Application Of The Four Kinds Of Human Resource Allocation Methods To Predict Nursing Manpower Needs In Adult Cardiac Surgery ICU

Objective1. To revise Intensive Care Nursing Scoring System (ICNSS) and estimate the reliability and validity.2. To investigate the nursing manpower needs in adult cardiac surgery ICU using subjective evaluation method, Nursing Activity Score (NAS), Revised edition of ICNSS and Acute Physioloy and Chronic Health Evaluation Ⅱ (APACHE Ⅱ).3. To Compare the manpower requirements of the four kinds of human resource allocation methods.Methods1. Revised edition of ICNSS was made according to ICNSS framework by reviewing the relevant scale, group discussion and clinical using.2.208shifts were selected from Adult Cardiac Surgery ICU, the Second Xiangya Hospital, Central South University, and Revised edition of ICNSS was applied to assess nursing workload. Cronbach’s a coefficient, split-half reliability and scorer reliability were used to estimate the reliability. While content validity and construct validity were used to estimate the validity of the scale.3.385shifts were selected from Adult Cardiac Surgery ICU, the Second Xiangya Hospital, Central South University, and subjective evaluation method, NAS, Revised edition of ICNSS, APACHE Ⅱ were applied to predict nursing manpower needs.Rresults1. Revised edition of ICNSS was formed, including the16items, a total of64detailed Grading Regulations.2. Reliability test of Revised edition of ICNSS:①Cronbach’s α coefficient for the total scale was0.822, for the dimensions were greater than0.6.②The split-half reliability coefficient for the total scale was0.889, for the dimensions were greater than0.7.③The two scorers Spearman correlation coefficient for the total scale was0.944, for the dimensions were0.889to1.000.3. Validity test of Revised edition of ICNSS:(1)The content validity index was0.892.(2)construct validity:①Inter-scale correlations studies showed that the correlations between items and total scores ranged from0.329to0.785, the correlations among these dimensions ranged from0.229to0.506, the correlations between each dimensions and total scores ranged from0.337to0.938. All correlations were significant (P<0.01).(2) Exploratory factor analysis showed that5common factors were extracted taking eigenvalues (λi)≥1as the selecting principle which can explain64.448%of the total variance.4.There was no significant correlation between predicted nurse-patient ratio and patient age according to subjective evaluation method, NAS, ICNSS (P>0.05). The correlation coefficient between predicted nurse-patient ratioand patient age was0.176according to APACHE Ⅱ.It is statistically significant (P<0.05).5. Four kinds of methods were used to predict nursing manpower needs. Nursing manpower needs (nurse-patient ratio) in different gender were not significantly different (P>0.05). Nursing manpower needs (nurse-patient ratio) in different types of surgery were significant different (P<0.05), while nurse-patient ratios predicted according to APACHE Ⅱ in groups which did not undergo surgery, undergo simple congenital heart surgery and undergo complex congenital heart surgery were not significantly different (P>0.05). Nursing manpower needs (nurse-patient ratio) in different periods staying in Cardiac Surgery ICU were significant different (P<0.05),while there was minimum nurse-patient ratio on the day patients transferred out. Nursing manpower needs (nurse-patient ratio) of different shifts according to subjective evaluation method, ICNSS, APACHE Ⅱ were not significantly different (P>0.05), while nurse-patient ratios predicted according to NAS among groups of different shifts were significantly different (P<0.05) and nurse-patient ratio that night shift required was the highest. Nursing manpower needs (nurse-patient ratio) were significantly different between mechanical ventilation and non-mechanical ventilation groups (P<0.05), and mechanical ventilation group required higher nurse-patient ratio. Nursing manpower eeds (nurse-patient ratio) in different severity were significantly different(P<0.05), the higher severity of the disease needed the higher nursing workforce.6. Nursing manpower needs (nurse-patient ratio) according to subjective evaluation method, NAS, ICNSS and APACHE Ⅱ were significantly different (P<0.05). Nursing manpower predicted by subjective evaluation method was minimum, APACHE Ⅱ and NAS were middle, ICNSS was highest.Conclusion1. Revised edition of ICNSS has good reliability and validity.2. There were different nursing manpower needs in types of surgery, times, shifts, mechanical ventilation or not and severity of the disease.3. There were differences nursing manpower needs according to the four methods. subjective evaluation method was minimum, APACHE II, NAS were middle, ICNSS was highest.