| AimThere are many research reports about nursing quality evaluation system.Howver,the nursing evaluation system at present mainly focuses on evaluation of basic nursing quanlity and outcome of nursing quality while ignores the non-technical aspects of nursing care, which does not match the development of nursing profession.With the development of nursing science,the connotat ion and denotation of nurs ing has developed,as well as the nursing workload has been increasing.In the hospital, nursing workload varies in different departments.It is easy to know that heavier the workload is,the less qualified the nursing quality is likely to be.If nurses' performance at a ward is evaluated completely by nursing quality,it is unfair to the nurses who work at the departments with heavy workload.But if nurses' performance is evaluated completely by nursing workload,the nurses will be misguided to perform more nursing tasks,while the nursing quality is ignored,and it leads to low level patient satisfaction.Therefore,in order to comprehensively evaluate nurses' work,it is necessary to establish a comprehensive evaluation system considering both nursing workload and nursing quality.The aim of this research is to establish a comprehensive evaluation system which can guarantee patients' safety and improve nursing quality.Meawhile,it can embody the fairness in the management so as to motivate nurses to maintain high working efficency.MethodsMain methods used in this research are as following:1.Literature review.Extensive literature study was done by searching articles and books on different databases.The researcher have analized the relevant information about nursing quality management nationally and abroad,and thus make clear the problem to be solved in this study.2.Expert consultation.The baseline survey was shaped through panel discussion, expert consultation and brain storming method.3.Questionnaire.Three questionaires were designed by the researcher and used in this study.They were Nurses' Professional Attitudes toward Profession,Nurses' job satisfaction, Patient satisfaction with Nursing Care,4.Statistic analysis.The data collected were analysed in Excel and SPSS 13.0 statistical package.The statistical methods used in this research are multiple linear regression, Chi-square test,t test,one way ANOVA,and Pearson correlation.Main results1.The concept of nursing was redefined and role of some theories in the nursing evaluation was clarified.Based on the nursing practice and literature review,the connotation and the charatcteristics of nursing were analysed.The definition of nursing at present was reconsidered.The nursing is redefined as following:nursing is that nurses who have nurse license provide professional help to people to recover from disease or to take part in activities good for health,and it is a kind of invisible service.According to this definition,nursing contains two attributes:one is the technical attribute,the technique activities provided by nurses,such as delivering medication according to the physician's order,assiting physicians to carry out tests,etc;The other is the service attribute,for example,nurses having good attitudes toward patient.Meanwhile,roles of relevant theories in quality evaluation were analized based on literature reivew.The establishment of comprehensive evaluation system was based on the system theories.Continuous quality improvement theory and performance management theory were applied in the measurement of nursing workload and the re-establishment of nursing quality evaluation system.2.The results of the empirical study on nursing quality management. Through retrospective analysis on the nursing quality control results in a Level 3 hospital,it showed that the current outcome-oriented nursing quality evaluation has advantages on standardizing nursing operation behaviors and improving nursing skills.But it also has some disadvantages,such as not reflecting the service attribute of nursing,ignoring total staff,total process management,iadequate attention to economics and not encouraging staffs to achieve zero defects.Questionnaires were used to measure patients' satisfaction with nurses' performance.It was found that patients were satisfied with nurses' etiquette and their attitudes,but they were not satisfied with their initial service awareness.Results also indicated that the explanation before and after nursing activities and the frequency of nurses' ward rounds are the factors influencing patients' satisfaction.The reason for the results above may be the heavy nursing workload for nurses,leading to the lack of time and energy to do explanation to patients.The investigation on nurses' professional attitudes and their job satisfaction showed that nurses had good professional attitudes while their job satisfaction was relatively at low level. The most unsatisfied aspects were about welfare and the balance between family and job. Nursing professional attitude is positively related to their job satisfaction.Questionnares were sent to nurse to collect their opinions abour present nursing quality management.The result showed that nurses were willing to take part in the nursing quality management,and they really have valuable suggestions about quality management.It indicates that the nursing quality can be improved ultimately as long as