摘 要
目的本研究旨在全面了解并比较目前河南省三级医院临床护士的循证护理实践水平（包括知识、态度、技能和行为）及影响因素现状，明确护理人员在循证护理实践过程中的困难，为临床护理人员开展继续教育和循证护理教育的方向及管理提供理论依据，有效的提高河南省临床护士的循证素质，促进循证护理的发展。
方法抽取河南省五所城市（郑州市、开封市、洛阳市、新乡市、平顶山市），方便抽取 5所三级医院，采用随机抽取符合研究条件的护士为研究对象。
调查工具：调查问卷有一般人口学资料的调查问卷，包括年龄、科室、工作年限、婚姻状况、第一学历和最高学历、职称、职务、工作性质；杨如美等修订的循证实践知识、态度、行为问卷（EBPQ）（中文版）及循证实践影响因素问卷（DEBPQ），EBPQ量表共 24 个条目，包括知识、实践和行为 3 个维度，按“从不”到“经常”采用 7 级计分法，分别赋予1分到 7 分，得分越高表示临床护理人员在护理过程中的知信行水平越强，总问卷及各维度 Cronbach,s 系数分别 0.940、0.841、0.789、0.935;DEBPQ 量表由 26 个条目 4 个维度组成，总问卷 Cronbach's B系数为 0.930,量表及内部一致性较高，可用于评价国内护理人员 EBN 水平。
调查方法：本课题组首先选定河南省的 5 个城市分别为郑州市、开封市、洛阳市、新乡市、平顶山市，然后在选中的城市中方便抽取 5 所三级医院，课题组成员与各医院护理部领导联系，取得同意并协助发放和收回问卷。采用随机抽取符合条件的护士为研究对象，被调查护理人员获得知情同意后采用无记名填写方式调查。
统计学分析：应用 SPSS17.0 统计软件包对数据进行统计分析，P<0.05 为有统计学意义，均取双侧概率，对数据进行 t 检验、方差分析、Pearson 相关分析等统计推断和统计描述。
结果本研究共发放问卷 550 份，回收有效问卷 521 份，回收率 94.72%.研究对象年龄分布范围为 20~55 岁，平均（28.62±5.37）岁。内科（39.53%）和外科（30.13%）为主，62.96%的被调查对象工作年限在 10 年以内；第一学历以中专和大专为主（85.60%）；最高学历为本科者占 62.57%,初级职称的人数占 62.38%.521 名研究对象的 EBPQ 问卷总分均分为（4.34±1.05）分，实践行为、态度、知识各维度平均分分别为（4.05±1.14）分、（4.64±1.13）分、（4.47±0.96）分。不同科室 EBPQ 问卷调查调查发现，不同科室的循证知识技能和实践行为有统计学差异（P<0.05），急诊科护士的得分在实践行为维度高于其他科室（P<0.05），而 ICU 护士的得分在知识技能维度高于其他科室（P<0.05）。
不同年龄组的护士在循证实践行为、循证知识技能之间具有统计学差异（P<0.05），但态度得分无差异（P>0.05）；其中≤30 岁年龄组的得分低于 31~40 岁年龄组。不同工作年限在循证知识态度和行为上具有统计学差异（P<0.05），其中工作 16~20 年的护士在各维度上得分最高，其次是工作 21 年以上者。婚姻对循证护理的实践行为、态度和知识技能没有明显的影响（P>0.05）。第一学历不同，研究对象的实践行为维度、知识技能维度存在统计学差异（P<0.05）；最高学历不同，护士的实践行为维度、态度维度、知识技能维度得分存在统计学差异（P<0.05）。高级职称的护士循证知识、态度和实践行为维度得分高于中级职称护士（P<0.05），中级职称护士的得分高于初级职称护士（P<0.05）。采用 Pearson 相关分析，分析 DEBPQ 与 EBPQ 问卷实践行为各维度和总分之间的关系，具有统计学差异（P<0.05）。
结论急诊科室、高学历、高职称、工作年限的延长和年龄的增长均有利于临床护士循证护理的实践。循证实践的实施在知识来源、实践困难、支持情况和查找、评价证据的技能各维度均有影响。
关键词：循证护理，临床护士，实践水平，影响因素
Abstract
ObjectiveThis study is to realize fully and compare the current level of evidence-based nursing practice onTertiary Hospitals in Henan province （including knowledge, attitudes, skills and behaviors）， andinfluencing factors of the status of the nurses. To realize the difficulties of evidence-based nursing practicein the process, to find out the direction and management of evidence-based nursing education and providea theoretical basis of continuing education for clinical nurses, which could be improve the quality ofevidence-based clinical nurse effectively in Henan Province, and to promote the development ofevidence-based care.
MethodsIn this paper, with the methods of convenient campling, the study extracted five cities in Henan（Zhengzhou, Kaifeng, Luoyang, Xinxiang, Pingdingshan）， easy to extract five Tertiary Hospitals, the use ofqualified nurses randomly selected for the study.
Survey Tool: This study is survey questionnaires including demographic data, including age,department, work experience, marital status, education, and finally the first degree, title, Position, nature ofwork. Rumei Young amendments the evidence-based practice knowledge, attitudes, behavior questionnaire（EBPQ） （Chinese version）， and evidence-based Practice Factors Questionnaire （DEBPQ）， EBPQ scalehave 24 entries. Including knowledge, practices and behavior of the three dimensions, according to “never”to “always” using seven scoring methods, were given one minute to seven fractional numbers, the higherthe score indicates the level of the nurses in the process, The each dimension of the total questionnairescronbach, s coefficients were 0.940, 0.841, 0.789 and 0.935; DEBPQ scale of 48 entries and sixdimensions, with a total questionnaire cronbachs coefficient was 0.930, higher scale and internalconsistency, could be used to evaluate the level of domestic nurses.
