求学爱尔兰，梦想照进现实

 

一个人至少拥有一个梦想，有一个理由去坚强。心若没有栖息的地方，到哪里都是在流浪。

——三毛

 

2019年6月17日，在与家人依依惜别后，怀揣着对未来的憧憬，我翻开了人生中崭新的一页，踏上了爱尔兰留学之路。大学时期总以为这样的梦想离我很遥远，却没想到在工作了第8个年头之时，我获得了如此珍贵的机会，新的征程让梦想照进了现实！

我深知，这次出国深造的机会是多么的可贵！感谢医院各级领导同事的支持与鼓励，感谢北京华通国康公益基金会（BHGF）的悉心组织，我才能有幸成为第五期爱尔兰国际护理硕士班中的一员。时光飞逝，原本为期一年的留学生涯不得不在全世界人们共同抗击新冠病毒的战疫中提前结束。宁静的夜晚，俯身桌前，遗憾，不舍，感恩……复杂的情绪涌上心头。遗憾的是未能穿上最美的隔离服战斗在抗疫一线；不舍的是即将要离开这个美丽的Tralee小镇和翡翠爱岛；感恩的是让我遇到了一群可敬可爱的爱尔兰导师和同学们。

下面我将在爱尔兰研究生学习期间的所见所闻所学整理汇报如下，希望能与大家共勉。

一、爱尔兰等级教育简介

爱尔兰自2004年起施行10级学历学位体系。在高等教育阶段中，7级为普通学士学位（相当于我国专科），8级为荣誉学士学位（相当于我国学士学位），9级为硕士学位，10级为博士学位。

我们所申请的国际护理硕士就属于LEVEL-9。针对这个级别的学生，学院对每一门课程的学习目标都有明确的考核标准，导师们也时刻强调我们在写作论文时所应展现的思辨水平。虽然只要通过学业考核，就能获得硕士学位而不是荣誉学位。但对于英语为非母语的我们而言绝非易事，因此，我们只能花大量的时间安坐桌前，“寒窗苦读”，尽快摸索和适应迎面而来的困难和挑战。

二、两个月的浸润式英语学习，为正式开学打好语言基础

对于中国留学生来说，提高英语听说读写能力，摆脱哑巴英语，是保证后续进行高效全英文课程学习及查阅大量文献资料的前提和关键。因此，经过一天的简单休整和倒时差，我们立即进入了语言培训。语言课是在学院南校区进行，老师根据人数将32名学员分成了2个小班以便于课堂管理和互动。

语言课全英文教学，内容多样化：除了常规英语写作、日常话题交流外，还涉及了很多爱尔兰的文化习俗，如文化冲击（Culture Shock）、爱尔兰体育和音乐（Irish Sport and Music）等 ，后期加入了专业课词汇，为我们九月份正式开学打基础。授课方式包括小组讨论、presentation、各种小游戏、小组battle、随堂quiz等；头脑风暴（Brainstorm）、思维导图贯穿于每一堂课。这里的老师极大地调动了我们学习英语的兴趣，每一堂课气氛生动活泼，每个人都积极参与其中；老师们的包容和风趣也是对我们的一种鼓励，让我们不再畏惧犯错，勇敢开口说英语，在游戏和互动中潜移默化地提升了语言技能。一周5天的语言课程看似轻松，但常常有homework的压力，“写作业至深夜”对于而立之年的我们来讲，既是磨练也是享受；课后消化和练习、课前预习和准备占据了我们大部分的课余时间，大家都乐此不疲；两周一次的雅思测验，方便老师调整教学的重点，也让我们明白逆水行舟不进则退的道理。每个人都感受到了语言提升的迫切和必要，在这样的学习氛围下，我们以宿舍为单位组成了学习小组，每晚集中进行口语话题练习，大家互帮互助，共同进步。

三、初次感受中西方“教与学“的差异

中西方文化差异下的教学使我们面临着巨大的挑战。受传统文化影响，中国学生在教学过程中总是秉持着以老师为主导的学习态度和习惯，更适合封闭式学业考核方法；而西方教学模式大大不同，教学中以学生为主导，老师更加注重学生的自主性、批判思想和创造性，授课只是辅以引导和点拨，并不是将知识全盘灌输，考核方式也是开放性的论文写作，鼓励学生拥有自己的独特见解，而不批判对与错。

