| Objective:1.To establish an evaluation model of nursing difficulty for patients with acute coronary syndrome(ACS) and develop an scale.2.To describe the current status of nursing difficulty in patients with ACS and explore the influential factors. To analyse the relationships between the nursing difficulty and the cost of nursing, the time of nursing work, and the length of stay. Methods:1.The evaluation system was constructed in the first part. Based on the theoretical framework of “Biological-Psychological-Social” medical model, combined with the results of previous qualitative research, the goal of nursing difficulty for patients with ACS was decomposed step by step through literature review. Expert grading method was used to screen indexes and the analytic hierarchy process(AHP) to distribute weights, and the evaluation model of nursing difficulty for patients with ACS was obtained. Then, a convenient sample of 30 patients with ACS was extracted to test internal consistency of the evaluation scale in preliminary survey.2.The second part was a clinical empirical study. A total of 243 patients were selected from a cardiovascular medicine department prospectively and conveniently in a tertiary first-class comprehensive hospital in Fujian, and then the nursing difficulties of the patients were evaluated by the model. T test, variance analysis, and rank sum test were applied to analyze the differences of nursing difficulty in different genders, admission forms, medical payment types and treatment methods. Correlation analysis were adopted to analyze the correlation between the nursing difficulty and the nursing cost, the direct nursing working hours, and the length of stay. After a classification of nursing difficulty level in which K clustering method was used, the differences of nursing cost, direct nursing time and length of stay were compared in patients with ACS in different nursing difficulty levels. Results:1.The evaluation system of nursing difficulty for patients with ACS included 3 dimensions and 13 indicators, and the indicators of “self-care ability”, “mental and psychological status” and “social support status” were assessed by reference to independent scale.2.The item-level content validity index was from 0.80 to 1.00 and the scale-level content validity index was 0.90. The integral Cronbach's alpha coefficient of the evaluation scale was 0.717.3.The nursing difficulty of 243 patients with ACS were scored 0.0875~2.2680, an average of 0.8733, a standard deviation of 0.4378. Compared with the range in theory, the scores of sample were below the average level.4.The nursing difficulty scores in different gender and medical payment types were no statistically difference(P>0.05). The emergency admission group scored higher than the out-patient admission group(P<0.001). The immediate percutaneous coronary intervention(PCI) group scored highest(P<0.001), but scores of the group of conservative treatment after coronary angiography and the group of late PCI were no statistically difference(P>0.05). The nursing difficulty was positively associated with nursing cost, nursing working hours, and the length of stay(P<0.001), and the coefficients of correlation were 0.559,0.624 and 0.477. The higher the level of nursing difficulty, the higher the cost of nursing, the more time of nursing work, and the longer the length of stay. Conclusions:1.The evaluation scale of nursing difficulty for patients with ACS has a comprehensive content, a reasonable structure and internal consistency, so it could be a scientific and practical model in clinical nursing management.2.The empirical study not only analyses the influencing factors of nursing difficulty in patients with ACS, but also provides a basis for the application of the model in performance evaluation and human resource allocation. |
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