Research On Weighted Nursing Workload Measurement Method In Third-Grade Class A Hospitals

[Objective]The purpose is to construct a domestic weighted nursing workload measurement method based on the average hours?the technical difficulty of nursing items and the care difficulty of patient,and to form a formula and correction library for the nursing workload,to provides ideas for clinical to quantify nursing workload reasonably.[Method](1)Based on literature review,drawing on foreign indicators,combining with the current research status and clinical practice of nursing workload in China,a preliminary framework of weighted nursing workload measurement methods was established in china third-grade class A hospitals.(2)Based on the results of field investigations conducted by the research team at six hospitals in the eastern,central,and western parts of the country in the early stage,the included nursing operation items were determined according to the screening criteria and the average hours of the included items were calculated.(3)Delphi method and Analytic Hierarchy Process were used to construct a technical difficulty evaluation index system for nursing operation items,and to evaluate the technical difficulty coefficient of the included items according to the formed evaluation system.(4)The "Difficulty Evaluation Scale for Nursing Care of General Adult Ward Patients"developed earlier by the research team was used to investigate the care difficulty of eligible patients at four levels in 12 departments of a third-level general hospital in Nanjing from March to August 2019.(5)Based on the average hours?the technical difficulty coefficient of nursing items?the care difficulty coefficients of patients at all levels,a weighted nursing workload correction formula and correction coefficient library for third-grade class A hospitals were constructed.[Result](1)Results of include items and items average hours:A total of 175 items that meet the criteria were selected,including 31 basic nursing items,13 condition observation items,57 basic treatment items,51 specialized nursing items,and 23 traditional Chinese medicine nursing items.The average hours of 175 items ranged from 1.07 to 62.02min.(2)Results of technical difficulty evaluation system for nursing items:After two rounds of Delphi with 30 experts,the enthusiasm of each round was 100%.The authoritative coefficients of the two rounds were 0.922 and 0.910,and the coefficients of variation were 0.159 and 0.108.Four dimensions of operation skill complexity,operator requirements,operation load intensity,and operation risk,and the introduction of each dimension were established.The weights of each dimension were 0.3449,0.2201,0.2264,and 0.2085.(3)Results of technical difficulty coefficient for each item:After 2 rounds of inquiry with 30 experts,the enthusiasm of each round was 100%.The authority coefficients of the two rounds were 0.907 and 0.900,the coefficients of variation were 0.315 and 0.169,and the technical difficulty coefficient range was 0.36?1.67.(4)Results of the care difficulty of patient:A total of 384 patients in 12 departments were surveyed,including 82 special-grade patients,101 first-grade patients,101 second-grade patients,and 100 third-grade patients.The average care difficulty of special-grade patients was 1.62,the average care difficulty of first-grade patients was 1.27,the average care difficulty of second-grade patients was 0.81,and the average care difficulty of third-grade patients was 0.43,and the difference in nursing care coefficients between groups was statistically significant(P<0.05).Among the 6 dimensions of the scale:the differences between the disease severity,self-care ability,mental status,and social support were statistically significant(P<0.05),compliance and expected value dimensions were no significant difference(P>0.05)(5)The mathematical correction formula for the weighted nursing workload in third-grade class A hospitals was formed from the perspectives of patients and nurses and a workload correction coefficient library covering 175 items in five categories was initially constructed.[Conclusion](1)Average hours of nursing itemsThe included items were selected on the basis of surveys in 6 hospitals across the country with good comprehensiveness and representativeness.The average hours were nationwide multi-center large sample average working hours data measured under the rigorous research design and strict quality control.The data is scientific and accurate,and has strong clinical popularization(2)Technical difficulty coefficient of the itemsBased on mature system,the technical difficulty evaluation system of the nursing operation items constructed in this study is updated and improved.It is more in line with the changes of modern clinical nursing,more scientific and clinical applicable.The technical difficulty coefficient of 175 items obtained on this basis is scientific,reasonable and clinical applicable.(3)Care difficulty coefficient of patientsIn this study,the care difficulty of patient was combined with graded nursing,which is reasonable and practical.The scores of patients of different grades in each dimension provides guidance for clinical nursing workers to carry out targeted nursing.(4)Calculation method of weighted nursing workload in third-grade class A hospitalsThe weighted nursing workload correction formula from the perspectives of patients and nurses are simple and easy to calculate,with a wide range of application and the nursing workload correction coefficient library is comprehensive and practical,which is conducive to workload statistics in clinical scientifically and comprehensively,and is conducive to performance evaluation and salary distribution fairly and reasonably.