每一门课都没有固定教材，老师会将课程相关的值得推荐的资料以阅读清单（Reading List）的形式下发，我们自己去查阅资料拓展知识。在课堂上，老师经常随机分组，以小组形式针对一个主题进行头脑风暴，充分注重学生的参与性，也加强了我们在大量阅读基础上进行知识储备的自主意识。老师们还会用到自己的研究课题、论文、著作来帮助我们更好地理解护理研究的方法和理论，甚至为我们创造了与国际护理前辈对话的机会。

由于终究不是母语教学，老师们讲课的超快语速加上爱尔兰口音、英语的表达习惯和思维差异都让我们倍感压力。为了帮助我们解  决实际困难，学院还特别设置了Academic support 课程，内容包括文献检索方法、英语辅导、参考文献引用等。学校的图书馆（丰富的藏书、强大的数据库）对我们的学习也起到了关键的支持作用。无论是难以查找到全文的文献或是借阅新出版的书籍，图书馆都能满足学生们的需求。对于查询文献有困难的学生，只需提前预约，就能得到图书馆管理员的专人辅导。

四、八门专业课程，接受新理念、新知识的洗礼

全年两个学期共有八门课程，每一门都分属于独立的学科，却又紧密联系相辅相成。第一学期的四门课程分别为科研方法学（Research Methodology and Project Design），护理理论（Nursing Theory），领导力（Leadership）和反思实践（Transforming Practice through Reflection）。第二学期的四门课程分别为徇证实践（Evidence-Based Practice），伦理决策力（Ethical Judgement in Professional Leadership），护理信息学（Healthcare Informatics）和毕业论文（Dissertation Project）。每门课程也跟国内一样，采用学分制，不同的模块学分值不同。正式开课之前我们都会收到关于这门课程详细介绍的Handbook，包括每周的课程安排，期中的考核要求，期末的论文写作标准、相关的文献阅读清单等。除了毕业论文字数要求为10000字，其余的每门课程都要上交2500字左右的论文。

每门课程都采用双导师制，授课方式大多为多媒体集中授课。课堂形式不拘一格，有工作坊（workshop），学生主导的讨论会（Student-led Seminar），自选题目和资料的演讲（Presentation）和小组辅导课（Group Tutorials）等。毕业论文设计部分我们都在一对一的Supervisor的监督与帮助下，通过面对面讨论，邮件和社交软件交流，选定主题，搜索文献，制定初稿，反复修改，最终顺利地按时完成。比较特殊的是由于今年疫情的影响，我们在宿舍接受了近两个月的网络授课，这对导师和我们来说都是一次特殊的教学体验。每次上网课，导师们都准备了丰富的授课内容，结束之余还关心我们居家隔离期间的心理健康。同学们也都端正学习态度，按时出席，积极发言，十分珍惜疫情之下难得的学习机会。

1、科研方法学Research Methodology and Project Design（5个学分）：这门课程算是为我打开了护理研究的大门。以前在临床工作中虽然也略有接触护理科研相关工作，但是却并未深入而系统地了解护理研究。学习了这门课程，我才明白，护理研究应该是一个科学严谨的过程，锁定研究问题，在worldview的指导下，选择适合的研究方法（质性、量性和混合性研究方法），样本量，研究对象的选择方法，数据收集与分析的方式，伦理考虑和结果讨论。每一个步骤都需要仔细考量，才能得出严谨的研究结果。我所感兴趣的领域是晚期癌症患者的家庭照顾者负担。因此，在这门课程中我完成了论文“Caring for patients with advanced cancer: caregiver burden”，通过大量地查询文献，我对国内外晚期癌症患者的照顾者负担研究现状有了清晰的了解和认识，在文中也对目前研究照顾者负担的主要研究方法做了详细地讨论，为我第二学期的毕业设计储备了一定的知识和经验。

2、护理理论Nursing Theory（5个学分）：护理理论为护理实践和研究提供了可靠的理论依据。这门课程我们主要学习的是中层理论（Middle Range Theory），它被认为是大理论（Grand Theory）与护理实践之间的桥梁。因为它能更好的指导解决实际问题而被广泛运用于护理研究中。通过对Walker and Avant的护理构建策略的学习，加上文献检索和广泛阅读，我完成了对照顾者负担（Caregiver burden）的概念分析，了解了照顾者负担的关键属性、前因后果、测量工具以及其适用的多个护理理论。对一个护理概念如此深入的了解和分析让我有了前所未有的成就感。

