Volume 39 Number 2
Effects of enterostomal therapists training: Evaluated with Kirkpatrick’s model
Shenlv Ying, Jiang, Hai-Hong and Ai-hua Chen(Alice)
Keywords Enterostomal therapist, training, evaluation, Kirkpatrick’s Model, ETNEP, reaction, learning, behaviour, result
For referencing Ying S et al. Effects of enterostomal therapists training: Evaluated with Kirkpatrick's model. WCET® Journal 2019; 39(2):28–33
DOI https://doi.org/10.33235/wcet.39.2.28-33
Abstract
Objective To evaluate the effect of training for enterostomal therapists (ETs) based on Kirkpatrick’s Four Levels of Training Evaluation model. To understand ET trainees' work status after completing the Enterostomal Therapy Nursing Education Program (ETNEP) course as well as the ET students' satisfaction of teachers and studying conditions when completing the Wenzhou ETNEP.
Methods One hundred and sixty-nine students who had completed the Wenzhou ETNEP were evaluated by Kirkpatrick’s Four Levels of Training Evaluation model from four perspectives, namely the Reaction, Learning, Behaviour and Result levels.
Results The overall satisfaction of the Wenzhou ETNEP was high in the Reaction level. In the Reaction Level the average matrix score of training programs and teachers was: >1.4. In the Behavioural level, 103 ETs participated in stoma and wound clinics, with 99.2% of them actively promoting ET nursing knowledge and 18 ETs (13.2%) serving as teachers of ETNEP schools. One hundred and sixteen ETs (85.3%) conducted ET-related nursing courses for other nursing staff and 58.8% of ETs had conducted continued education courses. Of the ETs, 22.8% participated in the hospital’s outpatient or outreach stoma and wound care services. In the Result level, 58.8% of ETs participated in nursing research of the specialty, 29.4% of ETs had obtained scientific research funds and 136 ETs had published papers.
Conclusion Students are satisfied with the ETNEP training they received. Their ability to work and function as ETs has improved on completion of their training. In addition, their professional standing has improved, with all ETNEP participants having achieved good results in the fields of specialised nursing, extended nursing, scientific research and teaching. However, in reviewing the survey results and aligning these with current standards of practice and employment of ETs in China, there is the need to modify parts of the ETNEP (such as raising the degree of ET students' entry criteria), standardise teaching materials and establish communication processes with mechanisms for exchanging ET teachers nationally and internationally, to ensure the quality of teaching and improve the quality of specialised ET nursing.
Introduction
The Wenzhou Enterostomal Therapist Nursing Education Program (ETNEP) in the Zhejiang Province of China was recognised by the World Council of Enterostomal Therapists (WCET®) in 2008. The Wenzhou ETNEP is one of 12 Chinese schools that train enterostomal therapists (ETs). Annually since 2008, Wenzhou has recruited ET students from all over China and by the end of 2018 had recruited 199 students for 10 terms. Excluding those 30 students in training for their tenth term, all these students have completed all courses within the ETNEP program and have successfully passed all examinations and evaluations and subsequently received their ET certificates from the WCET®.
As a clinical nurse specialist in the field of ostomy, wound and incontinence care, the ET nurse's main responsibilities are: taking care of ostomates; preventing and treating stoma complications; managing chronic wounds and incontinence; and providing psychosocial care and counselling services for nurses, patients and their families1.
This study was undertaken to evaluate and better understand ET students’ feedback from and satisfaction with the Wenzhou ETNEP. The evaluation included satisfaction with teachers, learning conditions as well as students' respective hospital’s working conditions after obtaining their ET qualifications. A survey was conducted among 169 ETs who had graduated from the Wenzhou ETNEP using Kirkpatrick’s model, which was proposed by Professor Kirkpatrick of Wisconsin University in 19592-6. This model has been widely used in the education field for evaluating education programs, especially in evaluating the effect of training and education on medical staff5.
