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Strategy Study on Improvement of Nursing Practice and Teaching Quality

With the implementation of Health China Strategy and the gradual establishment of modern vocational education system, the cultivation of nursing talents is facing the new situations including expansion of scale, change of current situation of student sources and change of medical environment, etc. This paper proposes to improve the nursing practice and teaching quality through enhancement of coordinated management of medicine science and teaching integration; establishment of professional teams and guarantee system for practice and teaching quality; improvement of practice and teaching assessment, incentive mechanism, theory adjustment, practice and teaching thoughts and enhancement of communication ability and humanistic quality and other strategies. Keywords—nursing; talent cultivation; clinical practice; teaching quality


INTRODUCTION
With the implementation of "building moderately prosperous society" and "health China strategy", the broad masses of the people have put forward higher requirements on the demands of health and the overall quality of medical and health services. And the requirements of patients on the nursing service level also become higher and higher while getting high-quality clinical medical technology and services. The nursing work is closely related to the life of patients and the nursing quality is the important indicator for measuring the hospital management level and the level of nursing is closely related to the professional quality of nursing personnel. [1] For the students of nursing major, clinical practice is an important link in learning, where the students convert the theoretical knowledge learned from classes and textbooks into practical skills so as to absorb and digest knowledge and continuously conclude and improve such knowledge in practice as well as comprehensively improve their nursing service abilities. With the change of medical environment, the practice and teaching process of students of nursing major also face the new changes including increase of quantity of students recruited and lack of hardworking spirit of students, etc. And it has become the major issue faced by all the health professional colleges about how to adapt to the changes of health and education situations, enhance the reform and innovation of practice and teaching and improve the practice and teaching quality of nursing major.

A. Change in Enrollment Scale of Nursing Major
The major of nursing belongs to the scope of vocational education. It is the health secondary vocational schools or higher vocational colleges which mainly undertake the cultivation of talents of nursing major. Recently, China has been vigorously promoting the construction of modern vocational education system and the enrollment scale of higher vocational education has been greatly expanded and the number of internal students of nursing major has also been continuously increasing accordingly. [2] The enrollment of students of nursing major is gradually increasing and the number of interns also increases accordingly. And it is inevitable that the pressure of clinical teaching of various hospitals for internship will be increased. Many hospitals with one-on-one teaching have to adjust the mode into one teacher teaching two or more interns. Therefore, the opportunities for students to participate in nursing practice and operation are reduced and it becomes hard to guarantee the effects of clinical teaching. In the meantime, the workload of nursing intern teaching management department in teaching plan and arrangement for interns, teaching operation management and organizational discipline guarantee, etc is greatly increased which influences the assessment and supervision works of the department during frontline teaching process and is not favorable for guaranteeing the practice and teaching quality.

B. Change in Current Status of Intern Sources of Nursing
who have the current status including poorer self-control abilities and weaker autonomous learning abilities and have difficulties in concentrating their attention on study and realizing the learning target set when facing the external temptation. [3] Meanwhile the quantity of enrollment of medical schools is increased, the quality of student sources slightly declines and the learning autonomy of interns are relatively poorer. But the practice and teaching are the bilateral interaction between "teaching" and "learning". Facing to the interns with no learning autonomy, the teaching aspiration and seriousness of teachers will be impacted. The increase of graduates will inevitably cause the fierce competition of employment market. The circumstance where the interns put their energy in seeking for employment positions too early occurs frequently and they may even terminate the internship in advance for this purpose, which also have significant impacts on the practice and teaching quality.

C. Change in Overall Medical Environment
On one hand, under the impact of medical system reform and completion of medical guarantee systems, the patients are greatly increased and various hospitals for internship are all in full-load operation, the clinical work load of nursing personnel is very heavy which accounts for too much energy and time and causes impacts to their teaching works. [4] At the same time, due to the increase of patients, the hospital rooms and other infrastructure are all in serious shortage which limits the providing of accommodation and learning places for internship and causes part of the interns to rent houses out of the hospital and causes the economic pressure and safety problems to diffuse their energy in internship and is not favorable for interns to wholeheartedly throw themselves into learning. With increasing of medical service quality requirements of patients, their awareness of guarantee of rights and interests is also increased and the doctor-patient relationship is generally tense. To guarantee medical safety, the hospitals limit the operation activities of interns to certain extent which impacts the practice and teaching. The marketization degree of medical industry is significant promoted and the purpose of getting profits of medical institutions is stronger. There is the phenomenon where part of the hospitals arrange interns to transfer divisions at will for the business volume which is not favorable for interns to finish the practice and teaching according to the fixed plans.

