云南省某三级综合医院基于治疗干预评分系统和护理工时测量的ICU护理人力资源配置模型研究

发布时间：2018-09-07 22:06

【摘要】：[目的]1.构建适合ICU (Intensive Care Unit)病区的护理人力资源配置现状调查表和护理工作量测量项目框架,为调查ICU护理人力资源配置现状和测量ICU护理工作量提供科学有效的工具。2.通过测量ICU的护理工时和评定ICU患者的治疗干预评分系统-28(therapeutic intervention scoring system 28,TISS-28)评分,并根据护理人力资源配置数量公式建立护理人力资源配置数量与TISS-28评分之间的数学模型,为有效、简单、快速地测算ICU所需护理人力资源数量提供依据。[方法]1.通过文献回顾和现场观察,初步拟定ICU护理人力资源配置现状调查表和直接护理、间接护理、个人活动项目框架,并设计《ICU护理人力资源配置现状调查表和ICU护理项目框架专家咨询问卷》,选取云南省三级医院的10位护理专家进行两轮德尔菲专家咨询,对专家咨询结果及专家基本情况进行统计分析,最终确定正式的“ICU护理人力资源配置现状调查表”、“ICU直接护理项目框架”、“ICU间接护理项目框架”和“ICU个人活动项目框架”。2.采用便利抽样法选取云南省某三级综合医院中心ICU作为研究对象,使用德尔菲专家咨询法确定的“ICU护理人力资源配置现状调查表”对上述ICU进行护理人力资源配置的现况调查。3.将选定的ICU的在职在岗护理人员作为研究对象,测量其直接护理项目操作时间、间接护理工时和个人活动工时。每个直接护理项目测量30次操作时间,包括不同职称的护理人员为不同病情级别的患者提供护理操作的时间,取30次时间的平均值作为各直接护理项目的操作时间。间接护理工时、个人活动工时则连续测量周一至周日每日各间接护理项目、个人活动项目的工时。采用随机抽样法选取2016年6月至2016年8月间的5个周,对5周内ICU收治的患者共133人次作为研究对象,评定这133位患者的TISS-28评分,并记录护理人员每日为每一位患者提供各直接护理项目的操作频次。通过Pearson线性相关分析和简单线性回归分析建立直接护理工时与TISS-28评分之间的关系模型,再根据护理人力资源配置数量公式,建立ICU所需护理人员数量与TISS-28评分之间的数学模型。4.将数据录入Microsoft Excel 2010、Microsoft Word 2010中文版软件建立数据库,使用SPSS 17.0进行统计学分析。采用均数±标准差、频次、构成比、率进行统计描述。采用单因素方差分析、LSD-t检验、S-N-K检验、秩和检验、两独立样本t检验进行统计推断。采用Pearson相关分析、简单线性回归分析建立数学模型。P0.05为差异有统计学意义。[结果]1.德尔菲专家咨询:(1)专家积极系数为100%,专家个人权威系数在0.825～1之间,整体权威系数为0.91。(2) ICU护理人力资源配置现状调查表包括医院基本情况(3个条目)、病区基本情况(4个条目)、护士长基本情况(7个条目)、护理人员基本情况(9个条目)和护理员基本情况(4个条目)五部分内容。(3)ICU护理项目框架分为直接护理项目框架(三个一级指标共98项直接护理项目)、间接护理项目框架(63项间接护理项目)和个人活动项目框架(3项个人活动项目)。2.护理人力资源配置现状:(1) ICU实际床护比为1:1.83。(2)护理人员休息系数为1.398。(3)护理人员年龄多集中在26～30岁,占57.14%。(4)工作5年以下的护理人员占26.19%。(5)护理人员高、中、初级职称之比为0:14.29:85.72。(6)护理人员学历以大专和本科为主,分别占47.62%、52.38%。(7) 42名护理人员中,有男护士 5人,占11.90%。(8)编制内、编制外护理人员所占比例分别为28.57%和71.43%, 2013-2015年,编外护理人员离职率为4.65%,无编内护理人员离职。(9)护士长职称及学历仍有提升空间。(10)护理员均为中年女性,文化素质较低。3.护理工作量测定和配置模型建立:(1)最耗时的直接、间接护理项目分别是血液透析和书写危重患者记录单。(2)与静脉输液相关的护理项目操作频次较高、耗时较多。(3)不同工作日患者人均所需直接护理工时、间接护理工时、个人活动工时无差异。(4)患者白班所需要的人均直接护理工时、人均个人活动工时大于夜班。(5)直接、间接护理工时和个人活动工时占总工时的比例为55.25%、36.46%、8.29%,间接护理工时较高。(6) ICU理论床护比应为1:3.2,护理人员处于超负荷工作状态。(7) TISS-28评分越高,患者所需直接护理工时越多。(8)直接护理工时与TISS-28评分的Pearson相关系数r=0.811,具有正相关关系。(9)护理人力资源配置数量与TISS-28的模型为:1所需护士人数=(?)(42.5×TISS-28i- 124.3)/286.12 ,式中,TISS-28i 为第 i 个患者的TISS-28评分,n为患者总数。[结论]1.随着社会的发展,患者对护理服务的要求在提高、需求在增强,护理项目的数量也在不断增加,且不同专科的护理项目框架也有差异,因此,很有必要界定ICU的护理项目框架。2.通过德尔菲专家咨询法构建的“ICU护理人力资源配置现状调查表”和“ICU护理项目框架”具有代表性和有效性,可用于现况调查和护理工时测量。3.云南省某三级综合医院中心ICU护理人力资源配置存在一定的问题,需要管理者增加护理人力资源配置数量,优化护理人力资源配置结构,明确护理员准入条件,实施护理员团队化管理,进一步提高护理队伍的整体素质,更好地为患者服务。4.对单个护理项目工时的测量可凸显ICU专科特点。ICU患者每日所需护理工时无差异,管理者不应盲目减少节假日排班人数。ICU白班护理工时大于夜班,夜班排班人数可少于白班。5.护理人员处于超负荷工作状态,加强护理人员培训,以质量替代数量,同时采取弹性排班方法,能在一定程度上缓解护士的超负荷工作状态,而根据病区护理工作量编配合理的护理人力资源能从根本上解决问题。6.基于治疗干预评分系统-28 (TISS-28)和护理工时测量构建的ICU所需护理人员数量与TISS-28评分之间的数学模型可有效、简单、快速地测算ICU所需护理人力资源数量,便于管理者根据护理工作量对护理人力资源进行动态管理,以更好地为患者提供及时、准确、安全的护理服务。
[Abstract]:[Objective] 1. To construct a nursing human resource allocation questionnaire and nursing workload measurement project framework suitable for ICU (Intensive Care Unit) ward, and provide a scientific and effective tool for investigating the status of nursing human resource allocation in ICU and measuring the nursing workload in ICU. 2. To evaluate the treatment intervention of ICU patients by measuring the nursing hours in ICU and evaluating the treatment intervention of ICU patients. The mathematical model between the number of nursing human resources allocation and the score of TISS-28 was established according to the formula of the number of nursing human resources allocation. Through on-the-spot observation, a questionnaire on the status quo