美、英、日护理人力配置基准比较及其对我国的启示

世界各国护理人力配置基准中,以美英为代表的是根据不同护理班次,从护理实际需求出发,结合不同级别护士的专业技术组合能力,根据实际护理工作量和工作时间来配置护理人员的方法;另一种是以日本为代表,从护理供给角度出发,规定24小时内护士对患者比例的平均标准,根据床位数量和相对的护理工作量来配置护理人力的方法。不同角度的“基准”是由于各国不同的护士雇佣方式、护理班次和薪金支付方式,同时受到各国护士专科化的程度和使用机制的影响,其后果是护理人力状况在各国间存在较大差异。中国对护理人力配置也有明确的规定,但由于缺乏具体的管理措施,在实际中没有得到很好的执行,影响了护理质量和护理专业健康、有序的发展。借鉴国外经验和我国医疗保险实际,明确我国护理人力配置的原则,并坚持科学地测算和有效的监督管理,才可以确保合理的人力配置得到有效的实施。     

休假及双休日对部队医院护理人力配置的影响

通过对部队某医院护理人员数量、现状、分布、出勤率、编制床位数和实际展开床位数进行调查和分析;对临床科室中各科最少应配备的护理班次进行了问卷调查,对各科每日实际上班的护士人数进行了测算,计算出了床护比和日均床护比,结果发现由于休假及双休日的影响,使护士的实际出勤人数减少了36.99%,使床护比在原有的基础上降低了35～39%.根据分析结果,对部队某医院人力配置提出了建议.     

汶川抗震救灾中护理人力配置及其启示

任何医学救援工作若缺乏护理学知识和技能的应用,很难适应重大灾难具有突发性、群体性、复杂性、破坏性等特点的需要。因此,如何使护理人力配置从数量、结构等方面满足灾难救援特点的需要,是护理管理者不可忽视的重要问题。2008年5月14日,我院奉命组建医疗队奔赴四川绵阳安县灾区紧急救援。     

关于我国护理人力配置研究的思考

护理人员的合理配置问题越来越受到我国护理界的重视。本文通过分析我国护理人力现状及我国现有的护理人力配置方面的研究,结合国外有关方面的研究,提出我国今后护理人力资源研究方向:(1)我国护理人力资源现状的研究;(2)护理人力配置与护理质量的相关性研究;(3)护理人力的配置方法;(4)护理工作界定和任职要求;(5)护理分级标准的客观依据及收费标准。希望我国护理人力资源方面的研究不断深入以促进我国护理管理的科学化、使我国的护理人力配置更加科学合理,使我国在有限的护理资源条件下提供最高的护理质量。     

护理工时测定与护理人力配置的调查研究

在护士人力资源严重不足的情况下,如何在人力效益和满意服务之间达到较好协调和双赢,是护理管理者急需解决的难题.作者采用书面调查法对护理人员的结构进行调查,采用观察员测量和操作护士自我观察记录法,对护理工时进行测定,现报道如下.     

护理工时测定与护理人力配置的调查研究

在护士人力资源严重不足的情况下,如何在人力效益和满意服务之间达到较好协调和双赢,是护理管理者急需解决的难题。作者采用书面调查法对护理人员的结构进行调查,采用观察员测量和操作护士自我观察记录法,对护理工时进行测定,现报道如下。     

国际护士会对护士安全配置的策略

护士人力短缺是全球的一个热点问题,在中国这一问题尤为严峻。据2004年卫生部对全国400多家医院调查,我国病房护士与床位比平均为1:0.33,还未达到卫生部1978年制定的1:0.4的标准。根据WHO1998～2002年的统计,我国香港地区、日本、泰国、德国以及英国等国家的医护比都超过1:4,我国2001年只有1:0.613。从护士和人口比来看,世界上除印度、土耳其、泰国等国家以外,许多国家每千人口的护士数都在3名以上,部分国家高达25～40名,亚洲国家平均为1:2.019,我国只有1名。2005年卫生部下发了《中国护理事业发展规划纲要(2005～2010年)》,明确提出了护士配置的具体要求。在我国护理人力资源管理中,既有数量上的不足,也有使用上的不合理;既有体制上的问题,也有分配、激励机制上的问题。研究和借鉴先进国家和地区的经验,分析我国的现状和存在的问题,对于探索我国护理人力资源的合理配置是十分必要的。2006年,国际护士会提出了“护士的安全配置对拯救生命至关重要”;日本将护理人力配置与医疗收费标准挂钩,即不同护士人力配置的医院实施不同收费标准;香港十分注重人力策划的科学性,根据对护士的需求制定护士人力指标。我国内地的护理管理人员也进行了这方面的探索,上海市卫生局设立了课题基金,专门研究上海市护理人力资源配置与人才需求;江苏省卫生厅也在此方面进行了调查与研究;福建省立医院承担的福建省医学创新课题,对护理人员的合理使用进行了研究和评价。在本专栏中,各位读者将分享这些经验和成果。     

