【摘要】：[目的]1.構建適合ICU (Intensive Care Unit)病區(qū)的護理人力資源配置現(xiàn)狀調(diào)查表和護理工作量測量項目框架,為調(diào)查ICU護理人力資源配置現(xiàn)狀和測量ICU護理工作量提供科學有效的工具。2.通過測量ICU的護理工時和評定ICU患者的治療干預評分系統(tǒng)-28(therapeutic intervention scoring system 28,TISS-28)評分,并根據(jù)護理人力資源配置數(shù)量公式建立護理人力資源配置數(shù)量與TISS-28評分之間的數(shù)學模型,為有效、簡單、快速地測算ICU所需護理人力資源數(shù)量提供依據(jù)。[方法]1.通過文獻回顧和現(xiàn)場觀察,初步擬定ICU護理人力資源配置現(xiàn)狀調(diào)查表和直接護理、間接護理、個人活動項目框架,并設計《ICU護理人力資源配置現(xiàn)狀調(diào)查表和ICU護理項目框架專家咨詢問卷》,選取云南省三級醫(yī)院的10位護理專家進行兩輪德爾菲專家咨詢,對專家咨詢結果及專家基本情況進行統(tǒng)計分析,最終確定正式的“ICU護理人力資源配置現(xiàn)狀調(diào)查表”、“ICU直接護理項目框架”、“ICU間接護理項目框架”和“ICU個人活動項目框架”。2.采用便利抽樣法選取云南省某三級綜合醫(yī)院中心ICU作為研究對象,使用德爾菲專家咨詢法確定的“ICU護理人力資源配置現(xiàn)狀調(diào)查表”對上述ICU進行護理人力資源配置的現(xiàn)況調(diào)查。3.將選定的ICU的在職在崗護理人員作為研究對象,測量其直接護理項目操作時間、間接護理工時和個人活動工時。每個直接護理項目測量30次操作時間,包括不同職稱的護理人員為不同病情級別的患者提供護理操作的時間,取30次時間的平均值作為各直接護理項目的操作時間。間接護理工時、個人活動工時則連續(xù)測量周一至周日每日各間接護理項目、個人活動項目的工時。采用隨機抽樣法選取2016年6月至2016年8月間的5個周,對5周內(nèi)ICU收治的患者共133人次作為研究對象,評定這133位患者的TISS-28評分,并記錄護理人員每日為每一位患者提供各直接護理項目的操作頻次。通過Pearson線性相關分析和簡單線性回歸分析建立直接護理工時與TISS-28評分之間的關系模型,再根據(jù)護理人力資源配置數(shù)量公式,建立ICU所需護理人員數(shù)量與TISS-28評分之間的數(shù)學模型。4.將數(shù)據(jù)錄入Microsoft Excel 2010、Microsoft Word 2010中文版軟件建立數(shù)據(jù)庫,使用SPSS 17.0進行統(tǒng)計學分析。采用均數(shù)±標準差、頻次、構成比、率進行統(tǒng)計描述。采用單因素方差分析、LSD-t檢驗、S-N-K檢驗、秩和檢驗、兩獨立樣本t檢驗進行統(tǒng)計推斷。采用Pearson相關分析、簡單線性回歸分析建立數(shù)學模型。P0.05為差異有統(tǒng)計學意義。[結果]1.德爾菲專家咨詢:(1)專家積極系數(shù)為100%,專家個人權威系數(shù)在0.825～1之間,整體權威系數(shù)為0.91。(2) ICU護理人力資源配置現(xiàn)狀調(diào)查表包括醫(yī)院基本情況(3個條目)、病區(qū)基本情況(4個條目)、護士長基本情況(7個條目)、護理人員基本情況(9個條目)和護理員基本情況(4個條目)五部分內(nèi)容。(3)ICU護理項目框架分為直接護理項目框架(三個一級指標共98項直接護理項目)、間接護理項目框架(63項間接護理項目)和個人活動項目框架(3項個人活動項目)。2.護理人力資源配置現(xiàn)狀:(1) ICU實際床護比為1:1.83。(2)護理人員休息系數(shù)為1.398。(3)護理人員年齡多集中在26～30歲,占57.14%。(4)工作5年以下的護理人員占26.19%。(5)護理人員高、中、初級職稱之比為0:14.29:85.72。(6)護理人員學歷以大專和本科為主,分別占47.62%、52.38%。(7) 42名護理人員中,有男護士 5人,占11.90%。(8)編制內(nèi)、編制外護理人員所占比例分別為28.57%和71.43%, 2013-2015年,編外護理人員離職率為4.65%,無編內(nèi)護理人員離職。(9)護士長職稱及學歷仍有提升空間。(10)護理員均為中年女性,文化素質較低。3.護理工作量測定和配置模型建立:(1)最耗時的直接、間接護理項目分別是血液透析和書寫危重患者記錄單。(2)與靜脈輸液相關的護理項目操作頻次較高、耗時較多。(3)不同工作日患者人均所需直接護理工時、間接護理工時、個人活動工時無差異。(4)患者白班所需要的人均直接護理工時、人均個人活動工時大于夜班。(5)直接、間接護理工時和個人活動工時占總工時的比例為55.25%、36.46%、8.29%,間接護理工時較高。(6) ICU理論床護比應為1:3.2,護理人員處于超負荷工作狀態(tài)。(7) TISS-28評分越高,患者所需直接護理工時越多。(8)直接護理工時與TISS-28評分的Pearson相關系數(shù)r=0.811,具有正相關關系。(9)護理人力資源配置數(shù)量與TISS-28的模型為:1所需護士人數(shù)=(?)(42.5×TISS-28i- 124.3)/286.12 ,式中,TISS-28i 為第 i 個患者的TISS-28評分,n為患者總數(shù)。[結論]1.隨著社會的發(fā)展,患者對護理服務的要求在提高、需求在增強,護理項目的數(shù)量也在不斷增加,且不同�？频淖o理項目框架也有差異,因此,很有必要界定ICU的護理項目框架。2.通過德爾菲專家咨詢法構建的“ICU護理人力資源配置現(xiàn)狀調(diào)查表”和“ICU護理項目框架”具有代表性和有效性,可用于現(xiàn)況調(diào)查和護理工時測量。3.云南省某三級綜合醫(yī)院中心ICU護理人力資源配置存在一定的問題,需要管理者增加護理人力資源配置數(shù)量,優(yōu)化護理人力資源配置結構,明確護理員準入條件,實施護理員團隊化管理,進一步提高護理隊伍的整體素質,更好地為患者服務。4.對單個護理項目工時的測量可凸顯ICU�？铺攸c。ICU患者每日所需護理工時無差異,管理者不應盲目減少節(jié)假日排班人數(shù)。ICU白班護理工時大于夜班,夜班排班人數(shù)可少于白班。5.護理人員處于超負荷工作狀態(tài),加強護理人員培訓,以質量替代數(shù)量,同時采取彈性排班方法,能在一定程度上緩解護士的超負荷工作狀態(tài),而根據(jù)病區(qū)護理工作量編配合理的護理人力資源能從根本上解決問題。6.基于治療干預評分系統(tǒng)-28 (TISS-28)和護理工時測量構建的ICU所需護理人員數(shù)量與TISS-28評分之間的數(shù)學模型可有效、簡單、快速地測算ICU所需護理人力資源數(shù)量,便于管理者根據(jù)護理工作量對護理人力資源進行動態(tài)管理,以更好地為患者提供及時、準確、安全的護理服務。
[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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R47

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