A. Aspiration, Awareness and Ability of Teachers for Teaching
The rapid development of nursing vocational education and unbalance of hospital development as well as insufficient hospitals with internship conditions cause the universal phenomenon where the nursing interns are over concentrated and the teachers for nursing practice are relatively insufficient. The quantity of nurses for the post of clinical nursing of medical institutions is relatively small and the clinical nursing workloads are large and they have large workloads and heavy duties in clinical nursing; for the clinical nurses, the clinical nursing work is the task before all other tasks. Many teachers for clinical nursing take the teaching as extra workloads and think that they only need to accomplish this task. Therefore, the practice teaching will still be easily ignored. The clinical teachers have no energy and lack the awareness and aspiration for practice teaching. Under such background, the interns are still just undertaking the simple and rigid works. And it is hard for them to receive the patient guidance and explanation of teachers at the same time of various kinds of clinical operations and they rarely have the opportunities to receive the teaching forms including clinical teaching with plans and teaching design and the ward round for clinical teaching. In addition, most of the existing nursing personnel are graduated from health vocational schools and they lack the education and teaching theories, just know simple teaching methods and teach only based on experiences compared with the graduates of normal schools, so it is difficult to effectively cultivate the abilities of students for independently thinking and solving problems. This is also one of the most important factors impacting the nursing practice and teaching quality.

B. Adaptive Capacity of Interns for Change of Learning Modes
The largest difference between practice teaching and teaching in school is the change of learning modes. The students learn in passive mode in school and their teaching contents, teaching time and teaching forms are all arranged by school. And the students are urged to learn during the teaching process so as to guarantee the teaching effects. During the practice teaching process, it is the process which requires nursing interns to actively specify and accomplish the teaching mode, method, learning task and learning target, etc. The students who cannot well adapt to the change of learning modes will have learning disabilities. During the process of learning in clinical practice, the abilities of interns for communication and exchange seem to be especially important. Whether the students are good at communication and exchange with teachers will directly impact the teaching aspiration and teaching attitude of teachers. In addition, the communication with clinicist, patients and their family members also has significant impacts on learning.

C. Opportunity of Operation
The education of nursing talents focuses on the cultivation of technical skills and it also has high requirements on the practical operation abilities. During the nursing practice teaching, it is the most important to train the operation abilities of interns. The practice teaching effects are closely related with the opportunities for operation of students. [5] The increase of opportunities for operation during practice process can not only promote the proficiency of clinical skills of interns but also can cultivate the communication and exchange abilities of interns with patients, exercise their clinical thinking and cultivate their professional spirits. In addition, compared with the practice in training room, there are significant uncertainty and complexity of state of illness with the skill practice applied on patients. And the feedback of the same skill obtained from each time of operation in training room is also the same, while they can obtain completely different feedback from different patients which can help to cultivate the abilities Advances in Social Science, Education and Humanities Research, volume 310 of nursing interns for comprehensive analysis of problems and solving of problems.

A. Enhancing the Coordinated Management of Medical and
Teaching Integration 1) Enhancing construction of professional teams: The school and experts of hospital shall jointly participate in construction of professional teams. The professional teams shall conduct investigation and analysis to the position requirements for nursing talents and formulate the talent cultivation plan and curriculum system and determine the practical teaching plans and contents by taking post demands as target. At the same time, the school shall also employ the part-time teachers of nursing major from hospital to teach classes and enable the hospitals to participate in the whole process of talent cultivation through comprehensive integration of hospital and school which is favorable to intensify the attention of hospital on practical teaching and the teaching awareness and teaching aspiration of teachers during practical teaching process and is also favorable for the effective connection between theoretical teaching and practical teaching and can further improve the practical teaching quality.
2) Establishing internship supervisor system and assigning teachers to teach in internship units: The practical teaching is carried out in internship hospital. But the quantity of interns received in single internship hospital is limited, therefore there are generally large quantity of internship hospitals which are distributed in different cities. During the internship process, due to lack of participation of schools, there lacks the supervision from the school during the teaching process of hospital and the management and care for interns are not like that for them in school which is also one of the factors not favorable for practical teaching quality. The schools shall explore and establish the internship supervisor system, assign the professional teachers to specifically and regularly go to internship hospitals to participate in practical teaching so that they can master the teaching conditions of internship hospitals on one hand and can understand the clinical progress and conduct adjustment and improvement to the theoretical teaching in school.
3) Establishing the management platform and quality guarantee mechanism: The guarantee of practical teaching quality relies on the construction of "diagnosis and improvement" system of internship works. [6] The most direct participants of practical teaching are the teachers and interns who understand the practical teaching quality and factors impacting the quality during teaching process the most. Therefore, the school shall establish the internship management platform from which we can know the feedback information of teachers and interns. At the same time, the school shall also establish the mechanism for diagnostic analysis and improvement of feedback information of management platform to timely feed back when finding problems, timely improve and implement so as to continuously promote the improvement of practical teaching quality.

