Study On The Establishment And Application Of Physician-nurse Collaboration Grading Nursing Model Under The Situation Of New Health Reform

[Background]Grading nursing is a patient care system that medical staff implement different grades of nursing interventions after assessment of patients’condition and self-care ability, according to the working procedure of nursing or the medical orders. The grading nursing system is one of the core systems to ensure the quality of medical care and medical safety. It provides evidence for determination of the personnel force of clinical nurses, reasonable arrangement of human resources, formulating charge standard for nursing service, and implementation of nursing interventions. Grading nursing system in our country was proposed in1954. The Ministry of Health revised the grading nursing system and released the Guiding Principles for Grading Nursing in General Hopitals for Trial on May22,2009, which was formally implentmented on July1,2009. However, there are still some problems and drawbacks in the implementation, including the inconsistency of definition on nursing grades between physicians and nurses, the mismatching between nursing grade and actual care needs of patients, the influences of uncertainty of nursing grades to their implementation, the nurse-patient disputes caused by the mismatching of nursing grades with the actual nursing interventions, waste of human resources caused by unreasonable nursing grades, and the decrease of performance caused by the inconsistency to grading standard between physicians and nurses, which concentrated on the attitude to physician-nurse cooperation of medical staff and the establishment of cooperative medical team. Under the situation of new health reform, medical institutions are required to establish the conception of patient-centered care, and provide patients with comprehensive, consecutive, and integrate health care, which requires the implementation of grading nursing with collaboration of medical staff. Although the physician-nurse relationship has changed to some extent and collaboration has been emphasized in recent decades, there is no measure tool for the application and attitude of physician-nurse collaboration. Application of physician-nurse collaboration grading nursing model (PNG) was rarely reported in China, which requires further study.[Objectives]1. Establish a physician-nurse collaboration model on the basis of grading nursing, and build a physician-nurse relationship characterized with communication, collaboration, and complementation, which would promote the cooperation between physicians and nurses.2. Explore the feasibility of physician-nurse collaborative definition and implementation of grading nursing, opertimize the linkage among physicians, nurses and patients, and improve the quality of nursing interventions.3. Adopt quality priority, process management and risk management tools to explore the feasibility of improving the patients’satisfication by reducing the nursing defects and adverse events through physician-nurse collaboration grading nursing model.4. Explore the effect of physician-nurse collaboration model on the promotion of active participation in nursing and self-care awareness of patients, and establish nursing work model combined with active care and active participation, to achieve the goal of treatment and nursing.[Methods]1. Study subjects:Physicians, nurses and type2diabetes mellitus (T2DM) patients were recruited from department of endocrinology of the tertiary general hospitals in two areas during March2010to August2010in this study. All subjects were randomly allocated to two groups, one of which was implemented with regular grading nursing and the other one with physician-nurse collaboration grading nursing.2. Data collection:the Barthel index scale and Likert-total subscale were adopted to evaluate the definition of grading nursing, nursing quality, defects in nursing process, patient’s satisfaction, prognosis of disease and the attitude to physician-nurse collaboration of medical staff.3. Data analysis:Software SPSS13.0was used for statistical analysis. Continuous data was described as mean±standard deviation and analyzed by Student t test. Statistical significance of difference in the proportions among different groups was determined by chi-square test or Fisher exact test. P value<0.05was considered to be statistically significant.[Results]1. Grades of Barthel index scale were consistent with grades of medical order in the collaboration group. Significant difference was shown in the second and third grade of nursing between the two groups (P<0.05).2. Comparative analysis of nursing quality shows that basic nursing quality, completeness rate of medical order execution, qualified rate of impletation of nursing plans in the collaboration group were much better than those in the control group (P <0.05). Significant difference was shown in the awareness rate of disease, compliance to medical interventions, the average hospital stays, and the readmission because of the same or relative diseases between the two groups (P<0.05).3. Grading nursing process defect analysis showed that defects occured more frequently in the consistency between doctor order and nurse order, professional knowledge and skills, the effectiveness of nursing, communication ability of life knowledge, and rationality of functional rehabilitation in the control group (P<0.05). There was difference in the defects in nursing process and nursing quality between the two groups (P<0.05). The incidence of defects in nursing process was decreased and the score of nursing quality assessment was promoted in the collaboration group (P<0.05). Satisfaction analysis showed that all the indicators in collaboration group were better than those in the control group (P<0.05), especially the communication between nurses and patients and health instructions.4. Comparative analysis of the attitude to physician-nurse collaboration showed that the score of attitude in collaboration group was much higher than that in the control group (P<0.01).[Conclusions]1. Physician-nurse two-dimensional grading nursing with Barthel index scale can significantly improve coincidence between nursing grade and patient’s condition and the integrate treatment effect.2. Physician-nurse joint shift, rounds and case discussions and the application of route inventory on physician-nurse collaboration turned the physician-nurse relationship to be characterized by communication, collaboration and completeness instead of leading and subordinate. The new relationship between physicians and nurses promoted the collaborations of medical staff, increased the completeness rate of medical order execution and the coincidence rate of nursing interventions, and shortened the average hospital stays, which improved the overall treatment effect.3. Physician-nurse collaboration grading nursing model consolidated the system of quality priority, process management and risk prevention, which reduced the nursing defects and adverse events and improved the sense of identity and satisfaction of patients.4. Physician-nurse collaboration grading nursing model improved the professional quality of nurses, enhanced the communication between nurses and patients, and promoted the implementation rate of basic nursing interventions. Patients were clearer with their therapy and nursing objectives. Therefore, a nursing work model combined with active nursing and active participation was formed, which increased the compliance of patients to medical orders, led to a better outcome, and increased the satisfaction of patients. Likert scoring scale and Barthel index scale can accurately compare and evaluate the implementation effect of regular grading nursing and physician-nurse collaboration grading nursing in a quantitative way, which has good reliability, validity and responsiveness in the assessment of patients’life quality and physician-nurse collaboration.