An Investigation On Nursing Grading Status Of Pension Agency In Guangzhou

BACKGROUND:The aging of the population has become a global problem in 21st century.It is the largest aging population country in China.According to the fifth census data shows that the country's population aged over 60 reached 130 million,accounting for 10.2%of the total population.It is a huge elderly population and the rapid development of aging,aging in advance of modernization in China's aging population.At present,a family-based old-age care in our country,community care and pension institutions coexist.But with the aging of the population,small household consumption structure and diversified development,traditional home care services increasingly weakening,"4-2-1" family structure will become the main mode of family structure,a family has to take care of four elders,to care the elder has appeared to be inadequate,thus the role of community care and pension institution care have become increasingly important.According to the statistics in January, 2005,the pension institutions have reached 182,and 18,014 beds in Guangzhou City. Therefore,how to improve the quality of care the elder in the pension institutions are increasing becoming a nurse managers should explore and study the issue.Clinical classification begins in China in 1956,which is an important element of hospital care management.Nursing grading is based on patient care priorities illness and the patient's own ability to assess,given special,one,two,three nursing. Because of objects and the contents of care different,clinical care and disease classification do not apply endowment institutional care classification characteristics. Because of this,It is necessary to understanding the endowment care classification status of implementation.But the elder care sector research started late in our country,institutional care for the old-age classification in question is more rarely. Although,on February 6,2001 issued by the People's Republic of industry standards, "the elder welfare organizations basic norms ".According to the elder and the ability to take care of themselves in daily life,the eder divides into self-care for the elder(General caregiving),Interleukin help the elder(half caregiving),referrals for the elder(all caregiving),but so far,Many old-age care sector classifications are very flexible,endowment is only part of the institutions required by the adoption of elder care in varying degrees,into specialized care,one,two,three categories of care; Some pension agencies implementation of the grading standard is basically its own or care for the elder have no basis.Overall,the current old-age care institutions grade classification problems are insufficient grading standards,care classification as a single,not embrace the basic needs of the elder,main content of the performance is only in the basic daily care and general medical care,about their psychological and mental health concerns are less,the basic content is not consistent with modern medical model requirements.Therefore,in the past at home and abroad on the basis of in-depth research endowment care classification,for accelerating the professional management of pension institutions,pension norms care market,the promotion of social welfare and aging cause of health development,undoubtedly have important practical significance and long-term significance. OBJECTIVES:We survey various types of pension on the current situation in institutional care classification in Guangzhou,assessment of differences in levels of care,Aged care pattern from abroad for analysis,identify problems and put forward reasonable proposals.and improving the pension sector classification system to identify different types of nursing services,to provide more accurate classification of nursing care was classified for pension agency in Guangzhou,to provide a more scientific basis for classification for the implementation of old-age care organizations in Guangzhou.To further explore the development of China's old-age model for clues and body care based on classification.SUBJECTS:One hundred ninty-four old adults and one hundred thirty-eight nursing staff were surveyed from May to December 2006 in three pension institutions in Guangzhou.The older age were 60～102 years old,The average was 80.65±8.57 (Mean±SD)years old.Including 64 male cases and 130 female cases,and the percentage of them are 32.99%and 67.01%;Nursing staff including 22 males (accounting for 15.94%)and 116 females(accounting for 84.06%)ranged 23 to 50 years-old.METHODS:A cross-sectional study was used in this study and was to facilitate the sampling, " The nursing staff's recognition of classified nursing items "," The nursing-graded elders's recognition of classified nursing items "and"The standards of grading and nursing content classification in Guangzhou ",Barthel Index were used to survey the elders and nuring staffs.Prevalence survey from two aspects,on the one hand,the nursing staff's recognition was knowledge of classified nursing in pension institutional,including the nursing staff's recognition of classified nursing items and the cognitive of the relevant factors affecting cognitive for the nursing staffs.On the other hand,the subjects of investigation were nursing-graded elders' recognition for the nursing satisfaction,including of the main needs for the nursing-graded elders,the elders' satisfaction to the nurses and related factor analysis and so on.SPSS11.5 software was used,main methods for statistical analysis,statistical methods of analysis:descriptive statistics.x 2 test,analysis of variance,multiple linear regression analysis,correlation analysis,factor analysis.RESULTS:1.The reliability and validity of the ScalesThe questionnaire used in this study is formulated eventually based on the expert advice and the results of the pre-survey conducted,after a thorough literature review. The re-test reliabilities of the nursing workers' recognition of the importance of classified nursing items,the main needs of the caring-graded elders,the satisfaction level of the caring-graded elders,and the internal correlation of the satisfaction items are 0.605,P=0.005;0.665,P=0.003;0.943,P=0.000;0.495,P =0.037 respectively, which shows that the two tests of the questionnaire have a relatively high consistency, and the questionnaire has good re-test reliability;Meanwhile,correlation analysis and factor analysis indicates that the questionnaire has good structure validity.2.The nursing staffs' recognition of classified nursing items2.1 General information of the nursing staffsThe demographic data of nursing workers from three resthomes show that there is a significant difference(P＜0.05)for the nursing years,while it is statistically insignificant(P values are 0.525,0.239,0.184 respectively)for