Survey methodology: The research team first selected five cities from Henan Province, which were inZhengzhou City, Kaifeng City, Luoyang City, Xinxiang City, Pingdingshan City, and then select hospitalsform extraction cities easily. The group members contact the nursing leaders of each hospitals, with theconsent and assistance to disbursement and recovery the questionnaires. Using a convenient campling ofnurses qualified for the study, when the surveyed nurses known what to do and then fill out the survey byno names.
Statistical analysis: To statistical analysis the numbers by SPSS17.0 statistical software package, P<0.05 was considered statistically significant, and which were taken bilaterally probability of t test,analysis of variance, Pearson correlation analysis, statistical inference and statistical description.
ResultsA total of 550 questionnaires were distributed and were returned 521 valid questionnaires, returned94.72%. The age distribution of the range of 20 to 55 years, with an average age of （28.62±5.37） and itsmainly the internal medicine department （39.53%） and surgical department （30.13%）。 62.96% of thosesurveyed nurses, work experience within 10 years; the most first degree is secondary school andcollege-based （85.60%）； highest degree is a bachelor accounted for 62.57% .the number of junior titlesaccounted for 62.38%. The research subjects of the EBPQ questionnaire scores were divided into4.34±1.05, the average dimensions of Practice behaviors, attitudes, knowledge were 4.05±1.14, 4.64±1.13and 4.47±0.96 respectively. Different departments of the EBPQ questionnaire survey found that thepractice of evidence-based knowledge, skills and behaviors of different sections had statistically significant（P < 0.05）， Emergency department nurses had a higher score than other departments in practice actsdimension（P < 0.05）， while in the ICU the nurses had a higher score than other departments dimension inknowledge and skills（P < 0.05）。Nurses in different age groups had a significant difference in conductevidence-based practice , evidence-based knowledge and skills（P < 0.05）， but had no difference in attitudescores （P > 0.05）； Which below 30 years group had lower score than the 31 to 40 age group. Differentwork experience with evidence-based knowledge on the attitudes and behaviors statistically significantdifference （P < 0.05）， which 16 to 20 years of working nurses had the highest score on each dimension,followed by more than 21 years. Marriage had no effects of evidence-based nursing practice acts, attitudesand knowledge skills（P > 0.05）。 Different first degree had an significant differences of the study, Practicesand behaviors（P < 0.05）； different educational background had a statistical different score in practicenurses, dimension behavior, attitudes dimension, knowledge and skills （P < 0.05）。 Senior nurses had ahigher scores in nurses evidence-based knowledge, attitudes and practice behaviors （P < 0.05）， junior titlesnurses scored higher than other nurses （P < 0.05）。 Pearson correlation analysis of the relationship betweenDEBPQ Practice acts and EBPQ questionnaire scores between each dimension and had a significantdifference （P < 0.05）。
ConclusionsEmergency departments, highly educated, highly title, years of evidence-based practice nurses areconducive to evidence-based care. Implementation of evidence-based Practice in knowledge sources,Practice difficult situation and find the support, skills, find evidences all had affects.
KEY WORDS: Evidence-based care; Clinical nurse; Practice level; Influencing factors
目 录
摘 要 …… I
Abstract …… III
1 引言 …… 1
1.1 循证护理产生的背景 …… 1
1.2 循证护理的概念 …… 2
1.3 循证护理的发展现状 …… 3
1.4 研究目的和意义 …… 4
2 研究对象 …… 5
2.1 调查对象 …… 5
2.2 调查工具 …… 5
2.3 调查方法 …… 6
2.4 技术路线 …… 6
2.5 统计学方法 …… 6
3 结果 …… 9
3.1 被调查对象的一般特征 …… 9
3.2 临床护理人员循证实践水平及相关影响因素总体得分 …… 10
3.3 不同人口学特征的 EBPQ 问卷得分情况比较 …… 11
3.3.1 不同科室 EBPQ 问卷调查…… 11
3.3.2 不同年龄组 EBPQ 问卷调查…… 11
3.3.3 不同工作年限 EBPQ 问卷调查…… 12
3.3.4 不同婚姻状态 EBPQ 问卷调查…… 13
3.3.5 不同第一学历和最高学历 EBPQ 问卷调查…… 13
3.3.6 不同职称 EBPQ 问卷调查…… 14
3.3.7 EBPQ 问卷各维度间和 DEBPQ 问卷的相关分析…… 15
4 讨论 …… 17
4.1 临床护理人员循证实践水平及相关影响因素总体得分 …… 17
4.2 不同人口学特征的 EBPQ 问卷得分情况比较 …… 19
4.2.1 不同科室 EBPQ 问卷调查…… 19
4.2.2 不同年龄组 EBPQ 问卷调查…… 20
4.2.3 不同工作年限 EBPQ 问卷调查…… 20
4.2.4 不同第一学历和最高学历 EBPQ 问卷调查…… 21
4.2.5 不同职称 EBPQ 问卷调查…… 22
4.3 本研究的局限性 …… 22
5 结论 …… 23
参考文献…… 25
文献综述…… 29