of ICU nursing human resources allocation and a framework of direct nursing, indirect nursing and personal activities were preliminarily drawn up. A questionnaire on the status quo of ICU nursing human resources allocation and an expert inquiry questionnaire on ICU nursing project framework were designed. Ten nursing experts from Yunnan tertiary hospitals were selected for two rounds of Delphi expert consultation. The results of expert consultation and the basic situation of experts were statistically analyzed, and the formal "ICU nursing human resource allocation questionnaire", "ICU direct nursing project framework", "ICU indirect nursing project framework" and "ICU individual activity project framework" were finally determined. 2. A three-level general hospital in Yunnan Province was selected by convenience sampling method. Heart ICU as the research object, using Delphi expert consultation method to determine the "ICU nursing human resources allocation status questionnaire" on the above ICU nursing human resources allocation status survey. 3. Selected ICU on-the-job nurses as the research object, measuring their direct nursing project operation time, indirect nursing hours and individuals. Human activity hours. Each direct care item measures 30 operations, including the time that nurses of different professional titles provide care to patients of different disease levels. The average time of 30 operations is taken as the operation time of each direct care item. Indirect nursing hours and personal activity hours are measured continuously from Monday to Sunday. The TISS-28 scores of 133 patients admitted to the ICU during the five weeks from June 2016 to August 2016 were assessed and the operating frequency of direct care items provided by nurses to each patient daily was recorded. Secondly, Pearson linear correlation analysis and simple linear regression analysis were used to establish the relationship model between direct nursing hours and TISS-28 score, and then the mathematical model between the number of nurses needed in ICU and TISS-28 score was established according to the formula of nursing human resources allocation. 4. Data were entered into Microsoft Excel 2010, Microsoft Word 2010. Chinese version of the software to establish a database, the use of SPSS 17.0 for statistical analysis. The use of mean (+) standard deviation, frequency, composition ratio, rate for statistical description. The use of one-way ANOVA, LSD-t test, S-N-K test, rank sum test, two independent sample t test for statistical inference. Pearson correlation analysis, simple linear regression analysis to establish a mathematical model. Model. P 0.05 was statistically significant. [Results] 1. Delphi Expert Consultation: (1) Expert positive coefficient was 100%, expert personal authority coefficient was 0.825-1, the overall authority coefficient was 0.91. (2) ICU nursing human resources allocation questionnaire includes the basic situation of the hospital (3 items), the basic situation of the ward (4 items), the basic situation of head nurses. (3) ICU nursing project framework was divided into direct nursing project framework (98 direct nursing projects with three first-level indicators), indirect nursing project framework (63 indirect nursing projects) and individual activity project framework (3 individual activities). Nursing human resources allocation status: (1) ICU actual bed-to-nurse ratio is 1:1.83. (2) Nursing staff rest coefficient is 1.398. (3) Nursing staff age