综合医院康复病房护理人力配置探讨

目的探讨综合医院康复病房护理人力的配置比例.方法记录本科护理人员7天所做的全部工作,采用台湾荣总医院研究数据（平均工时）作为计算标准,缺项的采用实时计算,算出每天工作时数及人力.结果床位与护理人力比为1：0.45;输液耗时最多,其次是病情观察、给药、预防压疮、更换床单、健康教育等.结论康复护理时数有待增加;康复护理训练安排在晚上进行更合理.     

病房护理工作量调查与护理人力配置

目的 进行科学合理的病房护理工作量调查及测算，了解全院各科的护理工作量，为全院护理人力合理配置提供依据。方法 采用自行设计的护理工时统计表，对10个临床科室的护理工作量进行调查并分析。结果 不同病房护理总工时数不同，病房间接护理时数大于直接护理时数，间接护理平均工时中，费时较多的项目是输液准备，电脑记账。结论 建议按病房实际工作量配备护理人力；通过加强后勤支持系统，建立静脉输液配置中心，按职称上岗，减少护士间接护理时间。提高护理人力资源利用率。     

护理人力配置与患者护理满意度的相关性研究

目的调查病房护理人力配置及住院患者护理满意度的现状,分析两者的相关性。方法采用问卷调查法,对哈尔滨市8所二级以上医院61个内外科病房护理人员的一般情况及住院患者护理满意度进行调查。结果住院患者的护理满意度与病房患护比、护士学历、职称、年龄、在编比例呈正相关,与医护比、床位使用率呈负相关。结论护理人力配置的变化影响住院患者的护理满意度,呼吁医院管理者应注重护理人力的合理配置,最大程度地保证护理安全,提高住院患者的护理满意度.     

The American Congress of Rehabilitation Medicine (ACRM) and rehabilitation research in a changing postacute landscape. The 2007 ACRM presidential address

DeJong G. The American Congress of Rehabilitation Medicine (ACRM) and rehabilitation research in a changing postacute landscape. The 2007 ACRM presidential address.Postacute rehabilitation is on the threshold of several major changes that have implications for rehabilitation practice and research. The most important of these is the desire of the Centers for Medicare & Medicaid Services to establish a uniform patient assessment method and implement a more setting-neutral prospective payment system across all major postacute settings. The proposed uniform patient assessment instrument will in all likelihood displace the FIM instrument as the industry standard. The rehabilitation research community needs to remain vigilant about the nature, scope, and measurement properties of the proposed uniform patient assessment instrument. A new instrument and setting-neutral payment system may provide new opportunities for service innovation and research. Neurorehabilitation has been one of the strengths of the American Congress of Rehabilitation Medicine (ACRM). ACRM needs to build on this strength and examine more earnestly the rehabilitation interventions and outcomes associated with the increasing prevalence of people with orthopedic and musculoskeletal conditions seen in rehabilitation centers today. ACRM’s ability to do so will depend in part on its ability to join forces with other professional and consumer organizations to increase research funding significantly for each of the major federal agencies that currently fund rehabilitation research.     

Coronavirus disease (COVID-19) prevention: Virtual classroom education for hand hygiene

Coronavirus disease (COVID-19), has spread rapidly in Asia, Europe, the Middle East and the Americas. Considering the recent outbreak of COVID-19, some precautionary measures have been announced, including campus class suspensions. Nursing campus courses have also been suspended, and there may be a learning gap between hand hygiene theory and clinical training for nursing students. A virtual classroom education approach may help address the learning gap by providing ongoing theoretical strengthening of hand hygiene during clinical nursing training. This editorial proposes a 3-step virtual classroom education approach to support nursing educators in online theoretical hand hygiene enhancement.     

Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department

Objectives

To evaluate the effect of introducing an extended scope physiotherapy (ESP) service on patient satisfaction, and to measure the functional outcome of patients with soft tissue injuries attending an adult emergency department (ED), comparing management by ESPs, emergency nurse practitioners (ENPs), and all grades of ED doctor.