The Kirkpatrick model or Kirkpatrick’s Four Levels of Training Evaluation is divided into four different evaluation levels, which are Level 1: Reaction; Level 2: Learning; Level 3: Behaviour; and, Level 4: Results7. The characteristics of each level, options for methods of program evaluation and the relevance or practical undertaking of each level are summarized in Table 1. The premise, therefore, of using Kirkpatrick’s model in this study was to evaluate the effectiveness of the Wenzhou ETNEP and to understand student ET nurses' responses to the training provided in order to provide a reference base to improve future training of specialised ET nurses.
Study Methodology
Study population: Inclusion and exclusion criteria
Included in this study were 169 ET nursing students from nine classes of Wenzhou ET schools. Excluded were 30 students of the tenth class who had not obtained their ET nursing qualification and certificates.
Study methods and design
The 169 ET nursing students were surveyed using a questionnaire that contained 85 questions containing the Kirkpatrick’s Four Levels of Training Evaluation model. The content of the questionnaire included questions on ET students' general situation, role functions and work achievements, as well as working organisation situation. The ETs' work and role functions were formulated according to the current ETs' role model ascribed to in the USA8, including professional title, direct nursing service and professional guidance, role of teacher, role of researcher, and self-development role.
The development, implementation and analysis of the survey results was done on an internal website. These processes were divided into several steps: online design, setting properties, release of the questionnaire, informing ET students of the questionnaire and setting a deadline date of one week in which ET nurses could access, complete and return the questionnaire. Provision was made to download the survey data, analyse the results and create reports. The internal website program was automated to enable data analysis of the survey results using simple descriptive statistics.
Ethical Approval
Ethical approval was not required to conduct this study. Completion of the questionnaire inferred implied consent by participants.
Results
Participant demographics
There were 136 ETs who participated in the survey: a response rate of 80.4%. Survey respondents included 7 males and 129 females. Five respondents had a master’s degree, 124 had a bachelor’s degree and 7 had a junior college degree. With regard to their professional titles, 9 respondents were chief director of nurses, 32 deputy director chief nurses, 73 chief nurses, 21 senior nurses and one junior nurse. There were 100 ETs working in tertiary-grade hospitals (73.5%), 22 ETs working in tertiary B hospitals (16.0%), 11 ETs working in second grade hospitals (8.%), and 3 ETs working in community hospitals (2.2%).
Reaction level
The average matrix score of training programs and teachers was: >1.4 (Table 1).
Learning layer
All students obtained their ET qualification certificates from WCET® after training, with 76.4% of students having participated in domestic academic exchanges and 13.2% participating in international academic exchanges (Table 2).
Behaviour level
Among the ET respondents, 113 (83.0%), believed that the hospital attached great importance to the specialised work of ETs and 126 (92.7%) believed that the staff of other departments were very cooperative with the specialised work of ET (Table 2).
Results level
After their ETNEP training, 80 students participated in scientific research projects and more than 100 students published papers (Tables 2 and 3).
Results Summary
ET training
The WCET® education committee created the ETNEP, providing tri-specialty education programs for wound, ostomy and continence nursing care and any of the specialty practice areas individually. The education program is made up of wound care, ostomy care, continence care and professional development, with each category at 30%, 40%, 18–20% and 12–10%, respectively. It is comprised of at least 180 hours of theoretical studies and 180 hours of clinical studies. The theoretical studies are mainly to explain relevant theoretical knowledge, which adopt various forms of teaching, such as discussion, questioning and role simulation. Clinical teaching is taught mainly by certified ETs through case discussions and case nursing. To ensure the students received hands-on opportunities, one ET can only teach two students during a training course9.
In order to promote specialised nursing development in general in China and to enhance the professional level of Chinese ET nurses to conform to the international standards, the Wenzhou ETNEP recruits ET nursing students from all over China. The purpose of the ETNEP is to promote the treatment and rehabilitation of patients with a stoma, wound or incontinence issue and improve their quality of life. The training content of the ETNEP includes two different parts which are theoretical learning and clinical practice; each part is of 210 hours' duration. The theoretical content includes four parts, which are wound care/stoma/continence care (85–90%) and professional development (10–15%).