3、领导力Leadership（10个学分）：这门课程让我认识到不同类型的领导力对组织文化、service users、下属及个人发展等方面有着深刻的影响。交易型、变革型、合作型和集体型领导方式各自拥有优缺点，引发了我们的思考：在工作实践中，应该怎样运用不同的领导方式从而对组织变革与发展，文化的形成与改造产生积极的作用？除此以外，组织的变革不仅仅需要强有力的领导，更需要每个成员的积极参与。作为非管理层的个体，在组织中也充当着不可忽略的作用。在这门课程中我们体验了一场特别的Workshop——marshmallow chanllenge。这是一种design&teamwork挑战项目。我们每5人一组，用少量的意大利面、细绳和剪刀三种材料，在18分钟内搭建出能够支撑棉花糖的最高塔。这个项目迫使团队中不熟悉的成员迅速建立联系，并且达到有效合作：热烈讨论方案，发挥设计、领导和协作能力，尝试-创新-制作，在失败中学习并迅速调整方案，最终搭建出能够承受棉花糖重量的意大利面塔，这就是设计思维中prototyping & Testing 的精神，也是团队合作精神和领导力的体现。

4、反思实践Transforming Practice through Reflection（10个学分）：这门课程帮助我们学习用辩证的思维去反思和理解我们工作中的行为。在日常的工作中识别困扰和约束着我们的护理事件（常常是那些被认为理所当然的行为），然后从一个旁观者的角度去评估和分析，再从个人价值观和成长经历、文化、政治、经济和社会等多个方面进行梳理和分析约束我们行为的原因，最后重建更加完善的护理行为从而改变现状。

5、徇证实践Evidence-Based Practice（5个学分）：这门课程教会我们如何科学地评估和利用各种证据。对于临床中遇到的护理问题可以首先转化为不同类型的PICO问题，然后检索最新最有力的科学证据，采用适宜的证据类型，系统评价和分析总结从而得出问题的答案，指导护理实践。基于几年的工作经验，我知道国内外的老年人跌倒发生率都居高不下，并且存在很多不良后果。通过对当前已知文献的学习，我发现在众多的预防措施中，太极拳占据重要地位。在对5项太极拳预防老年人跌倒的随机试验的系统分析发现，规律地练习太极拳可以减少跌倒的发生或降低跌倒发生率及伤害程度。但是对于具有跌倒史的较高跌倒风险的老年人而言，应该做好评估和防范，并在专业指导下练习太极拳。

6、伦理决策力Ethical Judgement in Professional Leadership（5个学分）：通过这门课程的学习，提升了我们的伦理意识。在日常工作中，医护人员经常不知不觉身处于各种伦理困境（Ethical dilemma），在需要做出艰难的决策时刻，我们不仅需要道德勇气（Moral courage），考虑职业守则（Professional code of conduct），还要遵循伦理原则。在2500字的Assignment中，我主要探讨了医疗环境下的告密行为（whistleblowing），遇到这种处境的我们应该怎样做出一个正确的选择（Making a right decision）以及组织文化在这当中所起到的作用等。并且，这本课程也让我明白了在护理研究中的伦理考虑，不应仅仅着眼于保障参与者的知情同意。每一项研究（尤其是临床试验）都应该经过伦理委员会的充分评估和审查，在确保每一个环节都遵循了伦理原则之后方可进行，这是前提。伦理委员会还应该保障研究者和参与者的各项正当权益，并且在研究过程中有能力为他们提供必要的支持与帮助。

7、护理信息学Healthcare Informatics（5个学分）：这门课程非常具有实际意义。作为临床一线的工作者，参与到医院的信息化管理的建设中，将护理与电子技术相结合，这是非常符合当代社会的发展趋势的。我们4人一组，协商合作，从App的概念设计到绘制纸质原型（paper prototype），到最后电子编码，软件顺利运行，这个过程充满创造力和趣味性。信息化技术的发展与临床护理工作密不可分，为了更好地改善临床工作流程（workflow），提高效率, 一线的护理人员拥有更多的发言权，因此应该广泛参与，提出自己的宝贵意见，与工程师一起完善和解决软件运行过程中的问题。