Methods

The ESP service operated on four days out of every seven in a week in an urban adult ED. A satisfaction questionnaire was sent to all patients with a peripheral soft tissue injury and fractures (not related to the ankle) within one week of attending the ED. Patients with a unilateral soft tissue ankle injury were sent the acute Short Form 36 (SF‐36) functional outcome questionnaire, with additional visual analogue scales for pain, at 4 and 16 weeks after their ED attendance. Waiting times and time spent with individual practitioners was also measured.

Results

The ESP service achieved patient satisfaction that was superior to either ENPs or doctors. Overall 55% of patients seen by the ESP service strongly agreed that they were satisfied with the treatment they received, compared with 39% for ENPs and 36% for doctors (p = 0.048). Assessment of long‐term outcome from ankle injury was undermined by poor questionnaire return rates. There was a trend towards improved outcomes at four weeks in those patients treated by an ESP, but this did not achieve statistical significance.

Conclusion

Adding an ESP service to the interdisciplinary team achieves higher levels of patient satisfaction than for either doctors or ENPs. Further outcomes research, conducted in a wider range of emergency departments and integrated with an economic analysis, is recommended.     

Measurement properties of the National Institutes of Health Stroke Scale for people with right- and left-hemisphere lesions: further analysis of the clomethiazole for acute stroke study-ischemic (class-I) trial

OBJECTIVE: To assess the psychometric properties of the National Institutes of Health Stroke Scale (NIHSS) in people with either left or right acute hemisphere stroke for the purpose of improving the scale's sensitivity in detecting neurologic impairment. DESIGN: Secondary analysis of data from the Clomethiazole for Acute Stroke Study-Ischemic using the Rasch partial credit model. We evaluated the data's measurement properties using item-total correlations, Rasch item fit statistics, principle component analysis of standardized person and item residuals, differential item functioning, separation reliability, and the separation ratio. SETTING: Original data were collected in academic and community hospitals as part of a clinical trial. PARTICIPANTS: People with acute ischemic stroke who were seen within 12 hours of onset: 380 people with left-hemisphere stroke and 347 with right-hemisphere stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The NIHSS. RESULTS: Items of the NIHSS function differently in the right- and left-hemisphere lesion groups. We constructed for each group separate linear scales consisting of a subset of items of the NIHSS to improve its measurement properties. CONCLUSIONS: Our findings provide initial support for the use of individual, targeted scales for measurement of impairment after ischemic stroke. Low person separation reliability may be a consequence of the sample, which included only people with large ischemic cortical strokes.     

Psychometric Validation of the Manual Ability Measure-36 (MAM-36) in Patients With Neurologic and Musculoskeletal Disorders

Chen CC, Bode RK. Psychometric validation of the Manual Ability Measure-36 (MAM-36) in patients with neurologic and musculoskeletal disorders.

Objectives

To evaluate the psychometric properties of the Manual Ability Measure-36 (MAM-36), a new hand function outcome measure, and to examine differences in manual abilities and item parameters in patients with neurologic and musculoskeletal conditions.

Design

Convenience sample from 2 time periods, cross-sectional.

Setting

Outpatient rehabilitation units and private hand clinics.

Participants

Patients (N=337; mean age, 50.3±14.9y) with a variety of neurologic and musculoskeletal (orthopedic) diagnoses. Most of these individuals were community dwelling, and all had residual functional limitations in the hand(s).

Interventions

Not applicable.

Main Outcome Measures

Rasch analysis was performed on MAM-36 data to evaluate both scale structure and psychometric properties, which include rating distribution, step measures, item fit, separation, and dimensionality. A t test was performed to examine the differences in manual abilities in patients with the 2 conditions. Uniform differential item functioning (DIF) between neurologic and musculoskeletal groups was examined. (DIF occurs when subgroup members within the sample with the same level of the underlying trait being measured respond differently to an individual item.) Manual ability estimates were recalibrated with step and common item anchoring; they were compared with those derived from the original analysis.

Results

The 36 items measured a single construct with no misfitting items. The scale was used as intended. The items can reliably separate the participants into 5 ability strata. Neurologic patients had a significantly lower mean manual ability than musculoskeletal patients. Fourteen items exhibited DIF. However, DIF had no effect on either scale quality or calibration of manual ability. We decided that a single rating scale is appropriate for both groups.

Conclusions

This study showed that the MAM-36 has more than adequate psychometric properties and can be used as a generic outcome measure for patients with a wide variety of clinical diagnoses.     