The ETNEP is mainly taught by overseas and domestic ETs as well as professional workers. The clinical preceptors are local ETs within the province, with a guiding commanding principle of “one preceptor to oversee two students”. The preceptors are committed to: cultivating students' clinical capabilities in stoma, wound and incontinence care; improving their assessment abilities; and helping them master ostomy complications, complex wounds and issues associated with incontinence. Furthermore, preceptors assist in the development of capable ETs by advancing students’ knowledge base, clinical skills, problem-solving abilities that allows ETs to assess patients and family members’ health problems and implement relevant nursing and health education strategies independently.
Approximately 100,000 new cases of permanent ostomies are created every year in China10. The basic nursing education curriculum in China does not include stoma care or specialist care provided by ET nurses11. Clinical nurses in China lack a standard model of care for ostomates compared with ETs. The total number of ETs in China is currently very small, which means the needs of all patients with ostomies are not met. Therefore, it is very important to provide better training for ETs and evaluate the effect of these specialised nurses. Kirkpatrick’s Four Levels of Training Evaluation model was adopted to evaluate the Wenzhou ETNEP and the effect of the ETNEP on individual ET nurses and their employment in order to promote cultivation of ETs as specialised nurses.
Reaction level: satisfaction of educators and teaching conditions
The results from the Reaction level showed that students were on the whole quite satisfied with the learning environment, teaching resources provided and clinical practice opportunities experienced at base hospitals as well as the quality of training provided by the preceptors. However, it was thought the ETNEP lacked consistency with teaching materials, ability to diversify teaching methods to meet student requirements and program evaluation methods given the trainees are from all over China. Therefore, the curriculum should be designed according to the characteristics and needs of students from different regions around the country. Therefore, the ETNEP school will make appropriate adjustments to the ET training courses such as: strengthening training in the clinical practice and application of stomal therapy techniques and increase requirements of hospitals providing clinical placements to ensure ET nursing students are exposed to as much clinical experience as possible. Another change would be increasing ET students education in research techniques that would increase their ability to participate in clinical and scientific research. These changes will be made to ensure that the training of ETs is more in line with the clinical needs of patients with stomas and in advancing the ET nursing as a specialist field.
Learning level and change in ET students’ educational qualifications
The Learning level demonstrated that all ET students successfully completed their training and obtained certification as an ET. Among the 136 students surveyed, there were no students with a doctoral degree. However, five students had a master’s degree (3.7%), 124 had a bachelor’s degree (91.2%), and seven had a college degree (5.2%). The need for specialised nursing care of patients with stomas, the importance of having trained nurses to provide ostomy, wound and continence care and the professionalism associated with certified ET or wound, ostomy and continence nursing services, and the benefits to patients and health care services are widely recognised internationally12. Therefore, it is necessary to gradually advance the standards required for candidates of ET training, especially educational background and foreign language level.
Behavioural level: working status of ETs
Findings from the Behavioural level show that all ETs' role and functions were approved by their respective hospital and supervisors. Approximately 130 hospitals (95.5%) have operational specialised stoma and wound care clinics with established consultation systems. The development of the ET role is inseparable from the support of hospital, medical and nursing executive and cooperation of clinical medical staff within relevant hospital departments and outpatient services. The majority of ETs [(n=113 (83.1%)] believed their hospitals attached great importance to the specialised nature of the ETs' work and 126 (92.6%) believed that other departments were very cooperative with ETs, allowing them to fulfil their role and function. Some ET nurses pointed out that due to internal organisational processes and bonuses received by authorised personnel for clinical work undertaken, some departments were unwilling to accept ET nursing services for all areas of hospital. Part-time ETs identified they not only participated in stomal therapy work, but also undertook clinical or managerial work on the wards, which meant they had a relatively heavy workload13.
However, only 31 ETs respondents (22.7%) in this survey enjoyed additional special bonuses and only 30 respondents (22.1%) indicated they thought their incomes were relative to their workload, which is bound to affect ETs' work enthusiasm. Therefore, it is necessary to improve the professional working conditions and level of remuneration of specialised ET nurses, to properly use available incentive mechanisms to engender the enthusiasm, initiatives and creativity of specialised nurses13.
