The Construction Of Hierarchical Model Based On The Three-dimensional Nursing

Objective:To establish a three-dimensional nursing hierarchical model based on the disease severity, daily life self-care ability, psychological reaction degree; To build auxiliary software modules for the project research that patients personalized care plan can be automatically generated; To provide the basis for specification and implementation of grading nursing system; To provide a reference for the rational allocation of nursing human resources; To provide evidence for nursing charge standard.Methods:Using the method of Delphi expert enquiry on the basis of literature review, survey and semi-structured interview to explore the feasibility of three dimensional independent classification of grading nursing for observation, life care, psychological care. including choose the illness severity evaluation questionnaire, life self-care ability evaluation questionnaire, the journal psychological reaction condition evaluation questionnaire. Enquiry different levels of nursing experts to write the content index system. Constructing auxiliary software modules for project research, build three dimensions of grading nursing mode information system platform. Using SPSS16.0statistical analysis. Statistical methods include statistical description, McNemar-Bowker Test,Kappa test.Results:1) Some of the patients and their families think there are a series of problems for the current grading nursing, mainly including nursing level is not consistent with the patient actual demand (33.5%), make it difficult to implement grading nursing measures in place (36.4%), grading nursing is not reasonable, lead to medical disputes (20.5%), improper care for grading nursing level (16.9%) and nurses nursing charge is not consistent with pay (39.7%).2) Patients needs sorting order:treatment, condition monitoring, psychological nursing, health education and life care.3) It found that anxiety in patients with suspected and incidence of certainly exist was32%, depression was29.7%, while the existence of anxiety and depression,9.8%of patients, high incidence of anxiety and depression in hospitalized patients. 4) The results of doctors’and nurses’judgment with double blind method according to the standard of grading nursing for the patients with the same classification differences, indicates that the doctor group judgment level of nursing and nurses usually judge the nursing level of consistency (P value for kappa value was0.724,0.000), the doctor set judgment level of care of the nurses group judgment result is on the high side.(McNemar test value of61.681, P value is0.000).5) Doctors’judgment according to the current class nursing standard and evaluation scale judgment nursing level comparison results show that: compared with the MEWS score method to judge the nursing level of consistency is poor (P value for kappa value was0.022,0.199), the doctor determine the nursing level of the MEWS grading method is a nursing level on the high side (McNemar test value of352.808, P value is0.000). Compared with ADL score method to judge the nursing level of consistency is poor (P value for kappa value was0.009,0.374), the doctor determine the ability to care for patients with a ADL score method to determine the patient life self-care ability is low (McNemar test value of568.295P value is0.000).6) Delphi method enquiry for two rounds of expert positive coefficient were90.00%and96.30%respectively; There were eight, two experts put forward the constructive Suggestions, accounted for29.63%and7.69%.7) The Delphi method in the enquiry for two rounds of consulting authority coefficient of0.81and0.83respectively.8) The Delphi method in the enquiry for two rounds of consulting primary index coefficients were0.74,0.79, and coordination; Secondary indexes coordination coefficient were0.63,0.69, P values were less than0.01.9) Formed after two rounds of consulting the expert consensus, finally constructed based on disease severity, daily life self-care ability, psychological reaction degree on the basis of three-dimensional nursing model classification10) Research developed to illness severity, daily life self-care ability, psychological reaction degree on the basis of three-dimensional nursing grading software modules. Conclusion:1)The current grading nursing system exists a series of problems, and severity, self-care ability and mental state should be the most important factors in making level of care. Doctors and nurses should both participate in the decision-making of level of care.2) It can not be ignored the high incidence of anxiety and depression in hospitalized patients, psychological care is very important.3) Determining the level of care based on the disease condition, life care, psychological care is more scientific and objective than the subjective judgment of the doctors.4) By Delphi method to write to determine the condition observation, life care, psychological care patient classification of three dimensions and at all levels of the corresponding nursing content and frequency, and to provide a basis for clinical nursing quality standards.5) Using the objective scales to evaluate the patient’s condition, self-care ability and mental status, and with supporting software platform that can efficiently and accurately capture all kinds of information related to the patient, the precise statistical inquiries quickly and efficiently determine the level of patient care and get the appropriate recommend-ations about the conten and frequency of care.