| Objective:1. To establish a comprehensive evaluation model of the nursing manpower cost with the aim of truly reflecting the labor value of nursing care.2. To analyze the influencing factors of nursing workload at nursing skill level with the purpose of controling these factors effectively when nursing manpower costs are accounted.Method:1. This article adopts the methods of documentary analysis and Delphi method to analyze the labor characteristics of nursing care. And applied descriptive statistic analysis and corresponding analysis through SPSS13.0software.2. Adoptting Delphi method and the comprehensive evaluation method to build the comprehensive evaluation model of the nursing manpower cost. And applied descriptive statistic analysis and corresponding analysis through SPSS13.0software.3. Using the comprehensive evaluation model of the nursing manpower cost and a relative cost method to preliminary assess the manpower costs of12basic care services and60specialist care services. And applied descriptive statistic analysis and corresponding analysis through SPSS13.0software. Computing the nursing manpower costs by Excel software.4. Questionnaire method and Delphi method were used to analyze the factor structure of nursing workload at single nursing care. The scale was adapted according to literature review and survey.①To preliminary analyze the indicators of the factor structure of nursing workload at single nursing skill level. We used this questionnaire to investigate1097nurses from9upper first-class general hospitals. An exploratory factor analysis was used to identify the factor structure(n=945), and a confirmatory factor analysis was conducted to validate the factor structure by Linear Structural Relations8.7(n=152) to preliminary analyze the indicators of the factor structure of nursing workload at single nursing skill level.②The Delphi method was used to confirm the final factor structure of nursing workload at single nursing cares, and the Delphi consultation was sent to22experts from14provinces. Questionnaire reliability was analyzed by internal consistency, Cronbach’s alpha coefficient and test-retest reliability test. The validity of the questionnaire was analyzed by content validity and construct validity analysis. The content validity was analyzed by expert assessment of CVI coefficient and the Pearson correlation coefficient test, The construct validity was analyzed by the software of SPSS13.0and software LISREL8.7.Results:1. Results of the labor characteristics of nursing care(1) Consultation results of the labor characteristics of nursing care. The performance of the labor characteristics of nursing care has certain risks and labor intensity, needs certain technical skills, and nursing care is time consuming.3items can be used to judge the technical difficulty:the complexity of the nursing skill steps, the knowledge requirements for the operator and the operator’s decision-making capacity requirements.2other items can be used to judge the labor intensity of nursing services:the degree of physical exertion per unit time and the degree of energy concentration per unit time. Another2items can be used to judge the risk degree of nursing care:the probability of potential safety problems to the patient and the occupational exposure probability to the nurses. The means of the second class indicators in the three rounds of the consultation were2.91-4.78,4.41-4.89and4.41-4.91respectively.(2) The expert representative and the reliability of the consultation results. The study selected32nursing experts as the consultants, in which eight experts were in the field of nursing education and another24expers were from the fields of clinical nursing as clinical nurse specialists or clinical nurse managers. The experts come from Beijing, Shanghai, Guangdong, Zhejiang, Jiangsu, Hubei, Hunan, Sichuan, Henan, Hainan, Anhui and Xinjiang. Expert average age was (43.53±4.94) years old, and the average work experience was (23.22±5.42) years, and the average management year was (12.41±6.22) years.The positive coefficients of the experts in the three rounds of consultation were as follows:100%,84.38%and81.48%. And the coordination coefficients were:0.315,0.135and0.126. And P values were all less than0.01. The expert agreements in the three rounds of the consultation were81%,81%and86%respectively. The coefficient of expert familiar with the contents was0.86, and the coefficient of the expert judgment on the content is0.91, and the degree of expert authority coefficient was0.89.2. Results of the comprehensive evaluation model of the manpower cost of nursing care(1) The manpower costs of nursing care are caculated by this comprehensive evaluation model as follow:The Comprehensive Evaluation Model of the Manpower Cost of Nursing Care(score)=C×XnⅠ-1XnⅠ-2XnⅠ-3XnⅡ-1XnⅡ-2XnⅢ-2XnⅢ-2XnⅣ-1. Which, XnⅠ-1-XnⅣ-1is indicator of the comprehensive evaluation model of the manpower cost of nursing care; C was as a unit labor costs.The comprehensive evaluation model of the nursing manpower cost includs a four first class indicators and8second class indicators. Agreed with the expert-level indicators was100%, the assignment of the second class indicators mean minimum4.30, maximum4.83, average of4.60.(2) The expert representative and the reliability of the consultation resultsThe study selected40nursing experts as the consultants, in which6experts were in the field of nursing education and another34expers were from the fields of clinical nursing as clinical nurse specialists or clinical nurse managers. The experts come from different provinces. Expert average age was (44.35±5.30) years old, and the average work experience was (24.05±7.06) years, and the average management year was (12.75±5.83) years. The positive coefficients of the experts was100%, and the coordination coefficients was0.126(P<0.001), the expert agreements of the consultation was100%. The means of the second class indicators was4.30-4.83. The coefficient of expert familiar with the contents was0.86, and the coefficient of the expert judgment on the content is0.92, and the degree of expert authority coefficient was0.89.3. The initial measurement by the comprehensive evaluation model of the manpower cost of nursing careThe correction factors of traditional manpower cost results of the72nursing services:skin traction0.23, small splint fixation0.33, perineum