Results level: ETs' role and research status
Data within the Results level shows that ETs nurses have many roles in addition to their traditional clinical nursing role. ET nurses also functioned as an educator, teacher and nurse consultant. Furthermore, they not only reviewed stoma and wound patients in outpatient clinics and hospital outreach services but also provided ET nurse consulting services to these patients in the ward. As educators, ET nurses provided related ostomy care courses for clinical nurses and medical health workers. ETs also participated in scientific research and published articles in many Chinese and international journals (such as the Chinese Nurses Journal, Morden Nurses Journal, International Journal of Nursing Sciences and so on).
Discussion
Overall the results of the study would indicate that the ETNEP school curriculum requires review and revision. The quality of teaching could be improved by adopting the method of ‘going out, coming in’ with the exchange of ET teachers between China and international ETNEP teachers. This would allow Chinese ET nurses to participate in and learn from advanced teaching techniques used within international ETNEPs13 and provide international ETs with the cultural experience of teaching in China which would also strengthen international communication. This exchange would also assist in compiling standardized teaching materials, improve students' academic experiences and foreign language level. It would also establish a communication platform for the teaching staff [12]. In addition, more attention needs to be payed to ET nurse’s professional growth and development after obtaining certification as an ET. Practicing ETs require easily accessible platforms to enable them to update their knowledge. They require mentoring in how to establish channels of communication with all levels of hospital hierarchy as well as associated medical personnel or organizations. Generally, in China, more professional support needs to be provided to ETs in their workplace to enhance their roles as specialized nurses. This would allow Chinese ET nurses to fulfil their roles and functions to the best of their abilities, which would enhance patient care, achieve better patient and organizational outcomes and facilitate higher levels of individual achievement in clinical care, scientific research, teaching and managerial elements of ET nursing.
