| ObjectiveThis study based on the theory of RBRVS,building nursing performance assessment model which is suitable to our country clinical nursing work,improving quality of nursing care and patient satisfaction,establishing a scientific and effective nursing management model and providing the basis for the development of the nursing profession.Methods1.The establishment of nursing performance assessment model based on RBRVS theory in the internal medicine system(1)Screening of nursing fee items in internal medicine system.This research took the first-class hospital medical system of Shandong province as an example,in view of the internal system disease which had long duration and heavy nursing workload.Through consulting a large number of literature at home and abroad,according to "National medical service price project specification(2012 edition)work manual ",combining with clinical nursing practice experience and consulting experts,adhere to scientific,comparable,orientable,operational principle,internal medicine nursing fees system was determined.(2)Determination of Relative Value Scale(RVS)of nursing operations in internal medicine system based on RBRVS.(1)The RVS of nursing operations in the internal medicine system was preliminarily determined based on RBRVS theory through the in-depth analysis.(2)Through the Delphi method,the RVS of the nursing operations in internal medicine system was determined.(3)Establish nursing performance accounting scheme.Combining with RVS of the nursing operations based on the RBRVS,determining the fee of each nursing oparations,building the nursing performance calculation scheme,building a scientific and reasonable nursing performance assessment model based on RBRVS.2.The application of nursing performance assessment model based on RBRVS theory in the internal medicine systemSince September 2017,the performance assessment model had been tested for 3 months in the internal medicine system of a third-level hospital in Shandong province.Before trial(August 2017)and after trial(December 2017)respectively comparing the nursing staff satisfaction,patient satisfaction to nursing service,and the results of the performance distribution,to evaluate the model.Results1.The building of nursing performance assessment model based on RBRVS theory in the internal medicine system(1)After two rounds of expert enquiry,determining the RVS of the project,combining with nursing performance calculation scheme,building nursing performance assessment model based on the RBRVS.The results of the first round of expert correspondence were as follows:(1)Operation of the diagnosis and treatment projects which nursing staff completed independently: three experts suggested that increase the project and its RVS espectively was "intravenous fluids 100;continuous ivinfusion artificial 120;liver care 900;infusion port 800";"skin test" should be adjusted for "intradermal allergic test";The RVS of "washing stomach" was adjusted to "200" and "subcutaneous injection" to "30".The research group discussed the decision and adopted expert advice.Finally,the number of this classification was 35.(2)Nursing operations: three experts suggested increasing project and its RVS were "indwelling catheter care 80";Four experts suggested that the "amount of fluid intake" should be adjusted to "the amount of fluid intake record";Two experts suggested that the "change" RVS in the document should be adjusted to "50".Three experts suggested that the term "nasal feeding" was too general and suggested that the two items should be "continuous feeding of nasal feeding;feeding of nasal feeding",and the RVS was "150,50" respectively.The "intubation tube" project was adjusted to "nasogastric tube",RVS was " 100";"drainage tube replacement" was adjusted to "drainage tube care",RVS was "150";The central venous pressure measuring RVS was adjusted for "100","PICC care;ecg monitoring" was adjusted for "50","the skin" was adjusted for "30","thrombolysis treatment" was adjusted for "200","paraplegia nursing" was adjusted for "300","moist heat on the perineum incision " was adjusted for " 30 ","bladder irrigation" was adjusted for "50","urethral catheterization" was adjusted for "230".The research group decided to take the advice of experts,adjusting and modifing the related items.After adjustment,the number of this classification was 44.(3)Operation which nurses assisted the doctor in the diagnosis and treatment projects: four experts thought that "blood gas analysis" should belong to the "Operation of the diagnosis and treatment projects which nursing staff completed independently",RVS was "250",the team decided to take the advice of experts,the number of this classification was 9.(4)Considering the practice of clinical medicine system,two experts advised the file of "dressing" was defined as "a little dressing," "rescue" was defined as "small to rescue",the team decided to adopt expert advice after team discussion.(2)The second round of the experts in the enquiry,mean value of each item was greater than 2 points,the coefficient of variation was less than 0.25,not modified,drew the conclusion.Finally,88 items of the internal system for nursing operation were determined.The number of nursing staff independent operation of the diagnosis and treatment projects was 35,the number of nursing class projects was 44,the number of nursing staff to assist the physician operation of diagnosis and treatment projects was 9.(3)The positive coefficient of the two rounds of Delphi method were 94.12% and 100%;The expert authority coefficient were 0.87 and 0.866,both greater than 0.7.After two rounds of consultation,the Kendall coefficient were 0.133 and 0.398,indicating the experts were highly motivated,focused and authoritative.2.The application of nursing performance assessment model based on RBRVS theory in the internal medicine system(1)Contrasting the conclusion of nursing staff performance satisfaction,there was a statistically significant difference(P <0.01);(2)Contrasting the conclusion of patients' satisfaction,the difference was statistically significant(P < 0.05);(3)The model has a positive correlation between nursing staff performance and nursing workload.Conclusions(1)Through two rounds of Delphi method to determine the RVS of nursing operation items in internal system,combining with nursing performance calculation scheme,building nursing performance assessment model,providing the basis for future research.(2)The performance assessment model based on RBRVS can quantitatively evaluate different diagnosis level of labor cost and risk of medical staff,knowledge and skill,which embodies the service value of nursing staff.The application of this assessment model improves the performance of the nursing staff income,improving nursing staff job satisfaction and work efficiency,arousing the enthusiasm of work,realizing the scientific and efficient management of human resources.It shows the performance assessment model is scientific and practical. |
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