Current prevention and control of health care-associated infections in long-term care facilities for the elderly in Japan

Residents of long-term care facilities for the elderly are vulnerable to health care-associated infections. However, compared to medical institutions, long-term care facilities for the elderly lag behind in health care-associated infection control and prevention. We conducted a epidemiologic study to clarify the current status of infection control in long-term care facilities for the elderly in Japan. A questionnaire survey on the aspects of infection prevention and control was developed according to SHEA/APIC guidelines and was distributed to 617 long-term care facilities for the elderly in the province of Osaka during November 2016 and January 2017. The response rate was 16.9%. The incidence rates of health care-associated infection outbreaks and residents with health care-associated infections were 23.4 per 100 facility-years and 0.18 per 1,000 resident-days, respectively. Influenza and acute gastroenteritis were reported most frequently. Active surveillance to identify the carrier of multiple drug-resistant organisms was not common. The overall compliance with 21 items selected from the SHEA/APIC guidelines was approximately 79.2%. All facilities had infection control manuals and an assigned infection control professional. The economic burdens of infection control were approximately US$ 182.6 per resident-year during fiscal year 2015. Importantly, these data implied that physicians and nurses were actively contributed to higher SHEA/APIC guideline compliance rates and the advancement of infection control measures in long-term care facilities for the elderly.Key factors are discussed to further improve the infection control in long-term care facilities for the elderly, particularly from economic and social structural standpoints.     

Suggestions for Refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): A Factor Analysis and Rasch Validation Study

Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): a factor analysis and Rasch validation study.

Objective

To perform a comprehensive psychometric analysis of Disabilities of the Arm, Shoulder and Hand (DASH) to examine its properties and provide insights for an improved version.

Design

Methodologic research on cross-sectional data from a convenience sample.

Setting

A free-standing rehabilitation center.

Participants

Outpatients and inpatients (N=238; 56% men; mean age, 52.2y) with upper-extremity musculoskeletal disorders.

Main Outcome Measure

The official Italian version of DASH was analyzed by factor (both explorative and confirmatory) and Rasch analysis for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices.

Interventions

Not applicable.

Results

Factor analysis established the presence of 3 underlying constructs related to manual functioning (items 1-5, 7-11, 16-18, 20, 21), shoulder range of motion (items 6, 12-15, 19), and symptoms and consequences (items 22-30). Rating scale diagnostics showed category malfunctioning. The fit to the Rasch model was good for all items except 4 (items 20, 21, 25, 26). Ten item pairs had high residual correlations after subtraction of the Rasch dimension (local dependency). A test model based on the 3 subscales suggested by factor analysis and corrected categories still showed misfitting in items 21 (“Sexual Activities”) and 26 (“Tingling”) and the presence of some dependent items.

Conclusions

Unidimensionality and the key domains identified by the original developers as the theoretic framework of DASH were not confirmed by our analyses. The response categories showed misfunctioning. “Sexual Activities” and “Tingling” misfit the Rasch model. Further detailed investigations of DASH are warranted, both to confirm these results in different health conditions and cultures, and to reanalyze in-depth content validity issues regarding the questionnaire.     

A comparison of disease-specific medical expenditures in Japan using the principal diagnosis method and the proportional distribution method

Background There are technical limitations to handling all the information mentioned in health insurance claims (HICs) in Japan. Therefore, conventional methods for estimating disease‐specific medical expenditures assume that all medical care expenditures in a given HIC are spent on only one principal diagnosis even when the HIC contains multiple diagnoses. Objectives To estimate the disease‐specific medical expenditures that consider all diagnosis on a given HIC. Methods Data were obtained from 169 622 outpatient HICs in May 2006 from health insurance provided by the employer. We compared the estimated disease‐specific medical expenditures of the conventional method with a proportional distribution method (PDM), which considers all diagnoses on the HICs. Results For diabetes mellitus and other diseases of the digestive system, the proportion of principal diagnoses among total diagnoses was 52.4% (4849/9251) and 19.6% (2614/13331), respectively. In addition, the ratio of the estimated disease‐specific medical expenditures between the conventional method and the PDM method was 1.49 for diabetes mellitus and 0.64 for other diseases of the digestive system. The estimation of disease‐specific medical expenditures using the conventional method may therefore have overestimated the expenditures on the disease category typically selected as the principal diagnosis and underestimated the expenditures on the disease category less likely to be selected as the principal diagnosis. Conclusions The conventional method for estimation of disease‐specific medical expenditures should be improved by utilizing all the diagnoses information on HICs.