Conclusion
Kirkpatrick’s Four Levels of Training Evaluation model was used from a holistic perspective to evaluate the effectiveness of the Wenzhou ETNEP in order to determine any changes that may be required to the content and implementation of the ETNEP. The Behavioural and Results levels showed that training currently provided could be improved to increase trainees' qualities and abilities. Wenzhou ETNEP is committed to cultivating ET students with excellent professional qualities. Nowadays the difference between it and foreign developed countries has become smaller. However, we still need to learn from each other.
Conflict of Interest
The authors declare no conflicts of interest.
Funding
The authors received no funding for this study.
造口治疗师培训的效果：用柯克帕特里克模型评估
Shenlv Ying, Jiang, Hai-Hong and Ai-hua Chen(Alice)
DOI: https://doi.org/10.33235/wcet.39.2.28-33
摘要
目标 基于柯克帕特里克四级培训评估模型评估造口治疗师（ET）培训的成效。了解造口治疗师学员在完成造口治疗护理教育项目（ETNEP）课程后的工作状态，以及造口治疗师学员在完成温州的ETNEP时对教师和学习条件的满意度。
方法 通过柯克帕特里克四级培训评估模型从四个层面评估完成温州ETNEP的169名学生，即反应层面、学习层面、行为层面和成果层面。
结果 在反应层面对温州ETNEP的总体满意度较高。在反应层面，培训项目和教师的平均矩阵得分：>1.4。在行为层面，103名造口治疗师参与到造口和伤口诊所当中，99.2％的人积极推广造口治疗护理知识，18名造口治疗师（13.2％）担任ETNEP学校的教师。116名造口治疗师（85.3％）为其他护理人员开设了造口治疗相关的护理课程，58.8％的造口治疗师开设了继续教育课程。在这些造口治疗师中，22.8％的人参与了医院门诊或外展造口和伤口护理服务。在成果层面，58.8％的造口治疗师参与了该专业的护理研究，29.4％的造口治疗师获得了科研基金，136名造口治疗师已发表论文。
结论 学生对接受的ETNEP培训感到满意。在完成培训后，他们作为造口治疗师的工作能力和职能有所改善。此外，他们的专业地位得到了提高，所有ETNEP参与者都在专业护理、延伸护理、科学研究和教学领域取得了良好的成就。然而，在审查调查结果并使其与中国现行造口治疗师实践和就业标准保持一致时发现，需要修改ETNEP的部分内容（例如提高造口治疗师学员的入学标准），标准化教材和建立沟通流程，设立国内外造口治疗教师交流机制，以确保教学质量，并提高造口治疗师专业护理的质量。
前言
中国浙江省温州市造口治疗护理教育项目（ETNEP）于2008年获得世界造口治疗师委员会（WCET®）认可。温州ETNEP是中国培训造口治疗师（ET）的12所学校之一。自2008年以来，温州每年招收来自全国各地的造口治疗师学员，截止2018年底共招收了10期199名学生。除了在接受第十期培训的30名学生外，所有这些学生都完成了ETNEP项目中的所有课程，并成功通过了所有考试和评估，随后从WCET®领取了造口治疗师证书。
作为造口、伤口和失禁护理领域的临床护理专家，造口治疗护士的主要职责是护理造口患者、预防和治疗造口并发症、管理慢性伤口和失禁，并为护士、患者及其家人提供社会心理护理和咨询服务1。
本研究旨在评估和更好地了解造口治疗师学员对温州ETNEP的反馈和满意度。评估内容包括对教师、学习条件的满意度，以及学生在获得造口治疗师资格后在各自医院的工作状况。使用柯克帕特里克模型对从温州ETNEP结业的169名造口治疗师进行了一项调查，该模型由威斯康星大学柯克帕特里克（Kirkpatrick）教授于1959年提出2-6。该模型已被广泛用于教育领域，用于评估教育项目，特别是评估培训和教育对医务人员的成效5。
