The Feasibility Study On The Grading Nursing Management Made By The Doctor And Nurse

ObjectiveTo investigate the feasibility on the grading nursing management made by the doctorand nurse .MethodsThe 240 patients were randomly devided into the control group and experimentalgroup.The experimental group: the nursing contained the observation of the patient'scondition and the care of living. the doctor decided the frequency of the observationand it had three grades. if the doctor gave the first observation order, the nurseshould observe the patients every 15-30minutes and we used "1" to represent; if thedoctor gave the second observation order, the nurse should observe the patients per 2hours and we used "2" to represent ; if the doctor gave the third observation order,the nurse should observe the patients more than twice everyday and we used "3" torepresent. at the same time, the care of living was decided by the charge nurseaccording to the Barthel index and it also had three degrees.if the score of the patientwas more than 61,it showed that the patient had a high activity of living and we used"C" to represent; if the score of the patient was between 41 and 60,it showed that thepatient needed help from the nurse and we used "B" to represent; if the score of the patient was less than 40,it showed that the nurse should do everything for the patient and we used "A" to represent. The charge nurse would make a nursing order according the score. On the second or third day in the hospital, the nurse would assess the patient's activity of living again according to the Barthel index and make some adjustment according the latest assessment.The control group: the grading nursing care was carried out according the current nursing system. the charge nurse also would assess the activity of living of the patients according to the Barthel index, but the charge nurse wouldn't make a nursing order.On the second or third day in the hospital, the observer would record the direct-care time of inpatients in 24 hours by stopwatch both in the control and experimental group. After a week in the hospital, the charge nurse would assess the patient's criteria of basis nursing and the satisfaction of inpatients'.The indicators of evaluation: The criteria of basis nursing, the satisfaction of inpatients and the direct-care time of inpatients in 24 hours.Statistical analysis: The data was analyzed by the SPSS 13.0, using 2 independent samples tests, 2 related samples test, chi-square test, there was significant difference if P≤0.05.Results1. In the control group, the differences of the degree of satisfaction and score of basis nursing in the groups of different grades of nursing were insignificative; the differences of the three indicators in the groups of the first grade of nursing and different grades of ADL were insignificative. Between the medical and surgical department, the differences of the three indicators in the groups of the first grade grading nursing and "A" grade of ADL were insignificative; the differences of the degree of satisfaction and score of basis nursing in the groups of the first or second grade of nursing and " C " grade of ADL were insignificative.2.In the experimental group, the differences of degree of satisfaction and direct-caretime were significative both in the groups of different observation of the patient andthe first grade of observation but different grades of ADL.3.Between the control and experimental group, the differences of three indicators ofthe groups which had the first observation and "A" grade of ADL were significative;the differences of direct-care time and score of basis nursing both in the groupswhich had the first grade observation and "B" grade of ADL or the secondobservation and the "A" or "C" grade of ADL were significative.Conclusions1. The differences exist among patients. the current patient classification system is imperfect.2. the new style of nursing care which the doctor and nurse make a dicision together is more perfect, it can reflect patients' conditions and allocate the nurses' working time more rationally , reduce the medical tangles and promote the development of nursing career.3. In a word , we advise to devide the nursing care into observation of the patient's condition and the care of living. The doctor decide the grade of the observation and the charge nurse decide the grade of care of living.4. we should do more about the training of the grading nursing care both for the doctors and nurses.