The Research on Technicalization Scheme of Clinical Nursing Practice-From the construction of practice example accumulation system and hidden wisdom from nursing experiences

范例积累组借助2007年建立的“日本护理实践范例积累中心”（Web Edition Japanese Nursing Practice Example Accumulation Centers），着手扩充可检索的病历数据库。在成立之时，该组输入了170例病例史，这些病例史已于2001年提交给护理杂志。2008年，该项目完成了2000年发表的125例病例史，并在作者同意的情况下添加到数据库中。同时，开始对1999年185例和2002年142例进行分析。在日本护理艺术与科学学会第六届会议上，小组参加了交流活动，除了宣传小组的主要活动外，还与一般与会者讨论了分析方法和发展临床智慧。在临床/教育环境中，使用了许多案例分析方法，因此没有固定的分析框架，事实上，有些人更感兴趣的是框架分析本身。如上所述，案例历史的执行建立了分析成员的习惯和培训。此后，由于案例积累的速度加快，而通过网络贡献案例的人却很少，因此建立一个贡献网络，改造系统，使其更易于使用的主题成为一个讨论的话题。通过视频叙述：(1)包扎技术，(2)重症监护病房妈妈，(3)吞咽困难患者的吞咽方法的疗效，从专家护士的熟练技术中提取。(1)的结果是：注意特定的动作并赋予其意义，反映经验智慧的行动，以及与个人技术成就有关的感受和情绪。对于(2)，用五感来解读病人的细微反应，表现出灵活性，不成为习惯的囚徒。对于(3)：口腔护理，反映出在吞咽困难患者的情况下，对患者舌背等频繁积聚点的痰进行清理的知识；这种评估基于吞咽机制；通过护士的言语指导或工具与身体的结合，实现口服摄入。少

The Example Accumulation Group, by means of the Web Edition Japanese Nursing Practice Example Accumulation Centers'(set up in 2007), set about to expand the searchable case history database. At the time of establishment, the group entered 170 case histories that had been contributed to nursing magazines in 2001. In 2008, the project proceeded to the point that 125 case histories published in 2000 were finished and were, with the consent of the authors, added to the database. At the same time, work began on the analysis of 185 cases from year 1999 and 142 from year 2002. At the 6th meeting of the Japanese Scciety of Nursing Art and Science, the group participated in an exchange session in which, besides publicizing the group's main activities, involved discussions with the general attendees concerning analysis methods and developing clinical wisdom. In clinical/educational settings, many methods of case analysis are used, so that there is not a fixed analysis framework In fact, some amo … More ng the group are interested in framework analysis itself As described above, the execution of the case histories establishes the analysis members' habits and training. Hereafter, because the tempo of case history accumulation is accelerating while only a few people are contributing case histories via the Web, the subject of building a contribution network to remake the system to be easier to use has become a topic of discussion. IL Through a video narrative the efficacy of methods for : (1) bandaging technique, (2) intensive care unit mom, and(3) swallowing for the patients with dysphagia were extracted from the skilled techniques of expert nurses. The results for(1) are : Noticing particular movements and attaching meaning to them , Actions reflecting wisdom from experience , and Feelings and emotions concerning one's technical achievements . For(2), reading slight patient reactions using the five senses and showing flexibility in not becoming a prisoner of habit For(3) : oral care reflecting knowledge of the clearing of sputum from frequent accumulation points such as the back of the patients tongue in the casa of those with dysphagia ; this assessment based on the swallowing mechanism ; enabling oral ingestion based on instructions through the nurse's speech or the uniting of tool and body. Less