nursing management system is scientific and fair.3.Setting scope of nursing care activity and measurement of nursing workload. All nursing activity items collected from 47 clinical units were categorized.There were 75 basic nursing items,in which there were 47 direct nursing care items and 28 indirect nursing items.There were 151 specialized care items,in which there were 125 direct nursing care items and 26 indirect care ones.Among indirect nursing care items,10 items in basic nursing care and 7 items in specialized nursing care belong to nonprofessional nursing care.The nursing workload per nurse day has been measured for the past 3 years.The results showed that there were no significances statistically in nursing workdload per nurse day among the medical,surgical,gynaecology and obstetrics,pediatric,emengency,oncology departments(P＞0.05).4.The nursing quality evaluation stardard has been established based on the "structure-process-outcome" theorectical framework.With the concept that nursing has both technique attribute and service attribute,a new nursing quality evaluation stardard has been established based on the "structure-process-outcome" theorectical framework with the reference of continuous quality improvement theory.The new standard has 4 domains:environment,nurses,nursing quality, and patients.Each domain contains structure,process,outcome standards.With experts consultation,the weight factors of the 4 domains are 0.1100,0.1180,0.4800,0.2300 respectively.The whole nursing quality standard system was established.5.The comprehensive evaluation system has been established.Nursing workload was calculated in hours,and is a dynamic data.The standard value of it was set down by median parallel moving method.With the consideration of nursing profession,nursing workload was graded at different levels,and has a standardized score accordingly.With experts consultation,the weight factors of nursing workload and nursing quality in the nursing evaluation system are 0.4 and 0.6.Finally,a comprehensive evaluation system considering both nursing workload and nursing quality was established on the basis of nursing workload score,the nursing quality score and their weight factors.Suggestions1.Nurses and their managers should acknowledge the service attribute of nursing so as to provide a high quality service to patients.The acknowledgement of the service attribute of nursing affects the nursing management. As long as the connotation of nursing is recognized,the ideas of nursing quality management can be matched to the development of nursing,adapting to the "patientcentered" healthcare.2.Nursing quality evaluation should be patient-centered and nursing management should be nurse-oriented.Heavy nursing workload is a main stressor for nurses.Nurses can't provide the expected knight service to patients due to limited time and energy caused by inadequate staffing.Therefore,it is strongly suggested that hospital administrator take enough considertion on nurse staffing level instead of considering too much on decreasing hospital cost by restricting the recruition of nurses.3.Nursing quality evaluation system should be established in the viewpoint of_different angles with the consideration of the whole nursing service process.Nursing quality is influenced by different factors,such as hospital system,staffs,environment,infrastructures, manpower allocation,etc.In order to achieve the goal of comprehensive nursing quality management,nursing quality evaluation system should be established in the viewpoint of different angles with the consideration of the whole nursing service process.4.Nursing evaluation should be carried out on the basis of comprehensive evaluation, considering both nursing workload and nursing quality so that it can reflect the fairness in the management.The new comprehensive evaluation system takes into account of nursing workload,the impact of which is showed as its weight factor in the system.The comprehensive evaluation system shows up the fairness in the management which denies the opinion that the less work it is done,the less mistakes it is likely to be made.Taking consideration of nursing workload into the evaluation system can encourage nurses to work initiatively and to improve their working efficency.Innovations of this study1.This study has ascertained the scope of nurses work and quantified nursing workload, so it has solved the problem that nursing workload is hard to meaure;2.A new nursing quality evaluation system fitting for the nursing management at present has been established in this study;3.A comprehensive evaluation system considering both nursing workload and nursing quality has been established.The results got from the comprehensive evaluation system can serve as reference to evaluate performance of individual nurse and care unit;it can also serve as a criteria for nurses' promotion,awarding and nurses' bonus.Furthermore,it provides important evidence for reasonable nursing manpower allocation.Deficiencies of this study1.The samples used in this study were collected in only one hospital.Samples should be collected in more hospitals to explore the status of nursing quality evaluation.2.The comprehensive evaluation system established in this study needs to be tested and improved in the clinical nursing management.
|
PDF Full Text Request