Study On The Content And Working Hour Of The First Grade Nursing In Internal Medical System Of A Grade Ⅲ-A General Hospital In Hunan Province

Objective To investigate the content and working hours of the First Rank Nursing of internal medicine system at a GradeⅢ-A general hospitals in Hunan,to explore if the Standard of Grading Nursing is fit for the clinical actuality.Methods A descriptive design was used in this study.At first,50 CNS (clinical nursing specialist)and physician from GradeⅢ-A general hospitals were investigated,to determine the content of the First Grade Nursing.Then,chosed 4 departments of internal medicine system for investigation at a GradeⅢ-A general hospitals in Hunan by a grade random sampling method from June to August 2007,four full-time investigators used a 24-hour follow-up investigation,measured the actual content and working hours of different patient with the First Grade Nursing by different grade nursing personnel,each section measured seven days continuously.Finally,colleted and sorted the data,three methods were employed for data analysis,that were mathematical statistics,Spearman rank correlation analysis,two samples t-test and SNK analysis of variance by using the Statistical Package for Social Science version13.0 and EXCEL2000 soft ware.Results1.Analysis on the findings about the First Rank Nursing's content of CNS and physician's:①The result of the important level about the nursing content:the Spearman rank correlation analysis showed that:the total value of r_s was 0.96,P value was 0.00,according to the standard a = 0.05,thought that CNS and doctors had a positive correlation.T-test showed the P value was 0.04,t value was -2.11,compared the mean between CNS and physician on direct care;The total mean of the first rank nursing was P= 0.01,t =-2.52,according to a = 0.05 inspection standards,it could be considered differences from these 2 aspects were significant statistically.②The total score in authority was 0.94 of experts,it proved the judgement of 50 CNS is high,the result is credible.③Theoretical framework of the First Grading Nursing's content in the Internal Medicine Ward:on the basis of the experts' primarily,refered to the doctors',formed the direct nursing care 63,indirect care 23,total 86. deleted direct care 15,indirect nursing 5,and total items was 20.2.The outcomes of the internal departments' investigation:①The actual content of the First Rank Nursing:the direct nursing care was 69,added 14,8 items in the questionnaire hadn't appear in wards. indirect care was 24,added 5,4 content in the questionnaire hadn't appear actually.②Compared the content with the Nursing standard of Hunan province: the actual direct care was 69,while only 14 standards,indirect care was 24 actually,while only two criteria;total items was 93,Only 16 standards.③Compared the content with the Charging standard of Hunan province: the actual total items was 93,while only 40 standards,53 nursing services did not reflect the economic value reasonably.④Analysis of variance results of 4 units:The P=0.00 in life care, observation of patient condition,care skill,total working hours of direct care,according to the criteria 0.05,it could be considered that mean difference of the four departments had significant statistically.Relative factors were the nursing staff to provide care as well as differences in the patients in need of care.⑤The direct care hours from different rank nurse shows that nurses generally need more time than senior nurse.⑥Compared the working hours with the Nursing standard of Hunan province:compared 8 comparable items,showed that the average actual working hours was smaller than the standard 4.12 minutes.3 The framework of the First Rank Nursing's content in the Internal Medicine Wards ofⅢ-A general hospitalAccording to the findings of theoretical and actual research, constructed the framework include:77 direct care and 24 indirect care, total items was 101,special content of Internal Medicine Unit was three.Conclusion: 1.The content of existed Nursing standard was smaller than the actual. The current rank institution is incompatible with the actual care.The first grade care system should be embodied and specialized.2.Constructed the content's framework of the First Grade Nursing about the Internal Medical System include:77 direct care and 24 indirect care, total items was 101,special content of Internal Medicine Unit was three.3.Actual working hours was smaller than standard.Different rank nurse influence the working hours,generally,practiced the same care item,the lower nurse need more time than senior.