8、毕业论文Dissertation Project（15个学分）：为期近半年的毕业论文设计虽然只有10000多字，却是其他课程知识的综合体现，如护理理论作为理论框架、伦理考虑、研究方法的选择等。在第二学期开学之前我们早早地收到了详细的Handbook。一开学就紧锣密鼓地筹备着，每周一次与导师会面沟通，汇报进展。为了在有限的一个小时内达到高效沟通，与导师见面之前我都会做大量的准备工作，查找资料、梳理问题、记录笔记等。照顾者负担是我这一年学习里的主要研究领域，国内外对于家庭照顾者负担的研究在很多种疾病中都有较详细的研究，大多数的研究采用了量性研究的方法去评估和测量照顾者负担，而对晚期肝癌患者的家庭照顾者负担的研究相对较少。因此，我的毕业论文：“ Caregiving burden among family caregivers of people with advanced liver cancer in China: An interpretative phenomenological analysis“采用了质性研究方法IPA深入探索了晚期肝癌患者家庭照顾者的经历。在此，我特别感谢我的导师Dr. Dominika，在疫情爆发之际，忙碌的她仍然远程为我提供耐心的指导，帮助我顺利完成写作。

五、丰富的课余生活，感受异国文化

虽然由于疫情的原因，我们没能前往当地医院进行临床见习，给我们留了个小小的遗憾。但在学习之余我也积极参加学校和小镇上的各项活动，爱尔兰人民的质朴和热情友好带给了我们一段美好的难忘回忆。

1、在特拉利国际玫瑰节（Rose of Tralee International Festival）60周年的盛大节日期间，我申请成为了一名志愿者，通过委员会的面试后，与几位同学一起参与了节日的筹备和运作，深入感受了当地的文化风情。

2、在学校举办的一年一度的国际大学生节中，我们筹备的中国文化展台宣扬中国传统艺术和文化，受到了在校师生的喜爱和高度好评，在20多个国家文化展台中被评选为第一名。

3、在特拉利首届中国新年系列庆祝活动中，我们到爱尔兰的当地小学，为那里的师生介绍中国春节习俗，弘扬中国传统文化。

4、学习之余我也不忘院领导和家人的嘱托，积极锻炼身体，保持充足的精力。镇上每周六早上9点半都有一个Park Run跑步活动，每到这时爱好运动的人们都会自发地聚集在公园参加5公里的长跑，有老人有小孩，甚至还有盲人，这让我真切感受到生命不息运动不止的精神。

六、学习成果

    一年时间的脱产学习，我努力让每一天都充实而有意义。在导师的帮助和自己的努力下，取得了一些小的成果。

1、顺利毕业并获得一等荣誉学位。

2、我的第一篇英语文章将在《International Journal of Nursing Sciences》上发表。

3、由2020届国际护理硕士班全体同学（每人一个章节）翻译的《护理理论实践与应用》将由西安交通大学出版社出版。

七、思考

1、严谨是护理研究最基本的态度

一年的硕士课程，完成了近10篇的英语论文写作。想要写出富有逻辑且论证充分的论文，就必须花大量的时间查阅文献，阅读文献，才能在理解的基础上加以运用；除了尽可能地使用英语词汇或句式准确表达观点之外，还培养了我的批判性思维，辩证地看待问题，最终形成自己的观点，而不是一味地接受或臆断他人的观念。学校严格的论文审查制度也让我们不得不认真对待，除了不能抄袭他人，我们还要特别注意避免自我抄袭、自我剽窃。就算是自己的文章，过分复制也属于抄袭、剽窃范畴，是严重的违纪行为。而且，在阅读外文文献时，研究者们的深思熟虑体现在字里行间，严谨性贯穿在整个科研过程，让我深受感染，严谨是科研人员必须具备的基本素质。

2、反思是护理实践与研究的重要手段

在学习反思实践这门课程时，中国留学生普遍表现出的不知所措与班里的当地研究生形成了鲜明对比。的确，我们习惯于各种工作守则和规范，惯性地参照执行而缺乏思考，不敢质疑。而这恰恰是护理实践和护理研究极其需要的可贵品质。反思，不是一味地纠错，而是为了更好地前进而做出的必要的思考。在日常工作和科研活动中，我们都应该保持反思精神，摈弃理所当然的想法，科学地、及时地做出改变，这样才能保持工作的活力，消除职业倦怠。

离家万里的求学经历将是我人生中不可多得的独特体验，感恩这一年里遇到的所有美好。今后的我会继续秉持初心，努力前行。

 

Study in Ireland, making dream into reality

On June 17, 2019, with a vision for the future, I was reluctant to part with my family, turned over a new leaf in my life, and embarked on the road of studying in Ireland. When I was in college, I thought that such a dream was far away from me. However, I didn’t expect that I could get such a precious opportunity when I worked for the 8th year. The new journey brings my dream into reality.