mostly concentrated in 26-30 years old, accounting for 57.14%. (4) Nursing staff working under 5 years accounted for 26.19%. (5) Nursing staff high, in the primary title ratio of 0:14.29:85.72. (6) Nursing staff education to tertiary education. Among the 42 nurses, 5 were male nurses, accounting for 11.90%. (8) The proportion of outside nurses was 28.57% and 71.43% respectively. From 2013 to 2015, the turnover rate of out-of-staff nurses was 4.65%. There was still room for improvement in the title and educational background of head nurses. 3. Establishment of nursing workload measurement and allocation model: (1) The most time-consuming direct and indirect nursing items were hemodialysis and writing the records of critical patients. (2) Nursing items related to intravenous infusion were operated more frequently and consumed more time. (3) Indirect nursing needs of patients in different working days per capita. Indirect nursing hours, indirect nursing hours, personal activity hours, there is no difference. (4) Indirect nursing hours per capita needed by patients in the day shift, personal activity hours per capita greater than night shift. (5) Direct, indirect nursing hours and personal activity hours accounted for 55.25%, 36.46%, 8.29% of the total working hours, indirect nursing hours higher. (6) ICU theoretical bed-to-nursing ratio should be 1:3.2, nursing care. (7) The higher the TISS-28 score, the more direct nursing hours the patients needed. (8) The Pearson correlation coefficient between direct nursing hours and TISS-28 score was 0.811, which had a positive correlation. (9) The model of the allocation of nursing human resources and TISS-28 was as follows: (1) Nurse requirement =(?) (42.5 *TISS-28i-124.3)/286.12, TISS-28i is the TISS-28 score of the first patient and N is the total number of patients. [Conclusion] The questionnaire of ICU nursing human resource allocation and the framework of ICU nursing project constructed by Delphi expert consultation are representative and effective, and can be used for current situation investigation and nursing man-hour measurement. Managing the number of human resources allocation, optimizing the structure of nursing human resources allocation, defining the admission conditions of nurses, implementing team management of nurses, further improving the overall quality of the nursing team, and better serving the patients. 4. Measuring the working hours of a single nursing project can highlight the characteristics of ICU specialty. Management should not blindly reduce the number of holidays shift. ICU day shift nurses more than night shift, night shift nurses can be less than day shift. 5. Nurses in the overloaded working state, strengthen the training of nurses, to replace the number of quality, while taking flexible scheduling methods, to a certain extent, can alleviate the overloaded working state of nurses. Nursing human resources can solve the problem fundamentally according to the nursing workload of the ward. 6. The mathematical model between the number of nurses needed in ICU and TISS-28 based on TISS-28 and the measurement of nursing working hours is effective, simple and quick to calculate the number of nursing human resources needed in ICU. The manager manages nursing human resources dynamically according to the nursing workload to provide timely, accurate and safe nursing services for patients.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R47

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