| [Objective]In this study,we constructed a scientific and objective evaluation system of nursing workload,investigated nursing workload and patients' perception of nursing quality,analyzed the current situation of nursing workload and patients' perception of nursing quality,and explored the internal relationship between the two,so as to provide reference for guiding clinical rational allocation of nursing manpower and improving patients' nursing quality.[Method]?Based on the theory of human factor engineering,expert letters and questionnaires were developed through literature review,group discussion and expert interviews.The evaluation system of nursing workload was constructed by expert letters and the weight of each evaluation index was established.?151 day shifts in general surgery ward of Nanjing Hospital of Traditional Chinese Medicine from July 2018 to August 2018 were investigated by random sampling method.Simple Clinical Score,Barthel Index,TimeCat software,National Aeronautics and Space Administration-Task Load Index and Perceived Nursing Service Quality evaluation scale were used to evaluate all duty nurses and inpatients in the day of study.Investigation and questionnaire survey were conducted to evaluate nursing workload and perceived nursing quality status of patients.?Based on the four dimensions of perceived nursing quality assurance,responsiveness,care and reliability,the relationship between nursing workload and perceived nursing quality was discussed through curve fitting,correlation analysis and regression analysis.[Result]?In this study,21 experts were questioned by expert inquiry method for two rounds.The effective recovery rate of the questionnaire was 100%.The authoritative coefficients of experts were 0.900 and 0.868,and Kendall's coordination coefficients were 0.476 and 0.492,respectively.Finally,the evaluation index system of nursing workload includes four first-level indicators:patient factors,Department factors and nursing activity factors,nurses'own factors,11 second-level indicators and 4 third-level indicators.?Nursing workload evaluation results showed that the 7 sensitive indicators selected were weighted and the formula for calculating nursing workload was as follows:nursing workload?0.215*severity of illness?0.1334*self-care ability+0.1480*operation number+0.1115*admission number+ 0.1463*direct nursing time+ 0.1004*language communication time?0.1459*psychological load.?Nursing workload status survey showed that the reliability and validity of the task load index scale were good(Cronbach's alpha = 0.816,item load value = 0.815-0.932);the longest time-consuming of nurses in various nursing activities were nursing document management(34.27%)and direct nursing(26.72%);the average number of interruptions in nursing work was(4.51 +1.65)times/hour,and the main source of interruptions was work.For family members,environment and nursing colleagues,the average nursing mult-tasking time per shift was(15.70+2.28)%.The multi-tasking situation mainly occurred in communicating with patients,nursing colleagues and family members while carrying out other nursing activities.About half of the behavior activities lasted less than 1 minute.Nurses had different workload at different time in a week(P<0.05).?The analysis of the status of perceived nursing quality of patients showed that the reliability and validity of the questionnaire were good(Cronbach's alpha=0.972,item load?0.649-0.927);the total score of perceived nursing service quality was(118.70 + 20.53),and the score index was 81.86%.The scores of each dimension from high to low were:assurance,reliability,caring and responsiveness.?The relationship between nursing workload and perceived nursing quality of patients was found:nursing workload and perceived nursing quality of patients presented an inverted U-shaped distribution relationship;nursing workload was negatively correlated with perceived nursing quality of patients(r=-0.177,P<0.05),and negatively correlated with assurance(r=-0.250,P<0.01),responsiveness(r=-0.359,P<0.01),and caring.There was a significant positive correlation(r=0.207,P<0.05),but no correlation with reliability(r=-0.120,P>0.05);the number of surgical patients had a significant negative predictive effect on perceived nursing quality(B=-0.906,P=0.009),responsiveness(B=-0.675,P<0.001),and the number of admissions had a significant positive predictive effect on perceived nursing quality(B=0.388,P=0.010).[Conclusion]?The evaluation index system of nursing workload constructed by expert inquiry method includes 4 first-level indicators,11 second-level indicators and 4 third-level indicators.The index system comprehensively considers the subjective and objective evaluation items,covering a comprehensive content,strong operability,and has great practical guiding significance.?Conclusion of nursing workload evaluation:7 sensitive indicators selected are given weight to get the formula of nursing workload calculation.The formula index covers the key content of the workload,can reflect the clinical nursing workload,and has strong operability and clinical practical value.?Conclusion of nursing workload status:nursing work mode based on time-action method and TimeCat software has significant advantages,which can clearly understand the time allocation,working characteristics and workflow of nurses;direct nursing time of nurses is less,the functional needs of patient-centered are not fully reflected;nursing work of nurses is busy,interruption and multi-tasking occurs more frequently.Nursing workload was regular in a week.?Conclusion of patients' perception of nursing quality status:the perceived nursing quality of patients is above medium level,and the overall perceived quality is better.The order of dimensions is assurance,reliability,care and responsiveness.It suggests that priority should be given to the improvement of response and care perceived nursing service quality on the basis of assurance and reliability.?There is an inverted U-shaped relationship between nursing workload and patients'perceived nursing quality,too small or too large workload will reduce the perceived nursing quality,and there is an optimal workload state to make patients' perceived nursing quality reach the peak level;nursing workload is negatively correlated with patients'perceived nursing quality as a whole,and the number of surgeons has a negative predictive effect on patients'perceived nursing quality.The number of admissions had a positive predictive effect on patients'perception of nursing quality.?Based on the results of data analysis,combined with the current situation of nursing workload and patients'perception of nursing quality,this paper puts forward some suggestions to alleviate nursing workload and improve patients'nursing quality. |
PDF Full Text Request