| ObjectiveThe grading nursing system,an important part of the nursing system,played a crucial role in clinical nursing work and nursing management.However,with the development of nursing,many problems appeared in the content and during performing the system,which resulted in some negative effects and harmful consequences.All these decreased the service quality of grading nursing and restricted the development of nursing discipline.The present theme studied on the content standard of grading nursing system,which intended to contribute to the consummation of the system for practical use.Methods1.The cross-sectional investigation of the implementation of grading nursing systemWith stratified sampling,patients and nurses in eight departments were chosen in a GradeⅢ-A General Hospital in Guangzhou as studying objects.Using the method of direct observation,(1) Recorded the number of in-patients of every grade of grading nursing system in every ward.(2) Noted the day-nursing workload of the four shifts of nurses during 8:00-18:00.The contents included all items and the corresponding time of each item which the four shifts of nurses supplying to the patients.(3) Randomized chose four patients of each grade in every chosen department and recorded all the items and the corresponding time of each item they got during daytime.(4) Collected datas about the round time of grading nursing system during the time 8am and 6pm.Every department was investigated for a week, and each task was collected randomly for every day.The software SPSS for Windows,version 13.0 for personal computers and Excel 2003 in office 2003 were used for statistical activity.Statistical methods including descriptive statistics analysis,One-Way ANOVA,Two-Way ANOVA,Bonferroni and SNK for multiple comparisons were used for measurement data.And constituent ratio, R×C Chi-Square test for numeration data.The statistical significance was set at a level ofα=0.05.2.Establish the new Content Standard of Grading Nursing SystemBased on the results of the above investigation,reviewing references and interviewing nursing experts,expert consultation questionnaires were made.By Delphi method,35 nursing specialists in 27 GradeⅢhospitals from 14 provinces and cities were investigated for three rounds,which mainly for the basic service items of each nursing grade,the least frequency in each item and the bottom qualification line of nurse to perform each item.The software SPSS for Windows,version 13.0 for personal computers was used for statistical activity.Statistical methods included descriptive statistics analysis,K related sample nonparametric test.The statistical significance was set at a level ofα=0.05.Results1.There were 436 patients totally in the 8 departments during a week,including 155(accounting for 35.55%),278(63.76%) and 3(0.69%) respectively in gradeⅠ, gradeⅡand gradeⅢ.2.With the statistical method of R×C Chi-Square test,there were significant deviation among the 8 departments in the constituent ratio of each grade(P=0.000). The ratios for the patients of gradeⅠin 8 departments were from 11.1%to 100%, while gradeⅡwere from 42.5%to 82.2%.Only a department had gradeⅢpatients, and the ratio was 6.7%in that department.3.The average nursing service time during a day which the patients got in 8 departments was as follows:24.61min for GradeⅠand 12.34 min for GradeⅡ.. While the average grading nursing time during a day were 12.32(accounting for 50%) for gradeⅠ.And 4.81 min(39%) for gradeⅡ.4.There was no statistical differences in time for daytime nurses performing for grading nursing service in the 8 departments in daytime(P=0.344).However,there was significant deviation among the time offered by different shifts of nurses (P=0.000).With SNK for multiple comparisons,the time which the duty-shift nurse offered to patient was significantly higher than other shifts of nurses did.5.From the collecting data of the nurses performing for grading nursing system, the items and the frequency with each item were organized.Comparing with the old content standard of grading nursing system,there were many changes and improvements both in the items and the corresponding frequency of each item.6.The transfusion round time was the mainly way serving for patient instead of the provided time in grading nursing system for each grade.With One-Way ANOVA for analysis,there was significant differences of the transfusion round time in 8 departments(P=0.000).Using SNK for multiple comparison found that the transfusion round time in the department of cardiology and neurosurgery were significant different with other 6 departments.However,there were no significant differences between the two departments,as well as the other 6 departments in transfusion round time.7.The results of expert-consultation by Delphi method showed that:Firstly there was great representativeness as the responding experts coming from 27 hospitals in 14 provinces and cities.Secondly,the percentages of questionnaire received from the three rounds of experts were more than 85%,which showed enthusiasm and support of the theme from the experts.Thirdly,the average authority coefficient was more than 0.86 which showed that the consulting results were reliable. Fourthly,the coefficients of Kendall's W of the consultation in items of each grade were statistical differences,which provided sufficient evidence of high consistency among experts opinions.Fifthly,experts made the eventual determination of items in each grade,those were 32,23 and 19 items for gradeⅠ,ⅡandⅢrespectively. Meanwhile,the least frequency in each item and the bottom qualification line of the nurse to perform each item were established,which were more practical. Conclusions1.The patients quantity of gradeⅠandⅡis great respectively,while that is small in gradeⅢ.2.The ratios of grading nursing time patients got in daytime accounting for total nursing time are small.This shows that more than half of the total time nurse serving for patients is used to perform medical orders.And the duty-shift nurse is the mainly performer of grading nursing service content.While,comparing with the old content standard of grading nursing system,there are many changes and improvements both in items and the corresponding frequency of each grade.But that is not an integrated system for practice.3.It is difficult to implement the round time standards of the old grading nursing system for practice.As a special kind of round time,there are two sides of transfusion round time,and it could not replace the round time standards of grading nursing system.So,it is important to improve the round time standard in the new content of grading nursing system.4.The new content standard of grading nursing system by Delphi method is good to practice.The items,the least frequency in each item and the bottom qualification line of the nurse to perform each item established in each grade are greatly meaningful and practical. |
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