I know very well how precious the opportunity to go abroad for further study is! Thanks to the support and encouragement from the leaders and colleagues at all levels of the hospital, as well as the meticulous organization of BHGF, Beijing. I have the honor to be a member of the 5th international master of science in the nursing program in Ireland.  As time flies, a year of studying abroad had to end early in the global battle against the Covid-19. On a quiet night, I lean over my desk. The complex emotions welled up in my mind, regret, dismay, appreciation...... It is a pity that I cannot wear the most beautiful protective suits to fight against the epidemic. I am reluctant to leave this beautiful town named Tralee and  Emerald Island. To my gratitude, I was fortunate to meet a group of respectable and lovely tutors and classmates in Ireland.

Now summarizes what I have seen, heard, and learned during the learning period as a graduate student in Ireland, in the hope of mutual encouragement with all my colleagues.

1. Introduction to hierarchical education in Ireland

Ireland has implemented a 10-level academic degree and diploma system since 2004. In the higher education stage, level 7 represents the general degree (College degree in China), level 8 represents the honor degree (bachelor's degree in China), level 9 is the master's degree, level 10 is the doctor's degree.

The international master of science in the nursing program we applied for is level-9. For students at this level, the Institute has clear assessment criteria for the learning objectives of each module, and tutors have always emphasized the critical thinking we should show when writing papers. Although individuals can receive a masters' degree rather than an honorary degree if they pass academic assessments. However, for us who are not native English speakers, it is by no means easy. Therefore, we can only spend a lot of time sitting at the desk, "Cold window study hard", exploring and adapting to the coming difficulties and challenges as soon as possible.

2. Two months of immersion in English learning, to lay a good language foundation for the official opening of the new semester

For Chinese students studying abroad, improving their English listening, speaking, reading, and writing skills, and don’t act like a mute. This is the premise and key to ensure the efficient learning of following English courses and access to a large amount of literature. So, after a day of simple rest and dealing with jet lag, we immediately started the language training. The language training was conducted on the south campus of the college. The teacher divided us into two small groups according to the number of students, to facilitate classroom management and interaction.

Language training courses are taught in English, with diversified contents. In addition to regular English writing and daily topic communication, it also involves a lot of Irish cultural customs, such as Culture Shock, Irish Sport, and Music, etc. Professional vocabulary has been added in the late stage, laying the foundation for our official opening in September. The teaching methods include group discussion, presentation, various mini-games, group battle, classroom quiz, etc. Brainstorm and mind map run through every class. The teachers here have greatly aroused our interest in learning English. The atmosphere of each class is lively and everyone is actively involved in it. The teachers' tolerance and sense of humor are also an encouragement to us so that we are not afraid to make mistakes, speak English bravely, and subtly improve our language skills through games and interactions. The arrangement of language courses five days a week seems relaxed, but we often feel the pressure of homework. "Doing homework till midnight" is both honed and a kind of enjoyment for us in our 30s. Digestion and practice after class, preview, and preparation before class occupied most of our spare time, which we all enjoyed. The biweekly IELTS test is convenient for teachers to adjust the focus of teaching, but also lets us understand that learning is like rowing upstream, not to advance is to drop back. Everyone was aware of the urgency and necessity of language improvement. In such an atmosphere, we formed a study group in the dormitory and practiced oral English every night. We helped each other and made progress together.

3.Experience the difference between Chinese and western "teaching and learning" for the first time

It is a great challenge for us to absorb the essence of education under the differences between Chinese and western cultures. Influenced by traditional culture, Chinese students always adhere to the teacher-led learning attitude and habits in the teaching process, which is more suitable for the closed academic assessment method. However, the western teaching model is quite different, in which students play the leading role, and teachers pay more attention to the autonomy, critical thinking, and creativity of students. Teaching is only supplemented by guidance and inspiration, rather than the overall indoctrination of knowledge. The assessment approaches are also open essay writing, which encourages students to have their own unique opinions without criticizing right and wrong.

