Development Of Nursing Difficulty Evaluation System For Emergency Patients

Objectives:1.To establish an evaluation system and scale of nursing difficulty for emergency patients.2.To describe the current situationof nursing difficulty in emergency patients and analyze its influencing factors.To explore the relationship between the nursing difficulty of emergency patients and the retention time of resuscitation room.Method:1.Delphi expert method was used to develop basic elements of patients care complexity for emergency patients.Composite index method was used to screen indexes and the analytic hierarchy process(AHP)to distribute weights.Then,internal consistency of the evaluation scale was tested in preliminary survey.2.A total of 238 emergency patients were selected from resuscitation room conveniently in a tertiary tree-lever comprehensive hospital in Fujian,and then the nursing difficulties of the patients were evaluated by the scale.Mann-Whitney U test and Kruskal Wallis H test methods were applied to analyze the differences of nursing difficulty in different genders,diseases,outcomes,MEWS,admission forms,admission period,medical payment types.The spearman rank correlation was adopted to analyze the correlation between the nursing difficulty and the retention time in resuscitation room.Results:1.The evaluation scale of nursing difficulty for emergency patients included 6primary indicators and 12 secondary indicators.The scale-level content validity index was 0.90,and the item-level content validity index was from 0.86 to 1.00.Theintegral Cronbach's alpha coefficient of the evaluation scale was 0.721,and Cronbach's alpha coefficient of the primary indicators was 0.716 ~ 0.907.3.The nursing difficulty of 238 emergency patients was scored 0.90~2.54,median1.42(1.26-1.75),an average of 1.53.Compared with 0~4 theoretical score range it was below the average level.4.There was no statistically difference of nursing difficulty scores(P>0.05)in the different genders,different time period as well as medical payment types.The group of injury patients scored higher than the group of urinary system patients(P<0.05),and there was no statistically difference between the other diseases(P>0.05).The group of discharged patients scored the lowest(P<0.05),and there was no statistically difference between the group of hospitalized patients and of automatic discharged patients(P>0.05).The group of scored more than 4 in MEWS was higher than the group of scored 0 to 3 in MEWS(P<0.05).The flat wagon admission group scored higher than the walking admission group(P<0.05).The difficulty of nursing was positively correlated with the retention time of resuscitationroom(P<0.05),and the higher the difficulty score,the longer the retention time.Conclusion:1.The evaluation scale of nursing difficulty on emergency patients is a valid and reliable tool that offers a comprehensive assessment of care complexity in emergency patients.2.The group of injury patients scored higher than the other groups.The higher difficulty score showed the longer the retention time in emergency room.