病人分类系统在优质护理服务病区护理人力资源配置中的应用

[目的]应用病人分类系统探索专科医院优质护理服务病区护理人力资源配置,为专科医院优质护理服务病区护理人力资源配置提供科学依据。[方法]2013年9月选择我院开展优质护理服务的肝病内科、肝胆外科、肝病产科、感染病科、肿瘤科5个病区的住院病人护理需求量及各班次护理人员每日护理时数作为研究对象。采用改良的罗斯麦迪可斯量表(RMT-PCS)调查,辅以工作参与法,计算出各病区病人24h的平均工作量指数、各病区病人疾病平均严重度,按照改良RMT-PCS量表护理人力分配比率计算出各病区所需护理人员数量。[结果]各病区由于病种不同,病人类别所占比例不同,病人严重度、每日平均工作量指数、每日所需护理时间均有不同。[结论]运用改良RMT-PCS量表对病人分类,建立专科医院的病人分类系统,为专科医院优质护理服务病区的护理人员配置提供科学依据,更加有利于护理管理,有利于为病人提供优质护理服务。     

运用病人分类合理配置外科病房护理人员的研究

目的探索外科病区护理人员的配置问题，建立适合临床实际的病人分类系统，为外科病区的护理人员配置提供科学依据。方法以2006年5月某院外科8个病区的住院病人护理需求量及各班次的护理人员每日护理时数作为研究对象。采用改良罗斯麦迪可斯量表——病人分类系统（RMT-PCS），用调查统计辅以工作参与法进行，计算出各病区每位病人24h的平均护理时数、需要的护理人数及各病区病人疾病平均严重度。结果各病区住院病人由于病种不同，病人类别所占比例明显不同，各类病人24h所需要的护理时数也不相同，第1类病人平均护理时数1．71h，第2类病人平均护理时数2．75h，第3类病人平均护理时数4．96h，第4类病人平均护理时数10．0h；各病房24h所需护理总时数为（第1类病人数×1.71）＋（第2类病人数×2.75）＋（第3类病人数×4.96）＋（第4类病人数×10．0）。按照RMT—PCS量表护理人力分配比率计算出各病区所需护理人员数量符合工作量和病人平均严重度的要求，避免了按床护比分配人员的缺陷。结论改良的RMT-PCS量表更符合国情，运用改良RMT-PCS量表对病人分类并建立病人分类操作系统，科学地配置护理人力，既有利于科学的护理管理，又有利于为病人提供优质高效的服务。     

应用因素型骨科病人分类系统进行护理人力资源配置的研究

目的 :建立因素型骨科病人分类系统,指导骨科护理人力资源科学配置。方法 :根据因素型骨科病人分类量表,对病人进行因素型分类,通过公式计算每类病人的护士配备系数,根据各病区病人分类情况,计算病区需要的护士人数。结果 :因素型骨科病人分类量表根据人均每日所需护理时间采用整数时数分割法将6个病区病人分为四类,护士配备系数分别为0.30、0.48、1.04、2.01,每个病区每日需配备的护士人数=(一类病人人数×0.30)+(二类病人人数×0.48)+(三类病人人数×1.04)+(四类病人人数×2.01);临床实际配备护士人数远远小于所需人数。结论 :因素型骨科病人分类系统的建立为病人客观归类提供了量化指标,可科学指导护理人力资源配置。     

患者分类量表在外科重症监护室护理人员配置中的应用

目的探讨修订版患者分类量表（RMT—PCS量表）在ICU护理工作量测量的应用,计算实际需要和动态需要护理人力,为科学合理的配备护理人员提供依据。方法于2010年4—7月在外科重症监护室（SICU）病区用随机抽签法抽取了20d的全部住院患者,共29位,151人次,用单盲法应用修订版患者分类量表进行记录,记录每位患者24h的护理需求量（护理活动项目及发生频数）,每人次为一份完整的记录表,并用SPSS11．0统计软件单因素方差分析。结果用患者分类量表测算护理工作量配备护理人力与用床护比配备护理人力差异有统计学意义（x^2=6．096,P〈0．05）;同一病区总床位不变而不同时间段其护理时数不同,所需护士数也不同。结论按修订版患者分类量表测算护理工作量实时配备护理人员较按照床护比规律循环配备人力科学,并为护理管理者提供科学的护理管理依据,避免人力资源浪费,把有限护理人力用于患者需要上,为患者提供优质高效的服务。     