B. Establishing the Motivation and Assessment Mechanism 1) Selection mechanism of internship unit:
It is suggested to actively expand new internship hospitals to adapt to the change of enrollment quantity. Carry out strict control when expanding internship hospitals; take the basic standard on whether the setting of divisions of internship hospital can accomplish the requirements of internship outline teaching and take the factors including whether the internship hospitals have employment opportunities, the teaching management standards of internship hospitals, living cost of internship hospital and accommodation safety, etc as the hospital selection indicators. Try to choose the high-quality and standard hospitals as the internship hospital to provide basic guarantee for obtaining high-quality practical teaching effects.
2) Practical teaching management and assessment mechanism: The internship hospital shall intensify the attention on practical teaching, deem the practical teaching as clinical services and scientific study and add the contents related to practical teaching works in the individual business assessment to promote the joint development of medical service, teaching and research. Enhance the assessment of practical teaching and formulate corresponding assessment standards for operational skills under the orientation of professional qualification assessment and take it as basis to standardize and improve the practical teaching management works.
3) Motivation mechanism of clinical teaching: it is suggested to establish the internship hospital part-time teacher employment system and grant corresponding teaching professional title to the frontline nursing teachers, appraise and elect excellent teachers and give commendation and corresponding awards so as to enhance the sense of responsibility and sense of honor of teachers. Enhance the communication between medical schools and internship hospitals and among different internship hospitals and improve teaching methods and intensify the teaching awareness through communication and learning. Establish the selection system for internship teaching physicians and teaching title assessment and employment system, control the teacher qualifications, optimize the teaching teams, pay attention to using multiple opportunities and resources to enhance the communication and training of teachers, improve their teaching awareness and enhance the sense of responsibility and sense of mission of teachers. the talent cultivation plans that can conform to the post ability requirements according to the characteristics of nursing major and the practical conditions of employment of graduates; take the cultivation of technical and skill-oriented excellent nursing talents as target; simplify the theoretical courses; enhance the training of practical operation abilities; enhance the communication with internship hospitals and the nursing division and teachers that undertake specific teaching tasks; formulate suitable practical teaching outline according to the practical working conditions of frontline of nursing; complete the training works before internship; enhance the acknowledgement of interns on the differences between clinical practice and the learning in school; put forth efforts to enhance the communication abilities of interns with teachers and patients and promote the learning autonomy; revise the teaching outline, reduce the excessive theoretical courses and increase the learning time of practical skills.
2) Adjusting practical teaching: The schools should establish the practice and training center for nursing skills and carry out nursing skill training in the meanwhile of clinical practice; repeatedly intensify the commonly used skills of rotation divisions in the practical training center; improve the practical operation abilities of interns with targets to improve the operation proficiency of interns in clinic, enhance the sense of trust of patients on interns, solve the key points of doctor-patient relationship and the problem of insufficient operation opportunities incurred by antipathy of patients on interns. The hospital shall enhance the practical training skills during internship period and construct the practical teaching center to conduct practical skill training to the interns in the meanwhile of clinic practice and intensify the skills commonly used in rotation divisions with targets, promote the operation proficiency of interns, reduce the chance of mistakes in medical operations on patients, reduce the resistance psychology of patients on interns and create more operation opportunities.
3) Enhancing the communication ability and cultivation of humanistic quality: The communication ability is one of core abilities of modern nursing talents. [7] It is the precondition for nursing work to satisfy the patients to establish harmonious relationship between patients and their family members through reasonable and effective doctor-patient communication. In addition, the communication ability of interns with teachers, physicians and students is also one of the most important factors for them to obtain the attention and learning opportunities from teachers. Currently, the higher vocational college students are mainly the generation after 95s and many of them are only child who have strong independent consciousness and insufficient external communication abilities. The promotion of communication abilities of students of nursing major is the important content of preparation before internship which is to cultivate the communication ability through the organic combination of nursing services, nursing etiquette and nursing technique courses and can enhance their confidence in the internship process and obtain favorable learning environment and more learning opportunities. [8] The nursing work is the basic service platform of hospital which faces to the people with different occupation, levels and cultural background. The humanistic quality has become the connotation of occupational qualities of nurses. The level of humanistic quality will directly impact the professional image of nursing workers and further impact the medical and nursing service quality. The hospital schools shall enhance the education of literary accomplishment and communication ability in setting of curriculum to adapt to the reform of health environment and guarantee that the students cultivated can better adapt to the position requirements of modern medical services.

V. CONCLUSION
The nursing major takes the main objective of cultivation of technical and skill-oriented talents and requires schools to pay attention to enhancing the cultivation of practical abilities at the same time when cultivate the students to master sufficient theoretical knowledge. 1/3 of the time of three-year higher vocational nursing major is spent in clinical practice. Therefore, the practical teaching management shall keep pace with the times and shall be continuously reformed and innovated according to the change of overall situations of health and education so that the practical teaching can be innovated based on practice and be put into practice based on innovation and can constantly enhance the service awareness and nursing abilities of nursing students which can provide more excellent nursing talents to the society and adapt to the demands of people's health services in the new era.