助产士处方权申请资格与培训内容研究
中文摘要。
研究目的：
本研究在《助产士特定情况下处方权内容的研究》的基础上，通过文献调研，借鉴国外助产士处方权申请者的资格要求及处方权的培训经验、结合我国医疗现状、护理及助产教育背景，探讨我国申请助产士处方权应具备哪些条件，对处方权申请者应进行哪些课程和内容的培训，以期为助产士处方权的落地实施提供理论依据。
研究对象：
本研究咨询了山西、陕西、安徽等省内外多所三甲医院从事助产的护理专家20 名，医疗专家 16 名。专家的入选条件为：①在本领域有至少 10 年的临床工作经验；②副主任医师、副主任护师及以上职称或临床工作年限相当于副主任医师和副主任护师职称的中级及以上职称；③本科及以上学历；④自愿参加。①②③中，满足其中两项即可。通过专家确定助产士处方权资格和培训内容。
研究方法：
1. 文献调研法。
通过查阅国内与国外文献和获取相关官方网站信息，初步拟定专家咨询问卷。
2. 半结构访谈法。
在查阅文献的基础上，对 3 名助产士和 2 名产科医生进行半结构访谈，根据访谈结果,修订初步拟定的专家问卷，形成正式的第一轮专家咨询问卷。
3. 德尔菲法。
邀请山西、陕西、安徽等省内外多所三甲医院从事助产的护理专家 20 名，医疗专家16名，进行两轮关于“助产士处方权申请资格与培训内容专家咨询”，并对咨询结果进行统计分析得出最终研究结果。
结果
1、助产士处方权申请资格的确定 专家对助产士处方权申请者的最低学历认同率最高的为本科，占 70.59%；对助产士处方权申请者的最低技术职称认同率最高的为主管护师，占 85.29%；对助 产士处方权申请者的科龄认同率最高的为本科 5 年，占 50%；对申请者所在医院级 别认同率最高的为三级医院，占 91.18%。
2、助产士处方权培训内容的确定 专家对药理学的认同率为 100%，课程内容中药物计量计算认同率最高为 100%，其次为药物滥用（94.12%）和 OTC(非处方药)药物知识（94.12%），药物依从性问题（91.18%，），产科合理用药（85.29%），药物的安全管理和处置（82.35%），助产士在药物治疗中的作用与责任（79.41%）；对法律法规和伦理的认同率为 100%，内容包括：药物治疗法律法规和伦理问题（97.06%），处方管理办法（91.18%），医疗事故处理条例（88.24%）；对导论的认同率为 97.06%，内容包括：如何生成处方及处方书写（94.12%），处方类型和处方决策框架（88.24%），与产妇有效沟通交流(82.35%)，与产妇主管医生有效沟通(82.35%)，与医生在合作环境下开 处方（82.35%）, 职业（处方）责任与义务(79.41%)；对诊断学的认同率为 94.12%， 内容包括：产妇及胎儿监测（94.12%），产妇和胎儿评估（85.29%），产前检查（79.41%），病史采集（73.53%）；对助产学的认同率为 94.12%，内容包括：妊娠诊断（91.18%）和妊娠生理（91.18%）。
结论。
1、建议将助产士处方权申请资格设为：同时具有本科学历和主管护师职称 且在三级医院的产科从事助产工作满 5 年。
2、培训内容设置药理学（药物剂量计算，产科合理用药，药品的安全管理和处置，药物滥用，助产士在药物治疗中的作用与责任，药物依从性问题，OTC非处方药药物知识）、诊断学（产妇及胎儿监测，产妇和胎儿评估，产前检查，病史采集）、法律法规和伦理（处方管理办法，药物治疗法律法规和伦理问题，医疗事故处理条例）、导论（如何生成处方及处方书写，处方类型和处方决策框架，与产妇有效沟通，与医生在合作环境下开处方，与产妇主管医生有效沟通，职业（处方）责任与义务）和助产学（妊娠诊断、妊娠生理）课程 5 门，课程内容 22 项。
关键词：助产士；处方权；资格；培训内容。
The study of qualifications and training contents of。
midwives’ prescribing rights。
Abstract。
Purpose:
On the basis of“ prescription content of midwife in particular situation”，the study,by doing literature research ， learning from the experience of foreign midwives’
qualifications and training contents of prescribing rights， combined with the currentsituation of medical care, nursing and midwifery education in our country, is todiscuss and determine the conditions for midwives to apply for the prescriptive right,and to determine the training contents of applicants who apply for the prescribingright. Based on this study, we hope to provide a theoretical basis for theimplementation of the midwives' prescription rights.
Object：
We carried two rounds of expert consultation aiming at 20 midwives and 16obstetricians from many top three hospitals in China, such as Shanxi, Shaanxi and Anhuiet al. The requirements of selecting expert are: 1) worked in midwifery field withsome practical experience for more than10 years. 2) has the vice-senior professionaltitle or above.3) has a bachelor degree or above. 4) is willing to answer the expertquestionnaire. Two items was required among the former three items ． Midwives’
qualifications and training contents of prescribing rights are determined by experts.