因素型病人分类系统在骨科护理人力资源配置中的应用分析

[目的]构建因素型骨科病人分类系统,探讨其在骨科护理人力资源配置方面可行性及作用。[方法]依据RMT-PCS原始量表与郑州大学附属第一医院骨科实际护理诉求相结合,构建因素型骨科病人分类量表,此量表四部分为中心制定67个护理及相关项目,运用整数时数分割法将骨科病人分为4种类型病人进行分析。[结果]一类与二类病人比例为44.88%、49.77%,足踝病区一类病人比例为49.48%,关节外科病区比例为46.75%,二类病人在脊柱外科病区和骨病骨肿瘤病区比例依次为50.87%、48.63%;创伤绿色通道病区和脊柱外科病区病人以三类、四类为主。5个病区四类病人平均护理时数依次为(1.76±0.67)h、(2.79±0.53)h、(5.97±1.05)h、(12.14±1.34)h。护士配备系数依次为0.34、0.51、1.16、2.18。[结论]因素型骨科病人分类系统的护理配备系数为科学化的护理管理提供可靠依据,对医院护理人力配比指明方向。     

整体护理病区直接、间接护理时间的测算分析

目的进行整体护理病区护理人员工时的测定,了解临床护士工作时间消耗情况.方法用分层抽样的方法分别从内科、外科、干部病区及其他科中抽取30例病人,用单盲法对其每日的护理干预及各班次内容在调查表中予以记录并进行统计学分析.结果每位病人白斑平均的直接护理时间为88.4min,占58.08%.结论护理部有效的管理、相关部门及时的协调,建立有效的支持系统,从效益角度出发寻求管理途径,以尽可能减少护理人员的间接护理时间,增加直接护理时间,是缓解护理人员短缺的有效方法之一.     

贵州省中医医院开展优质护理服务护士配置情况的调查分析

目的通过动作时间测定法,测定贵州省不同等级中医院开展优质病房的护理人力资源配制,揭示我省中医院护理人员配备情况,为我省不同等级中医院配备护理人员提供参考依据。方法选取我省不同等级中医院三家,采用动作时间测定法,计算各级医院不同病区理想的护理人员配备。结果省级三甲医院护理人员配备明显不足,地区级二甲中医院基本满足要求,县级二级中医院能满足要求。结论贵州省不同等级中医院护士人力资源配置不能满足要求,需结合患者收治情况配备护理人员,才能满足优质护理服务要求。     

数据挖掘技术平台在护理质量综合评价中的应用

目的 应用数据挖掘技术,为护理质量评价建立分析平台。 方法 运用数据挖掘技术中的决策树分析法为病区护理质量考评构建兼顾护理人员能级配置、护理技术操作风险与护理工作数量负荷综合分析的等级评估平台。 结果 应用数据挖掘技术综合分析各病区护理工作量、护理技术操作风险与护理人员配置后,各病区被数据挖掘分析技术自动分为不同的病区集群,并以树型图的方式表达,护理管理者再在不同的病区集群中进行护理质量评价。 结论 运用数据挖掘技术平台能进行更为公平、公正地护理质量综合评价。     

病人分类系统应用于护理人力配置的研究进展

随着卫生系统改革,人们健康需求增加及医学快速发展,护理人员的配置越来越受到护理界重视,科学地进行护理人力配置是护理管理中重要的一环,是决定护理工作质量的重要因素。护理人员合理配置对提高整个卫生人力系统的利用效率起着重要作用。目前,应用病人分类系统进行护理人力配置是国外最普遍的人力配置的方法,这项研究已较为成熟,近年来,国内有许多护理管理者已开始关注护理人力测算这方面的研究,但少见将病人的分类系统研究与护理人力测算结合起来的报道。本文主要介绍病人分类系统的发展状况及其应用于护理人力配置的研究,以及我国在护理工作测量和护理人力配置方面的研究状况,并期待其在国内能够得到发展与应用。     

