Research On Graded Nursing Model Of Public Hospitals In China Based On Self-care Theory

[Objective]The purpose is to establish a graded nursing service model suitable for public hospitals in China,to form a scientific and objective graded nursing service grading standard,to standardize and rationalize graded nursing service content,to provide guidance for clinical graded nursing,to explore the operating mechanism of graded nursing model,to predict nursing workload and develop a graded care management system,and to provide objective basis for hospital managers to evaluate nursing workload and rationally allocate manpower.[Method](1)A multi-center stratified random sampling survey was conducted to investigate 7200 patients in general adult wards.The patients with graded nursing in public hospitals were investigated by using patient general information questionnaire,APACHE II scale,SCS scale,Barthel index scale,graded nursing patients'service demand questionnaire and service implementation status questionnaire.The 24-hour direct nursing hours of 7200 patients were measured.Through the correlation analysis of APACHE II,SCS and Barthel index with patient grade and nursing hours,the decision-making body of grading nursing was analyzed,the grading criteria were deduced,and a new grading nursing grade was constructed.The results were verified and matched with the existing grading nursing.Using Delphi method,25 experts specializing in nursing management,clinical nursing and nursing education were selected to conduct two rounds of questionnaires to clarify the service items and implementation qualifications under the new nursing grade.(2)Using the method of mathematical modeling,the SCS score of patients and the total score of Barthel index scale were independent variables,and the 24-hour direct nursing hours was dependent variables.The multiple linear regression model was established by the least square method to find out the intrinsic relationship between patient's condition,self-care ability and nursing hours,so as to realize the function of predicting the workload of graded nursing.(3)Based on the three-tier design pattern of B/S(Browser/Server)architecture,MySQL 5.6,PHP 5.4 and Java language were used to develop the software of hierarchical nursing management system.[Result](1)The results of graded nursing system construction showed that:1)The results of the survey on the status of graded nursing services showed that:?The total score of patients'needs for nursing services was 19.15±8.71 and the current situation of nursing services was 11.79±5.34,There was statistical significance(P<0.05).The five items with the greatest difference were:illness knowledge explanation,bed cleaning unit,psychological counseling,discharge guidance and hospitalization introduction.?There was a statistically significant difference in the nursing needs of patients with different grades(P<0.05).Nursing needs of patients of different grades(>50%)were 27 items,17 items,15 items and 14 items respectively,but nurses provided services(>50%)for the patients were 11,9 items,8 items and 7 items respectively.?There was no statistically significant difference in the qualifications of the executives of different grades of nursing services(P>0.05).2)The results of grading nursing grade construction were as follows:?The results of graded nursing decision-makers analysis showed that both the doctor's order and nurse's order were negatively correlated with SCS and APACHE II scores(P<0.01),and positively correlated with Barthel index(P<0.01).The correlation between nursing order grade and illness and self-care ability was stronger than that of doctor order nursing grade.?The inference results of the new classification criteria showed that APACHE II and SCS scores were significantly correlated with nursing order grade,Barthel index and 24-hour direct nursing hours(P<0.01),but SCS scores were more correlated.?The results of the establishment of the new nursing grade showed that according to the 24-hour direct nursing time comparison of different Barthel and SCS patients,the two groups with no significant difference were merged to form seven new nursing grades,which are Level 1:ID,Level 2:IC,Level 3:?A,?B,?C,?D,Level 4:?B,?D,?D,Level 5:?A,?C,Level 6:?A,?B,?B,?C,Level 7:IVA.The validation results of the new nursing grade showed that there were significant differences in Barthel index,SCS score and 24-hour direct nursing hours among patients with different new nursing grades(P<0.01).?The results of matching application of new nursing grades showed that the seven new nursing grades were refined with the existing four grades of graded nursing used in clinic,forming sub-grades,which are special nursing,first-A,first-B,second-A,second-B,third-A and third-B.3)The nursing service items finally determined by Delphi method included 53 special nursing items,46 first-A nursing items,36 first-B nursing items,29 second-A nursing items,20 second-B nursing items,13 third-A nursing items,12 third-B nursing items.And the qualifications of the executing personnel of service items at different levels were defined.(2)The results of workload prediction model based on graded nursing showed that different patient data can achieve the prediction purpose.The fitting error of 24h direct nursing hours for different populations was all patients(1905.7)>surgical patients(1760.2)>medical patients(1744.5)>digestive patients(1556.1).(3)The developed graded nursing management system included five functions:patient data management,nursing grading,nursing items,statistical analysis,and system management.[Conclusion](1)Conclusion of the of graded nursing system construction:?Patients with different nursing levels have different needs for nursing service,and the current situation of nursing service implementation can not meet the needs of patients for nursing service.The qualification of graded nursing practitioners is not clear,and the use of graded nurses needs to be standardized.?The form of cooperation between doctors and nurses is graded nursing decision-making body.SCS score and Barthel index scale are used to provide the basis for objective quantitative grading,forming a new nursing grade is more scientific,reasonable,easy to operate and execute.?It clarifies the service items and executing personnel qualifications under the new nursing grade,which makes the graded nursing requirements more specific and detailed,and is conducive to guiding clinical implementation.?The establishment of a hierarchical nursing system based on self-care theory can change the traditional concept and working mode of grading,which can promote the change of nursing work from passive execution of medical advice to active participation in patient evaluation,determination of nursing level and provision of appropriate nursing services.(2)The workload prediction function based on graded nursing was initially realized,which provided the basis for nursing manpower arrangement,performance appraisal and cost accounting.(3)The graded nursing management software can provide a convenient and powerful graded nursing management tool for clinical practice,and provide reference and ideas for further development of graded nursing automation and delicacy management.