Methods:
1. Literature analysis。
We made the expert questionnaire based on literature reviews and official websites2. Semi-structured interview。
We had the semi-structured interview with 3 midwifes and 2 obstetrician s. The first round of expert consultation questionnaire had beenformed by performing analysis of the advice of clinical workers.
3. Delphi methods。
By using Delphi methods, we carried two rounds of expert consultation aiming at 20midwives and 16 obstetricians from many top three hospitals in China, such as Shanxi,Shaanxi and Anhui et al. The content of the questionnaire included the conditions formidwives to apply for the prescriptive right and the course training of the prescription right ofmidwife. Then we use SPSS22.0 to analyze expert advice and expert information.
Results:
1.Determine qualification of applying for the midwife prescribing rights 70.59% expertsbelieve that the lowest degree of midwife prescribing right applicants should be baccalaureate;while the lowest technical title of applicants should be charge nurse, which has the highestrecognition rate, accounting for 85.29%; applicants have more than 5 years of workingexperience in delivery room, which has the highest recognition rate (50.00％)，for the level ofhospitals where applicants work，the experts agree that the level should be the third levelhospitals(91.18%).
2. Determine the course setting of the prescription right of midwife The recognition rateof pharmacology courses was 100%，including drug dose calculation(100%), drug abuseproblem(94.12%), over the counter (OTC) drug knowledge(94.12%),patients with medicationcompliance issues and countermeasures(91.18%),rational drug use in obstetrics(85.29%),Safety management and disposal of drugs(82.35%), midwives’ roles and responsibilities in thedrug treatment(79.41%); the right to prescribe laws and regulations recognition rate of 100％ofthe course, including drug treatment laws and regulations and ethical issues(97.06%),prescription management(91.18%), Medical Malpractice(88.24%); recognition rate of97.16%for introduction to the right of the midwife's prescription courses, including how toproduce prescription and prescription writing(94.12%), prescription type and prescriptiondecision frame(88.24%), effective communication with parturient(82.35%), effective communication with maternal doctors(82.35%), prescribing with doctor in a cooperativeenvironment(82.35%), occupational responsibility and duty (prescription) (79.41); recognitionrate of 94.12% for Diagnostics, including maternal and fetal monitoring(94.12%), maternaland fetal assessment(85.29%), prenatal examination(79.41%),medical historycollection(73.53%); recognition rate of 94.12% for midwifery, including Pregnancydiagnosis(91.18%) and Pregnancy physiology(91.18%).
Conclusion：
1.The recommended qualifications of applying for midwives’ prescribing rights should beset as working in top three hospitals on the basis of undergraduate nursing education，alongwith the charge nurse title qualifications and five years of work experience in delivery room．2.It is suggested that the training contents of midwife's prescription rights providepharmacology(including drug dose calculation, drug abuse problem, over the counter (OTC)drug knowledge, patients with medication compliance issues and countermeasures, rationaldrug use in obstetrics,, safety management and disposal of drugs, midwives’ roles andresponsibilities in the drug treatment), diagnostics(maternal and fetal monitoring, maternal andfetal assessment, prenatal examination, medical history collection), laws and regulations andethics, (drug treatment laws and regulations and ethical issues, prescription management,Medical Malpractice), introduction (how to produce prescription and prescription writing,prescription type and prescription decision frame, effective communication with parturient,effective communication with maternal doctors, prescribing with doctor in a cooperativeenvironment) and midwifery (Pregnancy diagnosis and Pregnancy physiology) .
Keywords: midwives; prescription; qualifications; training contents
目 录
中文摘要
英文摘要.
1 引 言 .
1.1 问 题 的 提 出 与 研 究 意 义
1.2 国 内 外 相 关 研 究 综 述
1.3 研究方法 .
1.4 数 据 来 源 与 处 理 .
1.5 论文框架 .
1.6 论 文 的 创 新 点
2 咨 询 问 卷 的 设 计
2.1 专 家 咨 询 简 介
2.2 专家 的选 择.
2.3 编 制 专 家 咨 询 问 卷.
2.4 专 家 咨 询 的 实 施 .
3 助 产 士 处 方 权 申 请 资 格 的 确 定 .
3.1 第 一 轮 专 家 咨 询 结 果
3.2 第 二 轮 专 家 咨 询 结 果
3.3 咨 询 专 家 的 可 靠 性 分 析
4 助 产 士 处 方 权 培 训 内 容 的 确 定 .
4.1 咨 询 专 家 的 可 靠 性 分 析
4.2 第 一 轮 专 家 咨 询 结 果
4.3 第 二 轮 专 家 咨 询 结 果
5 结 论
参考文献.