scrubbing0.34, gypsum bandage fixation0.34, electronic fetal heart monitoring0.37, vaginal douche and medication0.46, nasal drops0.46, vulvar cold or hot compress0.51, nasal cavity irrigation0.53, throat spraying0.55, external drops0.56, external auditory canal irrigation0.65, infant Buttock nursing0.66, neonate umbilical nursing0.88, Intraocular pressure measuring0.99, oral nursing1, basal metabolic rate measuring1.03, postoperative functional exercise for breast cancer1.1, oral glucose tolerance test1.1, sponge bath in bed1.19, glucose monitoring1.19, continuous closed drain1.28, lacrimal passage irrigationl.29, conjunctival sac irrigation1.33, papillary invagination nursing1.36, blind enema1.37, T-tube drainage nursing1.57, maxillary sinus puncture and irrigation1.58, tuberculin test1.63, subcutaneous injection1.66, iodine-131absorption test1.68, gastrointestinal decompression1.71, peritoneal lavage1.78, intramuscular injection1.81, positional drainage1.9, vacuum sealing drainage2.0, skeletal traction2.09, sputum aspiration2.18, naso-biliary drainage nursing2.2, end tidal CO2monitoring2.21, intravesical instillation2.23, subconjunctival injection2.28, colon irrigation2.4, bladder irrigation2.55, tracheotomy nursing2.61, cleaning enema2.66, opening-producing anal dilation2.68, colostomy care2.69, intravenous infusion2.98, ventricular drainage nursing3.1, inferior turbinate submucosal injection3.14, retrobulbar injection3.16, gastric lavage3.45, indwelling catheter3.48, infusion via indwelling needle3.72, removal corneal foreign body3.74, infant enema3.98, neonatal caring Touches4.08, femoral vein blood collection for infants4.1, stomach-tube intubation4.25, peritoneal dialysis4.27, hyperbaric oxygen therapy for children4.45, transfusion through children’s scacp veins4.95, extirpation of lithiasis conjunctivae4.95, blood transfusion4.97, auripuncture5.18, breathing function exercise5.19, neonatal bathing5.2, hemodialysis5.33, infant congenital megacolon cleaning enema5.62, compression hemostasis via using three-channel double-balloon catheter13.26.4. The indicators of influencing factors of nursing workload at nursing skill level(1) Initially indicators of influencing factors of nursing workload at nursing skill level. The influnecing factors are4dimensions, including nursing risk、labor intensity、technical skills and time consuming. The amount of individual care services labor influencing factors initially identified. Exploratory factor analysis and obtained confirmatory factor analysis, influencing factors of the individual care services the amount of labor for four-dimensional structure factors for the risk of care, including three entries, primary care nurses care services disputes, the occupational exposure and patient care nursing risk of accidents; factors in patients with the disease, including four entries, the main contents of the patient’s disease severity, type of illness, self-care ability and degree of cooperation with; factors as operating environment, including three entries, the main content of care services the surrounding environment, whether or not advanced ward layout and care of tools; factor for the characteristics of the nursing services. Three entries, the main content of the technical difficulty of the nursing service project, the labor intensity and time. The overall Cronbach’s alpha coefficient for this questionnaire was0.827. The Cronbach’s alpha coefficients for the four factors were all above0.7. and the test-retest reliability of the questionnaire was0.831. A four-factor structure for nursing workload measurement at single nursing care was extracted, accounting for67.392%of the total variance. And the confirmatory factor analysis showed a good overall fit of this four-factor model, X2=78.32, df=59, X2/df=1.33, RMSEA<0.05, NNFI、CFI、IFI and GFI were all above0.90.(2) The factor structure of nursing workload at single nursing skill level Ultimately determine the amount of individual care services labor expert advice on the basis of impact factors for the four dimensions of the structure, which includes the four-level indicators (characteristics of the nurses, the patient’s condition, care services to the project’s characteristics and operating environment) and14two level indicators (the ability of nurses to communicate with patients, nurses, technical proficiency, the ability of the health education of nurses, the patient’s disease severity, patient self-care ability, the patient’s degree of cooperation with the patient’s type of illness, the services of the time the technical difficulty of the services, the degree of risk of the services, the labor intensity of services, ward layout, nursing equipment and materials, a reasonable configuration, operation, the environment around the patient bed unit.)Conclusion:1.The comprehensive evaluation model of the nursing manpower cost includs a four first class indicators and8second class indicators. The manpower costs of nursing care are caculated by this comprehensive evaluation model as follow:The Comprehensive Evaluation Model of the Manpower Cost of Nursing Care (score)=C×XnⅠ-1XnⅠ-2XnⅠ-3XnⅡ-1XnⅡ-2XnⅢ-1XnⅢ-2XnⅣ-1. Which, XnⅠ-1XnⅣ-1is indicator of the comprehensive evaluation model of the manpower cost of nursing care; C was as a unit labor costs.The correction factors of the traditional manpower costs of nursing cares are caculated by this comprehensive evaluation model of the nursing manpower cost and the relative value method. The comprehensive evaluation results of the nursing manpower cost are caculated by the formula which is the correction factors multiplied by the traditional manpower costs.2. A four-factor structure for nursing workload measurement at single nursing care was extracted, which are nursing risk, patient condition, work environment and characteristic of nursing cares. The14second class indicators are nurses’ communication ability with patients, the technical proficiency of the nurses, nurses’ capacity of the health education, the patient’s disease severity, patient self-care ability, the type of illness, the time consuming of the service, the technical difficulty of the services, the risk of the services, the labor intensity of the services, ward layout,the rational allocation of care equipment and materials and the environment around the patient bed unit. |
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