There is no fixed teaching material for each course. The teacher will make a reading list of the recommended materials related to the course, and we need to look up the materials and expand our knowledge according to this list. In class, the teacher often randomly groups students. Brainstorm a topic in a group, so as to fully pay attention to the participation of students, but also strengthen the awareness of knowledge reserve on the basis of a lot of reading. Teachers will also use their research projects, papers, and books to help us better understand the methods and theories of nursing research, and even create opportunities for us to have a dialogue with international predecessors in the nursing field.

As a result of not teaching in the mother tongue, the teachers' super fast speaking speed, along with the Irish accent, English expression habits, and differences in thinking all put us under pressure. To help us solve the practical difficulties, the college has specially set up the academic support course, which includes the method of literature retrieval, English tutoring, the correct citation of references, and so on. The school library (rich collection, powerful database) also plays a key role in supporting our study. Whether it is difficult to find full-text literature or to borrow newly published books, the library can meet the needs of students. For students who have difficulty in searching the literature, they only need to make an appointment in advance to get special help from the librarian.

4. Eight professional courses, to accept the baptism of new ideas, new knowledge

A total of eight courses are offered over the two semesters, each of which is a separate but closely linked discipline. In the first semester, the four courses were Research Methodology and Project Design, Nursing Theory, Leadership Transforming through Reflection. In the second semester, the four courses were Evidence-based Practice, Ethical Judgment in Professional Leadership, Healthcare Informatics, and Dissertation Project. Each course is also the same as the domestic university, using the credit system, different modules of the credit value is different. Before the formal opening of the course, we will receive a detailed handbook, including weekly course arrangement, mid-term assessment requirements, final essay writing standards, the reading list of the relevant literature, etc. In addition to the 10,000-word thesis for the Dissertation Project, about 2,500 words should be submitted for each course.

Each course adopts the double tutorial system, and the teaching techniques are mainly concentrated teaching assisted by multimedia. There are workshops, student-led seminars, self-management presentations on topics and materials, and group tutorials. Under the supervision and help of the one-to-one Supervisor, we selected the topic, searched the literature, wrote the first draft, and revised it repeatedly through face-to-face discussion, email, and social software communication. Finally, we finished the dissertation on time. What is special is that due to the impact of the epidemic this year, we received nearly two months of online teaching in the dormitory, which was a different experience for both the lecturer and us. In each online class, the lecturers have prepared rich teaching content, and they are also concerned about our mental health during the home quarantine. We also have the correct attitude towards study, attend on time, speak positively, and cherish the rare learning opportunity under the epidemic.

4.1 Research Methodology and Project Design (5 credits)

This course opened the door to nursing research for me. Although I had a slight exposure to nursing research work in clinical work before, I did not have a deep and systematic understanding of the nursing research approach. After learning this course, I realized that nursing research should be a scientific and rigorous process. Identifying research topics, and selecting appropriate research methods (qualitative, quantitative, and mixed methods), determine sample size and target population, data collection and analysis, ethical considerations, and outcome discussion should under the guidance of worldview. Each step requires careful consideration before a rigorous study can be made. The area I’m interested in is the family caregiver burden for patients with advanced cancer. Therefore, I completed the thesis "Caring for patients with advanced cancer: caregiver burden". Through a large number of literature inquiries, I have a clear understanding of the current research status of caregiver burden for patients with advanced cancer at home and abroad. In this paper, I also made a detailed discussion on the main research methods for caregiver burden at present, which provided me with some knowledge and experience for my graduation project in the second semester.

4.2 Nursing theory (5 credits)

Nursing theory provides a reliable theoretical basis for nursing practice and research. In this module, we mainly study the Middle Range Theory, which is considered as a bridge between the Grand Theory and nursing practice. It is widely used in nursing research because it is better guidance for nurses to solve problems in practice. Through the study of Walker and Avant's nursing construction strategy, coupled with literature retrieval and extensive reading, I completed the conceptual analysis of caregiver burden and identified the key attributes, antecedents, consequences, empirical references, and the multiple nursing theories embedded in it. Such a deep understanding and analysis of a nursing concept gave me an unprecedented sense of accomplishment.

