The Research Of Nursing Process Optimization In Comfortable Wards

Background:The theory of Business Process Reengineering was put forward in 1990, which was prevailing all over the world fastly and had far-reaching influence on management model and people's mode of thinking. In order to strengthen hospital's competitive edge in the healthe care market and satisfy patients'multiplex needs,domestic and foreign medical institutions applied the theory of process management to improve medical service and management.Recent years, nursing administrator had carried out exploration of nursing process optimization in such aeras as outpatient service, emergency, hospitalization and operation. They had attained certain achievements in improving nursing quality and patient satisfaction,shortening the waiting time,etc. From 2004,a general hospital of Jiangsu province created comfortable wards which insist on the tenet of"patient demand-oriented, patient satisfaction as the goal". Athough comfortable wards achieved better results for offering holistic nursing for patients, the quality connotation of"humanized, integration , specialization ,keep-free"had not been fully implemented in nursing staff. According to the philosophy of excellent service from the excellent process,process optimization need to focus on the quality connotation of comfortable wards. However,the research of nursing process more limited to nursing activities or experience reports,there is little research about process optimization based on surveyting the wards especially comfortable wards.Objective:The purpose of this study was to design the process that met comfortable wards tenet and quality connotation .This study had three objectives: 1. To explore the design principles and main evaluation tools of nursing process so as to provide the references for process design.2. To survey the opinion of nursing process in comfortable wards nurses and the embodiment degree of the nursing process design principle in bedside reporting and infusion process.3. After surveying the process status of comfortable wards, we selected key process to optimize and looked forward to establishing the process that accorded with the tenet and quality connotation of comfortable wards to improve quality, efficiency, cost and patient satisfaction.Methods:1. Delphi method was adopted and 27 expert was consulted by a questionnaire survey .2. To test the reliability and validity for the self-administered questionnaire of satisfaction degree of comfortable wards patients toward nursing service.3. Self-administered questionnaires of nursing process status in comfortable wards were used respectively in 50 patients, 26 nurses in comfortable wards in a general hospital of Jiangsu province by convenience sampling method.4. Follow the steps of planning, diagnostics, redesigned,we selected five processes including bedside reporting, infusion process, perioperative nursing, movement assistance, bed shifting to optimize.5. We put the optimized process into implementation in certain comfortable ward and evaluated the effect by comparing the change of related indexes and patient satisfaction pre- and post-optimization.Results:1. The principles of nursing process design which contain 4 dimensions 25 items are established. 2. The reality and validity of the self-administered questionnaire are acceptable.3. Nursing staff can realize the importance of nursing process optimization and implemented the written procedures which had existed in comfortable wards. But some of the written procedures can't be used as a guide for nurses.Nurses lacked of related knowledge about process optimization,and related contents needed to be trained.4. The embodiment degree of the nursing process design principle about bedside reporting, infusion was respectively 3.94,3.87(5 likert), Some process such as preparing before bedside reporting , infusion inspection,etc, needed to be optimized.5. The mean score of patient evaluation about bedside reporting and infusion process were higher then pre-optimization.Time needed for replacing infusion liquid, catheter-sealing, and for checking and dispensing liquid were significantly shortened(P<0.01). The mean score of nursing quality about perioperative, movement assistance, bed shifting were significantly heightened(P < 0.01). Patient satisfaction in some dimensions such as inpatient introduction, health education improved significantly(P<0.01).Conclusions:The principles of nursing process design were affirmed by experts,but part of the existing process can't manigest the principles fully and can't be used as a guide for nurses. Through analysising the problems existing in comfortable wards and selecting key process to optimization can improve the nursing quality, efficiency and patient satisfaction. The tenet and quality connotation of comfortable wards had been reflected.