the difference of age, gender,and education level of the nurses.The average age of 38.53±5.66 years(mean±SD)with 50 year old as the oldest;Female is predominated the population with a percentage 84.78%;and this population has lower levels of education,among which primary and secondary school graduates accounts for 84.78%.2.2 The statistical results of a total of 138 nursing workers surveyed show that they have a higher recognition for nursing classification(68.8%),the bases of nursing classification(54.3%),and the whole attendance(inter-nursing)(94.9%),while they have a lower recognition for the remaining items.Nursing workers with different nursing years and different educational levels have no significant difference(P＞0.05) for 4 grades,the standards and the bases of nursing classification.2.3 The cognitive on the classification of items need care for the nursing staff,except n12,n13,n19,the rest were equally divided among more than four hours,the maximum is 4.38±0.569.Different years(except n5,n25,n26),educational level (except n1,n3.n8)for the classification of nursing projects need of awareness,there was no significant difference(P＞0.05).3.Statistical analysis of the nursing-graded elders3.1 General information of the elders living in the resthomes,ages of 80 year old and above accounts for 58.8%;education level of primary schools and below is 80.9%,among which 45.9%are illiterate;63.4%of the elders have one or more chronic diseases such as hypertension,coronary heart disease,diabetes,chronic bronchitis;56.2%of the elders have a total monthly income of more than RMB800 yuan;62.9%of the elders are satisfied with the level of care and support from their families and the community;79.3%of the elders have no spouse.In summary,the elders surveyed are characteristic of lower education level,older age,and better economic conditions and family and social support.3.2 The nursing-graded elders' recognition for the nursing classificationFor the 194 elders surveyed,only 15 people(7.7%)know the nursing classification;and 81 people(41.8%)know their own nursing grades;but there are 146 people(75.3%)don't know the specific content of nursing of their own grade.It shows that the elders from three resthomes are at the low level of recognition for the nursing classification.3.3 Main needs of the nursing-graded elders and their factor analysisThe caring need ranked foremost for the elders is visits of their family members or friends,the need of communication and spiritual/cultural life come in the next place.Among the eight variables affecting needs,gender and occupation were the most closely related factors affecting the needs of the elders.The regression equation was Y=31.878-1.402X2+0.431X6.3.4 The elders' satisfaction to the nurses and related factor analysisPsychological counseling and psychological care are the lowest score(2.68±0.770).the highest score(3.62±0.666).which was shown that pension agency nurses score lower grades care of the elder;Multiple stepwise regression analysis showed that chronic was the most closely related factors affecting the satisfaction of the elders.The regression equation was Y=50.291-2.491X5.3.5 The scores of nursing satisfaction mostly concentrate in the 41 to 50 with a percentage of 54.1%;and scores of and above 51 are in the next place with a percentage of 29.9%;scores of extremely dissatisfaction is less,only accounting for 3.3%.Demographic data on satisfaction score are no significant difference(all P are greater than 0.05).Multiple regression analysis shows that the factor affecting satisfaction most is the chronic history.3.6 Assessment on three nursing classifications Classification correlation of doctors' advice,standard,and Barthel Index is x2=17.100,P=0.002.The difference of three nursing classifications is of statistically significance;correlation of doctors' advice and standard is of significant difference(x2=8.763,P=0.013);correlation of doctors' advice and Barthel Index is also of significant difference(x2=12.887,P=0.002);while correlation of standard and Barthel index is of no significant difference(x2=3.487,0.175).CONCLUSIONS:1.The questionnaire has good reliability and validity,which can be used to find out the nursing workers' and the classified elders' recognition to nursing classification, the elders' main needs,classified nursing items and the elders' satisfaction to the nursing cares.The questionnaire covered all the items to be tested,which can be referenced to assess the elders and the nursing workers from resthomes.2.The nursing workers have a lower level of recognition of nursing classification.It should be a very important part of the vocational training for nursing practitioners to enhance the recognition level of nursing classification.3.The nursing-classified elders have a lower level of recognition of nursing classification,and this problem can be resolved by enhancing the nursing workers' recognition of nursing classification and strengthening4.The caring need ranked foremost for the elders is the affective dependence to offspring,kinfolks and friends,the needs of communication with people and spiritual/cultural life come in the next place.It shows that caring the psychological side and enriching the spiritual and cultural life of the elders should be emphasized, besides giving the necessary attendance of ordinary life to the elders in such a relatively closed environment like resthomes.5.The two variables,gender and occupation,are the most important factors for the needs of the elders,among which,the male elders have more needs than female, while the intellectual elders have more needs than others.6.The survey of the elders' satisfaction to the nursing cares shows that, psychological consultancy and care have the lowest scores,which is consistent to the results of need survey of the elders.The elders want more psychological care.The chronic history is the most closely related to the satisfaction the elders,for example, the elders with chronics have lower satisfaction.Therefore,it is of great importance for the elders' life to provide regular medical care,observe the elders' health status dynamically,guide functioning exercises,and provide pertinent health education according to the psychological character of the elders.7.The assessment for three nursing classifications provides an accurate method of nursing evaluation for the elders from the resthomes.This paper suggests that Barthel Index classification should be regarded as a good supplement to the current standards of nursing,which can greatly improve the current standards of nursing classification system,and may improve the Guangzhou nursing classification system at the same time,based on "people-oriented" philosophy,human management and human caring is taken as example from the developed countries.