无陪护模式病区护理人力资源配置及工作满意度现状研究

[目的]了解无陪护模式病区护理人力资源配置现状,发现存在的问题,提出解决方案.[方法]采用自行设计的调查表,对30个无陪护模式病区及287名无陪护模式病区护理人员进行调查.[结果]无陪护模式病区护理人员学历结构、工龄结构配置合理,人员数量、职称结构、年龄结构、性别结构配置不合理,护理人员对职业满意度较低.[结论]合理配置护理人力资源有助于提高无陪护模式病区护理质量.     

整体护理病历中常见问题及分析

目的 探讨整体护理病历中存在的问题并分析其原因。方法 随机抽样整体护理病历60份,分为A组(工作5年以上护士书写)和B组(工作5年以下护士书写),每组病历30份,进行统计分析。结果 从护理资料收集、护理诊断及护理计划等方面,B组发生错误的百分率均高于A组,并以护理诊断最为明显。结论 加强护理诊断训练及年轻护士的培养和指导是提高整体护理病历质量的关键。     

Factors impacting on nurses’ transference of theoretical knowledge of holistic care into clinical practice

Since nurse education moved to universities, a reoccurring concern of health consumers, health administrators, and some practising nurses is that nurses are not able to transfer the theoretical knowledge of holistic care into practice. Much has been written about this concern usually under the heading of the theory–practice gap. A common reason that has been highlighted as the cause of this gap is that the theoretical knowledge that nurses learn in academia is predicated on concepts such as humanism and holistic caring. In contrast, the bureaucratic organisation where nurses provide care tends to be based on management concepts where cost containment and outcome measures are more acceptable. Hence nurses’ learned values of holistic caring are pitted against the reality of the practice setting. So what is this practice reality? This paper attempts to provide an insider view of why the theoretical knowledge of holistic care may be difficult to enact in the clinical setting. In-depth taped interviews with nurses and participant observation were conducted in acute care hospitals in Western Australia. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings indicated that utilitarian nursing and role models had impacted on the transference of theoretical knowledge of holistic care into practice. The paper outlines some measures that nurses themselves can undertake to ensure the narrowing of the theory–practice gap in this area.     

综合医院开展个性化护理的做法和效果

目的 :开展个性化护理 ,深化整体护理内涵。方法 :确立个性化护理服务理念 ,制定护理质量标准和目标 ;护理信息化管理及流程改造 ;建立护理支持系统 ,整合资源。结果 :个性化护理体现了整体护理的内涵和发展延续 ,护理满意率保持在 97%的高水平 ;为病人提供了既科学又能满足病人个性需求的安全护理 ,提高了护理工作自身的价值 ;信息化管理和护理支持系统的建立 ,提高了护理技术质量。结论 :实践证明个性化护理是先进的服务理念 ,是促进整体护理深化的重要内涵 ,符合医疗市场经济发展需求。     

Parish nursing: holistic nursing care in faith communities

Modern-day parish nursing is a specialized practice in professional nursing that addresses the spiritual, physical, and emotional health needs of clients within a faith community. Parish nursing care has been described as holistic care; however, few studies have focused on the holistic nature of parish nursing care. A qualitative study was conducted with the clients of parish nurses. Seventeen clients utilizing the services of 3 parish nurses in Christian faith communities participated in the study. Following the institutional review board approval, the clients were recruited with the assistance of the parish nurses. The clients completed a 7-item demographic questionnaire, followed by a face-to-face interview with the author who used a semistructured interview tool. The interview questions encompassed 6 aspects of parish nursing: education, personal counseling, health screenings, spiritual support, referrals, and health advocacy. The interviews were transcribed and analyzed by the author. The results of the study indicated that the clients in all 3 churches received holistic care from their parish nurses. The care they received addressed their spiritual, physical, and emotional health needs. Recommendations for future research and implications for the clinical practice of parish nursing, using a holistic approach, are included. The findings of future research and the holistic interventions of parish nurses could influence the funding and positions for parish nurses in the future.     