柯克帕特里克模型或柯克帕特里克四级培训评估被分为四个不同的评估层面，其中第1层面：反应；第2层面：学习；第3层面：行为；和第4层面：成果7。表1总结了各个层面的特点、项目评估方法的选择以及各个层面的相关性或实际内容。因此，在本研究中使用柯克帕特里克模型的前提是评估温州ETNEP的成效，并了解造口治疗护士学员对所提供的培训的反应，以便为改善未来造口治疗专业护士的培训提供一个参考基础。
研究方法论
研究人群：纳入和排除标准
本研究纳入温州造口治疗师学校九期169名造口治疗（ET）护理学员。排除了仍然在学习、尚未获得造口治疗师护理资格和证书的30名第10期学员。
研究方法和设计
对169名造口治疗护理学员进行了问卷调查，问卷包含85个问题，包括柯克帕特里克的四级培训评估模型。调查问卷的内容包括造口治疗师学员的总体情况、角色职能和工作成就以及工作组织情况的相关问题。造口治疗师的工作和角色职能根据美国现有的造口治疗师的角色模型制定8，包括职称、直接护理服务和专业指导、教师角色、研究员角色和自我发展角色。
在内部网站上完成调查的制定、实施和结果分析。这些过程分为几个步骤：在线设计、设置属性、问卷发布、向造口治疗师学员通知问卷调查，并设置一周期限，造口治疗护士可以在这个期限内访问完成并提交调查问卷。做出了相应安排，以便下载调查数据、分析调查结果并创建报告。内部网站程序经过自动化，使用简单的描述性统计数据对调查结果进行数据分析。
伦理道德审批
这项研究不需要伦理道德审批。完成调查问卷暗示参与者的默示同意。
结果
参与者人口统计学数据
共有136名造口治疗师参与调查：应答率为80.4％。调查受访者包括7名男性和129名女性。5名受访者拥有硕士学位，124名拥有学士学位，7名拥有大专学历。在专业职称方面，9名受访者为护士长，32名为副主任护士，73名为主任护士，21名为高级护士以及1名为初级护士。100名造口治疗师在三级医院工作（73.5％），22名造口治疗师在三级乙等医院工作（16.0％），11名造口治疗师在二级医院工作（8.％），以及3名造口治疗师在社区医院工作（2.2％）。
反应层面
培训项目和教师的平均矩阵得分：>1.4（表1）。
学习层面
所有学生在培训后都获得了WCET®颁发的造口治疗师资格证书，76.4％的学生参加了国内学术交流，13.2％的学生参加了国际学术交流（表2）。
行为层面
在造口治疗师受访者中，113人（83.0％）认为医院非常重视造口治疗师的专业工作，126人（92.7％）认为其他部门的员工非常配合造口治疗师的专业工作（表2）。
成果层面
在他们完成ETNEP培训之后，80名学生参加了科学研究项目，100多名学生发表了论文（表2和表3）。
成果总结
造口治疗师培训
WCET®教育委员会创办了ETNEP，为伤口、造口和失禁护理以及任何单独的专业实践领域提供三项专业教育项目。该教育项目由伤口护理、造口护理、失禁护理和专业发展组成，每个类别分别占据30％，40％，18-20％和12-10％。它包括至少180小时理论学习和180小时临床实践。理论学习主要是解释相关的理论知识，采用各种形式教学，如讨论，提问和角色模拟。临床教学主要由经认证的造口治疗师通过病例讨论和病例护理来授课。为了确保学员获得实践机会，一名造口治疗师只能在培训课程中指导两名学员9。
为了促进专业护理在中国的总体发展，提高中国造口治疗护士的专业水平，使其符合国际标准，温州ETNEP招募来自全国各地的造口治疗护理学员。ETNEP旨在帮助有造口、伤口或失禁问题的患者进行治疗和康复，并改善他们的生活质量。ETNEP培训内容包括理论学习和临床实践两个不同的部分；每个部分包括210小时。理论内容包括四个部分，即伤口护理/造口/失禁护理（85-90％）和专业发展（10-15％）。
ETNEP主要由海外和国内造口治疗师以及专业工作人员授课。临床指导员是省内本地的造口治疗师，指导原则是“一个指导员负责两个学生”。指导员致力于培养学生在造口、伤口和失禁护理方面的临床能力，提高他们的评估能力，并帮助他们掌握造口术并发症、复杂的伤口和与失禁相关的问题。此外，指导员通过提高学生的知识基础、临床技能、解决问题的能力，使造口治疗师能够评估患者和家庭成员的健康问题，以及独立实施相关的护理和健康教育策略，从而协助培养有能力的造口治疗师。
中国每年约有10万新发永久性造口病例10中国的基础护理教育课程不包括由造口治疗护士提供的造口护理或专业护理11。与造口治疗师相比，中国的临床护士在为造口者提供护理方面缺乏一个标准模式。目前，中国的造口治疗师总人数非常少，这意味着无法满足所有造口患者的需求。因此，为造口治疗师提供更好的培训并评估这些专业护士的成效非常重要。采用柯克帕特里克四级培训评估模型评估温州ETNEP以及ETNEP对个体造口治疗护士及其就业的影响，以促进培养造口治疗专业护士。
反应层面：对教师和教学条件的满意度
反应层面的结果表明，学生总体上对学习环境、所提供的教学资源和在基础医院的临床实践机会，以及指导员提供的培训质量非常满意。然而，由于学员来自中国各地，ETNEP的教材缺乏一致性，教学方法不够多样化而无法满足学生的要求，并缺乏课程评估方法。因此，课程应根据全国各地区学生的特点和需求进行设计。因此，ETNEP学校将对造口治疗师的培训课程进行适当调整，例如：加强临床实践培训和造口治疗技术的应用，提高医院提供临床实习的要求，确保造口治疗护理学员能有机会接触尽可能多的临床体验。另一种改变是增加造口治疗师学员在研究技术方面的教育，这将提高他们参与临床和科学研究的能力。将会做出这些改变，以确保造口治疗师的培训更符合造口患者的临床需求，并推进造口治疗护理作为一个专业领域的发展。