4.3 Leadership (10 credits)

This course made me realize that different types of leadership have a profound impact on organizational culture, service users, subordinates, and personal development. Transactional, transformational, cooperative, and collective leadership styles have their strengths and weaknesses, which trigger our thinking. In practice, how to use different leadership styles to produce a positive effect on organizational change and development, the formation and transformation of culture? Besides, organizational change requires not only strong leadership but also the active participation of each member. As non-management individuals, they also play an important role in the organization. In this course, we experienced a special Workshop -- marshmallow challenge, which is a design&teamwork challenge project. Working in groups of five, we used a handful of spaghetti, string, and scissors to build the tallest tower that could support the marshmallow in 18 minutes. This project forces unfamiliar members of the team to connect quickly and collaborate effectively. Discuss the plan passionately, use the ability of design, leadership, and collaboration, try - innovate - create, learn from failure and quickly adjust the plan, and finally build a spaghetti tower that can support the marshmallow. This is the spirit of prototyping & Testing in “design thinking”, as well as the embodiment of teamwork spirit and leadership.

4.4 Transforming Practice through Reflection (10 credits)

This course helps us learn to use dialectical thinking to reflect and understand our behavior in practice. In our day-to-day work, we need to identify the nursing practices that are troubling and constraining us (often those that are taken for granted). Then, evaluate and analyze from a bystander's perspective. Furthermore, from the perspective of personal values and growth experience, culture, politics, economy, and society, we will sort out and analyze the reasons that constrain our behaviors. Finally, more perfect nursing behaviors are reconstructed to change the status quo.

4.5 Evidence-Based Practice (5 credits)

This course teaches us how to evaluate and make full use of evidence scientifically. The nursing problems encountered in clinical practice can be first transformed into different types of PICO questions, then the latest and most powerful scientific evidence can be retrieved, and the appropriate evidence types can be used for systematic evaluation and analysis to obtain the answers to the questions and guide the nursing practice. Based on years of work experience, I know that the incidence of falls among the elderly is high both at home and abroad, and there are many adverse consequences. By learning the present literature, I found that Tai Chi plays an important role in many preventive measures. In a systematic analysis of 5 randomized trials of Tai Chi to prevent falls in the elderly, it was indicated that regular practice of Tai Chi could reduce the occurrence or the incidence of falls, as well as related injuries. However, for the elderly with a history of falls and a high risk of falling, they should be evaluated and taken strict precautions, and practice Tai Chi under professional guidance.

4.6 Ethical Judgement in Professional Leadership (5 credits)

By learning this module, we have improved our ethical awareness. In daily work, healthcare professionals are often unconsciously in an ethical dilemma. When it comes to making difficult decisions, we need not only moral courage, consideration of the professional code of conduct but also ethical principles. In the 2500-word assignment, I mainly discussed whistleblowing in the healthcare context, how we should make the right decision in such a challenging situation, and the role of organizational culture in the process. Moreover, this course also helps me understand that ethical considerations in nursing research should not only just focus on the informed consent of participants. It is a prerequisite that every study (especially a clinical trial) be fully evaluated and reviewed by an ethics committee, after ensuring that ethical principles are followed at every stage. The committee should also protect the legitimate rights and interests of researchers and participants and be able to provide them with the necessary support and assistance in the research process.

4.7 Healthcare Informatics (5 credits)

This module is very practical. As a front-line nurse, I participated in the construction of hospital information management and combined nursing with electronic technology, which is very consistent with the development trend of contemporary society. We worked together as a team of four to consult and cooperate. From the conceptual design of the App to the drawing of paper prototype and finally, to code, the software ran smoothly, which was full of creativity and interest. Clinical nursing work is closely related to the development of information technology, to better improve the clinical workflow, increase efficiency, front-line nurses are best qualified to speak on this. Therefore, they should be extensive participation, put forward their valuable advice, together with engineers to improve and solve the problems in the process of software operation.