A concept analysis of holistic nursing care in paediatric nursing

Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative and contextual research design was used. An evolutionary concept analysis was undertaken to clarify the concept "holistic nursing care" in paediatric nursing in three Johannesburg hospitals. Rodgers' (1989, 2000) evolutionary method was utilised to analyse the concept. The study objectives were formulated in two phases to: --Conduct an analysis of the concept "holistic nursing care" --Obtain an emic viewpoint of holistic nursing care from paediatric nurses working in the academic hospitals. --Identify the characteristics and dimensions of "holistic nursing care" and develop a framework of holistic nursing care for paediatric nurses working in the academic hospitals. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-Spirit dimension. The decriptors of whole-person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual as a spiritual being with a mind-body-spirit dimension. Spirituality is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapeutic interventions that are directed to the mind-body-spirit dimension. Therapeutic interventions are designed to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has not been sufficiently investigated in child health care.     

Competence in providing mental health care: a grounded theory analysis of nurses' experiences.

OBJECTIVE: In view of the evidence that general nurses have difficulty in caring for patients experiencing mental health problems, the aim of this study was to explore and describe the subjective experience of nurses in providing care for this client group. DESIGN: A grounded theory approach was used. The data were collected via semi-structured individual interviews and analysed using the constant comparative method. SETTING: The study was conducted with nurses from general health care settings that provide medical and surgical care and treatment. SUBJECTS: Four nurses who were completing their second year post graduation participated in the study. MAIN OUTCOME MEASURE: The experiences of providing care for people experiencing a mental illness as described by participants. RESULTS: The findings indicated the nurses were striving for competence in the provision of mental health care. They acknowledged the mental health needs of patients and their right to quality care. CONCLUSIONS: This study supports the notion that general nurses lack confidence when caring for patients with mental health problems in medical and surgical settings. It also highlights a discrepancy between the holistic framework encouraged at undergraduate level and what is experienced in practice.     

奖金ABC制在护理管理中的应用

目的 :为充分调动模式病房护理人员的工作积极性和主观能动性 ,提高整体护理质量。方法 :设计考核内容及分值 ,每月对每位护士进行综合考核 ,将分值与奖金挂钩 ,奖金实行ABC制。结果 :护士的综合素质、病人的满意度和分级护理质量都有一定程度的提高。结论 :实行奖金ABC制可提高整体护理质量     

以整体护理观贯穿于护生带教实践

目的 :为了提高对护生的带教效果。方法 :通过更新护理和带教观念 ,充分发挥护生的积极性 ,指导护生实施护理程序。结果 :培养出了较高素质的护理人员。结论 :以整体护理观贯穿于护生带教实践 ,可以提高护生实习效果 ,并提高了护理质量。     

Holistic self care: strategies for initiating a personal assessment.

To be fully present for clients, occupational health nurses must assume responsibility for meeting their own self care needs. To promote holistic health care, occupational health nurses must assess personal values, priorities, and responsibilities. This can be accomplished by completing a personal assessment focusing on current use of holistic modalities. To implement a plan for holistic self care, nurses can write goals, set intentions, be open to holistic modalities, begin with small changes, recognize feelings, pay attention to breathing and self talk, simplify their lives, build support systems, and apply self care at work.     

Holism in community leg ulcer management: a comparison of nurses in Sweden and the UK

Collaboration between Kronoberg County Council and V?xj? University, Sweden, and Hull and East Riding Community NHS Trust and the University of Hull, UK, enabled an international comparison of care of patients with chronic leg ulcers in the two countries. An aim of the survey study was to compare what "holistic care" meant to nurses working in primary health care (PHC) and nursing home settings in Kronoberg County (KC) and the East Riding of Yorkshire and Hull (ER). A questionnaire, which obtained quantitative and qualitative data, was returned by 311 (222 completed) nurses in KC and 124 in ER (response rates of 54 and 50% respectively). Assessment and planning of wound management focused on the wound. Swedish nurses paid more attention to patients' experience of the wound, lifestyle factors and environment than UK nurses, but in both countries holistic care appeared to be lacking. Issues for nurse education concerning holistic care were identified. Revision of guidelines and consensus documents to facilitate holistic care is also suggested.