学习层面以及造口治疗师学员教育资历的变化
学习层面表明，所有造口治疗师学员都成功完成了培训并获得了造口治疗师证书。在接受调查的136名学生中，没有学生拥有博士学位。然而，五名学生拥有硕士学位（3.7％），124名拥有学士学位（91.2％），七名拥有大专学位（5.2％）。向造口患者提供专业护理的需求，由训练有素的护士提供造口、伤口和失禁护理的重要性、认证的造口治疗师的专业性或与伤口、造口和失禁护理服务相关的专业性，以及对患者和医疗保健服务的益处都在国际上得到了广泛的认可12。因此，有必要逐步提高成为造口治疗师培训候选人所需的标准，特别是教育背景和外语水平。
行为层面：造口治疗师的工作状态
行为层面的调查结果显示，所有造口治疗师的角色和职能均得到了他们各自医院和主管的认可。大约130家医院（95.5％）设有正在运营的专业造口和伤口护理诊所，并建立了会诊制度。造口治疗师的角色发展离不开医院、医疗和护理高管的支持以及相关医院部门和门诊服务的临床医疗人员的合作。大多数造口治疗师[（n = 113（83.1％）]认为他们的医院非常重视造口治疗师工作的专业性，126（92.6％）认为其他部门与造口治疗师非常合作，使他们能够履行自己的角色和职责。一些造口治疗护士指出，由于内部组织流程和授权人员因为临床工作获得奖金，一些部门不愿意在医院的所有领域都实施造口治疗师的护理服务。兼职的造口治疗师指出，他们不仅参与造口治疗工作，还在病房从事临床或管理工作，这意味着他们的工作量相对较大13。
然而，本调查中只有31名造口治疗师受访者（22.7％）享有额外的特别奖金，只有30名受访者（22.1％）表示他们认为自己的收入与工作量相当，这势必会影响造口治疗师的工作热情。因此，有必要改善专业外科护士的专业工作条件和报酬水平，适当运用现有的激励机制，培养专业护士的积极性，主动性和创造性13。
成果层面：造口治疗师的角色和研究状况
成果层面数据显示，造口治疗护士除了他们的传统临床护理角色外，还有许多其他角色。造口治疗护士还担任教育工作者、教师和护士顾问。此外，他们不仅为门诊诊所和医院外展服务中的造口和伤口患者提供检查，还为病房内的患者提供造口治疗护士会诊服务。作为教育工作者，造口治疗护士为临床护士和医疗卫生工作者提供相关的造口护理课程。造口治疗师还参与了科学研究，并且在许多中国和国际杂志上发表文章（如《中华护理杂志》、《现代护理杂志》、《国际护理科学杂志》等）。
讨论
总体而言，研究结果表明，ETNEP学校课程需要进行审查和修改。通过在中国和国际ETNEP教师之间采用“走出去，请进来”的交流方式，可以提高教学质量。这将使中国的造口治疗护士能够参与并学习国际ETNEP13中使用的先进教学技术，并为国际造口治疗师提供在中国教学的文化经验，这也能够加强国际交流。这种交流还有助于编制标准化的教材，提高学员的学习体验和外语水平。它还能为教学人员建立一个交流平台[12]。此外，造口治疗护士在获得造口治疗师认证后，需要更多关注他们的专业成长和发展。执业的造口治疗师需要易于访问的平台，以便能够更新知识。他们需要在如何与医院各级人员以及相关医疗人员或组织建立沟通渠道方面的指导。一般来说，在中国，需要为造口治疗师的工作场所提供更多的专业支持，以增强他们作为专业护士的角色。这将使中国的造口治疗护士能够尽其所能地履行其角色和职责，从而改善对患者护理，实现更好的患者和组织成效，并在造口治疗护理在临床护理、科学研究、教学和管理要素方面促进更高水平的个人成就。
结论
使用柯克帕特里克四级培训评估模型，从整体角度评估了温州ETNEP的成效，以确定需要对ETNEP的内容和实施方式做出的任何改变。行为层面和成果层面数据表明，目前提供的培训可以得到改善，以提高学员的素质和能力。温州ETNEP致力于培养具有优秀专业素质的造口治疗师学员。如今，它与外国发达国家之间的差异已变得越来越小。但是，我们仍然需要相互学习。
利益冲突
作者声明没有利益冲突。
资助
作者未因该项研究收到任何资助。
Author(s)
Shenlv Ying
ET, RN, BScN
Department of Colorectal Surgery, Wenzhou Central Hospital
Zhejiang Province, China
Jiang, Hai-Hong
MD, PhD
Professor and Director, Neuro-Urology Center
The First Affiliated Hospital of Wenzhou Medical University
Wenzhou, Zhejiang Province, China
Ai-hua Chen(Alice)
ET, RN, BScN
Director of Wenzhou Enterostomal Therapy Nursing Education Programs, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
Correspondence to Ai-hua Chen(Alice)
Email: 821046478@qq.com
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