4.8 Dissertation Project (15 credits)

Although the dissertation only has more than 10,000 words for nearly half a year, it is a comprehensive embodiment of the knowledge of other modules, such as nursing theory as a theoretical framework, ethical considerations, selection of research methods, and so on. Before the beginning of the second semester, we received a detailed handbook. As soon as the new semester begins, I am working hard to prepare for it. I meet with my tutor once a week to report on the progress. In order to achieve efficient communication within a limited time of one hour, I would do a lot of preparatory work before meeting with my tutor, such as quarrying data, sorting out questions, and taking notes. The caregiver burden was my main research area during my postgraduate years. Researches at home and abroad on family caregiver burden have been studied in detail in many disease types. However, most studies have employed quantitative methods to assess and measure caregiver burden, and there are relatively few studies on family caregiver burden in patients with advanced liver cancer. Therefore, my graduate paper: "Caregiving burden among family caregivers of people with advanced liver cancer in China: An interpretative phenomenological analysis" adopted qualitative research methods of IPA to explore the family caregivers’ experiences in the process of caring for people with advanced liver cancer. Here, I would like to express my special thanks to my supervisor Dr. Dominika, who was so busy when the epidemic broke out that she still provided me with patient guidance remotely and helped me complete my writing.

5. Rich extracurricular life, experiencing the foreign culture

Due to the epidemic situation, we failed to go to the local hospital for clinical probation, leaving us with a small regret. But in my spare time, I also took an active part in various activities in the school and the town. The simplicity, warmth, and friendliness of the Irish people brought us a wonderful and unforgettable memory.

5.1 Rose of Tralee International Festival: During the grand festival of the 60th anniversary, I applied to be a volunteer. After passing the interview of the committee, I participated in the preparation and operation of the festival together with several classmates, and deeply experienced the local cultural customs.

5.2 In the annual international student festival held by the university, we prepared a booth with Chinese characteristics. It promotes traditional Chinese art and culture, and highly praised by teachers and students in the school. In more than 20 countries in the cultural booth, we were voted the first.

5.3 During the first Chinese New Year celebrations in Tralee, we went to the local primary school in Ireland to introduce the Chinese New Year customs to the teachers and students and promote the traditional Chinese culture.

5.4 In off-school life, I also did not forget the instructions of my leaders and family. I actively exercised and kept sufficient energy. I often take part in the Park Run every Saturday morning at 9:30 in the town. At this time, people who love sports will spontaneously gather in the park to participate in the 5km long run. There are some old people, some children, and even some blind people, which makes me feel the spirit of “Cease to exercise and you cease to live”.

6.Learning outcomes

One year of off-duty study, I try to make every day full and meaningful. With the help of my tutor and my own efforts, I have made some small achievements.

6.1 Successfully graduated with a first-class honorary degree.

6.2 My first English article will be published in the International Journal of Nursing Sciences.

6.3 The book translated by all students of the 2020 international master of science in the nursing program (one chapter per student) will be published by Xi 'an Jiaotong University Press.

7.Reflection

7.1 Rigor is the most basic attitude that nursing researchers should maintain

During the one-year master’s degree course, I have completed nearly 10 English essays. If you want to write a logical and well-argued paper, you must spend a lot of time looking up and reading literature, and then you can use it based on understanding. In addition to using English vocabulary or sentence patterns to express my views as accurately as possible, it also developed my critical thinking, dialectically view a problem, and finally having my own opinions instead of blindly accepting or assuming other people's ideas. The strict paper review system in the university also makes us have to take it seriously. In addition to not copying others, we must pay special attention to avoid plagiarism and self-plagiarism. Even my articles, excessive copying also belongs to the category of plagiarism, which is a serious violation of discipline. Moreover, when reading foreign literature, the researchers' deliberation is reflected in the lines, and the rigor runs through the whole scientific research process, which has deeply touched me. Rigor is a basic quality that a scientific researcher must possess.

7.2 Reflection is an important means of nursing practice and research

In contrast to the local graduate students in the class, Chinese students are generally at a loss when it comes to the reflective practice course. Indeed, we are used to various codes of practice and norms, and we refer to them without thinking and dare not question them. And this is precisely the nursing practice and nursing research extremely needs valuable quality. Reflection is not a matter of correcting mistakes but thinking necessary in order to move forward. In our daily work and research activities, we should be reflective, discard the ideas we take for granted, and make changes in a scientific and timely manner, so as to maintain the vitality of work and eliminate job burnout.

Studying far away from home will be a unique experience in my life. I am grateful for all the wonderful things I have encountered this year. In the future, I will insist on the originality, and strive to move forward.

 

肝胆外科   刘竹

2020.7.12