training, it was difficult for me to keep up with the teacher's speech speed at once for a non-native English speaker, so I still used some real-time translation software to help me understand. The four courses in the second semester are Evidence-Based Practice, Ethical Judgment in Professional Leadership, Healthcare Informatics and Dissertation Project. Fortunately, we went to Ireland in the second semester, where we could really feel the classroom teaching. Here are the details of the eight courses:

Nursing Theory (5 credits): On the one hand, the teachers let me re-understand nursing from a theoretical perspective. It also made me aware of the importance of nursing theory in the nursing discipline. This course also answers my confusion for a long time, where the theory of many hospital-winning projects comes from. But when I began to study, I was confused, and I also found some videos on Bilibili to help me understand the theory of nursing. Finally, through this course, I knew what is a wide-area theory, middle-area theory, and it is these theories that support the development of nursing as a discipline. Through reading relevant books, I also knew the scope of the application of middle-area theory. Different from wide-area theory, middle-area theory can directly guide the clinical practice and research of nursing. On the other hand, this course aimed to form concepts through the analysis of the causes and consequences of a nursing problem and the detailed analysis of its contributing factors, and finally these concepts merge to form a nursing theory. In this course, the conceptual analysis of "moral distress" was completed by using the eight steps of nursing concept analysis.

Research Methodology and Project Design (5 credits): The course explained how to complete a research design from a methodological perspective, but not just the methodology. Because the root cause is the worldview, different worldviews determine different types of research. In terms of research design, the teacher emphasized the importance of theory to research, because qualitative research helped to construct nursing knowledge and help the development of a theory, and quantitative research could verify the theory. The two teachers explained how to complete a study design from the perspective of qualitative research and quantitative research respectively, whose main contents included literature review, research design, ethical consideration, sampling, literature writing, and so on. Through the study, I completed a literature review of ICU nurses' attitudes toward end-of-life care, which is also prepared for my dissertation project in the next semester.

Leadership (10 credits): This course helped me distinguish between management and leadership, and explained in detail four types of leadership: servant leadership, authentic leadership, transformational leadership, and collective leadership. Each leadership style has its own strengths, and different leadership has different abilities and requirements for leaders. The course assignment was divided into two parts, and the first assignment was a critical analysis of the sentence "Leadership involves the use of interpersonal skills to influence others to accomplish specific goals". In order to let us finish the homework better, the teacher held group discussions, allowing everyone to express their views and inspire us. The second assignment was about how leaders face the opportunities and challenges of today's society so that members of the organization feel that they are valued and empowered. Through the study of the course, I learned that each leadership style plays a different role in organizational practice, we needed to adopt different leadership styles according to the current situation of the organization to help each member actively participate in the work, so as to promote the change and development of the organization, to face the opportunities and challenges in today's society.

Transforming Practice through Reflection (10 credits): When I saw the name of the course, I thought that this reflection was the same as our usual reflection, but I found that it was very different after learning. This course taught me the important role of critical emancipatory reflection in nursing practice and used the Taylor model to help me reflect on past practices. The course was conducted through teacher lectures, seminars, and PPT presentations. Through these methods, I completed the paper "Emancipatory Reflection on the Sustainable Development of NCU Nurses". The Taylor model led me to realize that my actions were influenced not only by myself but also by the environment, society, and culture where I live in.

Evidence-based (5 credits): The ability to combine the best research evidence with clinical expertise and patient value to help patients make the best decisions. This course requires a comprehensive search and evaluation of the quality of literature on a professional issue. To conduct a comprehensive search, the teacher taught us to use the PICO retrieval principle to construct an answering question and recommended and explained a number of different literature quality evaluation tools. This course required PPT presentation, so, through a systematic search, I found that nursing students had higher test anxiety than students in other majors, but there is a lack of evidence summary to effectively alleviate exam anxiety, and then completed the paper "Does aromatherapy can reduce nursing students' exam anxiety". In the past, I did not know from what angle to evaluate the quality of the article, through the quality evaluation of the quality of the five articles, I learned about many evaluation tools and knew from what aspects to evaluate an article and judge the quality of an article. In addition, through evidence-based research, we can find the best solution to clinical problems, and find out which interventions are effective or ineffective, thus reducing medical costs, providing the best care and improving nursing quality for patients. In the future, we still need to continue learning and to output some content after certain inputs.

Ethical Judgment in Professional Leadership (5 credits): The course was taught by two teachers, one is responsible for informing us about patients' human rights from a philosophical perspective, while the other teacher focuses on making these abstract philosophical concepts more concrete through ethical code, guidelines and behavior standards. This course broadened my thinking perspective on issues. That is to say, I no longer just approach clinical issues from a nursing or healthcare perspective, but consider the choices and decisions made by patients and their families, and I will respect the decisions of patients and their families more. In addition, through this study, I found that the ethical code of conduct for Chinese nursing professionals is not as detailed and focused as those for Irish nursing and midwifery professionals. “The Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives” issued by the Irish Management Council of Nursing and Midwives regulates the ethical behavior of nurses and also guides nurses and midwives on how to make clinical decisions on ethical issues, which promotes the development of nurses' professional competence.

Healthcare Informatics (5 credits): This course showed us the development of e-health and its importance in the medical environment. It also taught us the current status and role of nurses in the development and management of e-health. As a nurse, we are not just users of electronic health, we can also be developers. The course was divided into theoretical and practical parts, with group and individual assignments. The group work required us to design an APP as a team. Our group was composed of five students, including one student from India. Through our cooperation and coordination, we completed the "Preoperative Visit APP" project. Through this project, I learned about the process of making an APP. Although we encountered many problems, we finally solved those difficulties through our cooperation and close communication. In addition, this course made me interested in the construction of nursing information, and I think I can improve the efficiency of nursing work and solve clinical nursing problems through various methods.

Dissertation Project (15 credits): It is a comprehensive summary of the content we have learned throughout the year. It required us to write a research plan, including two parts: a literature review and a detailed plan for addressing research questions, with a word count requirement of 10,000 words. In addition, the teacher announced the schedule requirements of this course at the beginning of the new semester, and each of us needed to complete the homework according to this schedule. In this plan, I needed to consider the following aspects: ① Research design: including research methods, sampling, etc.; ② theoretical framework; ③ ethical considerations. Although the requirements were high and the content was extensive, the school has arranged a supervisor for each student to assist us in completing this assignment. After consulting with my supervisor, the theme of my thesis was determined. It was "To Investigate The Relationship Between Psychological Empowerment And Job Burnout Among Intensive Care Unit Nurses At A Tertiary Hospital In Southwest China: A Cross-Section Survey". In the process of completing the graduation thesis, I kept a close contact with the instructor every week, in addition to individual discussions, we also communicated about the writing situation through email. The supervisor would also modify my drafts and provide suggestions based on my progress, and arrange the writing task for next week. I needed to read a lot of literature so that I had a deep understanding of cross-sectional research, which will be of great help to my future work.

三. Summary and outlook

In my spare time, I finished reading the book "On The Mend" which is not thick, but very rich in content. This book let me know that medical care is a profession that pursues leanness. In addition, respecting employees and allowing them to actively participate in change is also an important part. This also requires us to continue to learn, to accept the change is not to be eliminated by the Times.

At the end of the study, we had the honor to visit the hospital in Kerry County, but to protect the privacy of the patients, we had to enter the empty wards. Even so, we also learned about their hospital layout and the equipment and facilities of related departments, as well as feel their strong awareness of patient protection, which is very worthy of our learning.

In this year, I always remind myself to cherish the opportunity, not to waste time, to study hard, and established a deep relationship with teachers and students, and successfully passed all the courses and obtained the graduation certificate. Through a year of off-job study, I have a more systematic understanding of nursing and nursing scientific research knowledge. This study make me understand that nursing research and clinical practice are equally important, they are all to promote the development of nursing discipline, in order to provide better nursing services for patients, and also improve the satisfaction of nursing staff. Through this year's study, I have mastered the use of literature retrieval strategies, literature management tools and literature evaluation tools and known the relevant knowledge of nursing theory, these have provided help for my future clinical and scientific research work. In addition, as a member of the nursing research team of the department, I will share the theoretical knowledge of scientific research with my colleagues to promote the reserve of their research knowledge. I will carry out the work from the following aspects: ① nursing theory related knowledge training: nursing theory is an important aspect of supporting nursing for the nursing discipline, understanding the nursing theory can better guide our nursing practice. Based on this, I will introduce some nursing theories to our research group of the department to learn, provide theoretical support for our nursing research development, and provide them with some resources, so that they will no longer worry about finding theoretical support when writing project plan.② Evidence-based nursing training: this year's study make me master and understand of evidence-based nursing knowledge, evidence-based nursing is also an important part of nursing practice and research. So I'll share with our colleagues different article type evaluation tools to help them with how to read and appraise an article.③ Set up an English corner in the department to help our colleagues learn English and improve their English level.④ The nurses in our department will be trained to improve their ethical decision-making ability, improve their ethical vigilance, have more empathy, respect patients, think about problems from patients and their families’ perspective, and improve nursing satisfaction.