应用不同量表测量市级医院ICU护理工作量的研究

目的 测量ICU护理工作量,为科学配置ICU护理人力资源和合理排班提供依据.方法 选择2011年7～9月入住自贡市第一人民医院ICU和第三人民医院ICU的患者,应用治疗干预评分系统28版(TISS-28)和护理活动量表(NAS)联合测量护理工作量,记录每班护士人数.结果 两种量表测量的周一至周日每天总的护理工作量比较和周一至周日每天人均护理工作量比较差异无统计学意义;不同班次护士的人均护理工作量比较和甲乙2所ICU满足工作需要的护患比比较差异有统计学意义.结论 ICU护理人员的排班应均衡到每一天、每一班.ICU护理人力的配置应以实际工作量测算为基础,不仅要考虑床位使用率、病种、病情、患者的自理能力和合作能力,还要考虑护士自身技能熟练程度.     

3种评分系统评估ICU护士个人管床数的研究

[目的]探讨治疗干预评分系统-28(TISS-28)、改良版护理活动评分量表(NAS)、急性生理与慢性健康状况评分系统Ⅳ(APACHEⅣ)对于重症监护室(ICU)护士管床分配的适用性。[方法]采用3种评分系统于2016年12月15日—2017年6月15日对贵州省某大型三级甲等医院ICU 180d360个班次的护理工作量进行评分,评估病人330例,收集量表14 355份,根据各量表的评估分数计算每个护士管理病人数量。[结果]3种评分系统评估得分差异有统计学意义(P0.001);改良NAS与APACHEⅣ评分呈正相关(P0.001);改良NAS在ICU护士病人管理分配方面优于TISS-28与APACHEⅣ,即改良NAS预测分数段在40.9分～52.9分可参考护患比为1∶2.5,52.9～62.4分可参考1∶2.0,62.4～68.0分可参考1∶1.5,68.0～98.4分可参考1∶1。[结论]NAS在计算护患比时更便捷,量表内容可直接反映护理工作量,改良NAS在评估ICU护士病人管理分配方面更具有适用性。     

治疗干预评分系统-28在ICU护理工作量评估中的应用研究

[目的]探讨治疗干预评分系统-28（TISS-28）在重症监护病房（ICU）护理工作量评估中的应用。[方法]应用TISS-28评分软件,选择ICU病人24h内病情最重时进行评分,并记录ICU每天护士岗位职数。[结果]每位病人每天TISS-28评分为29.11分±8.29分,ICU每天总的TISS-28评分为236.38分±73.75分,每天满足病人直接护理需要的护士岗位职数为17.87人±5.93人,而实际每天护士岗位职数为13.45人±2.70人;ICU护士每天人均TISS-28评分为52.84分±14.00分;1周中每天的总工作量比较差异无统计学意义（P〉0.05）,1周中每天护士人均护理工作量比较差异有统计学意义（P〈0.05）。[结论]TISS-28可准确、简便地测量ICU护理工作量,ICU护士处于超负荷工作状态,ICU护士人力资源现状与所需存在一定的差距。     

护理活动评分系统在ICU人力资源管理中的应用

目的探讨护理活动评分系统在ICU人力资源管理中的应用效果。方法采用护理活动评估量表（nursing activities scale,NAS）测量在本院ICU住院的149例病人的护理工作量,根据工作量计算护士人数,并预见性地合理安排每班护士人数。结果 ICU病人当天需要的护理工作量得分最低为30.50分,最高为129.70分,平均（53.23±18.12）分。所需护患比为1～2∶1的占了68.73%。实施护理活动评分系统后护理不良事件总发生率为18.12%,明显少于实施前33.12%,实施前后比较,χ2=8.909,P〈0.001,差异具有统计学意义。结论 ICU护士人力应以所收治病人实际需要的护理工作量进行动态合理分配。采用护理活动评分系统进行人力资源管理可提高ICU护理质量。     

智慧ICU平台下TISS-28和NAS评分在ICU护理工作量评估中的应用研究

目的:基于治疗干预评分系统-28(TISS-28)和护理活动评估量表(NAS)评分调查重症监护室(ICU)护理工作量现状,以期了解智慧ICU平台下护理人员护理工作量的分配情况。方法:检索国内外文献,基于TISS-28和NAS条目初步构建ICU护理工作量测量条目函询问卷,采用德尔菲法对来自10所综合性三级甲等医院的10名护理专家进行2轮专家函询,确定测量条目。在2周内采用现场实时测量法对4个外科重症监护室病人的护理工作量进行一对一跟随记录,并统计各类项目所占用的工时以及构成比。结果:2轮专家函询问卷有效回收率均为100%,2轮专家函询权威系数分别为0.89,0.91,最终确定了14类护理工作量测量条目。4个重症监护室占工作总时间比例较大的护理项目各不相同,其中护理评估、治疗项目、基础护理、器官支持及行政管理工作占比较高。4个监护室直接护理工时相较间接护理工时占比高。结论:通过ICU护理工作量的测量发现不同专科ICU护理工作量有差异,可为科学的护理人力资源配置提供参考。     

治疗干预评分系统-28在ICU护理工作量评估中的应用研究

[目的]探讨治疗干预评分系统-28(TISS-28)在重症监护病房(ICU)护理工作量评估中的应用。[方法]应用TISS-28评分软件,选择ICU病人24h内病情最重时进行评分,并记录ICU每天护士岗位职数。[结果]每位病人每天TISS-28评分为29.11分±8.29分,ICU每天总的TISS-28评分为236.38分±73.75分,每天满足病人直接护理需要的护士岗位职数为17.87人±5.93人,而实际每天护士岗位职数为13.45人±2.70人;ICU护士每天人均TISS-28评分为52.84分±14.00分;1周中每天的总工作量比较差异无统计学意义(P>0.05),1周中每天护士人均护理工作量比较差异有统计学意义(P<0.05)。[结论]TISS-28可准确、简便地测量ICU护理工作量,ICU护士处于超负荷工作状态,ICU护士人力资源现状与所需存在一定的差距。     

应用护理活动评估量表对ICU护理工作量的调查与分析

目的应用护理活动评估量表(NAS)评价ICU护理工作量,分析ICU护理工作量特征,为护理管理者合理配置人力资源提供依据。方法翻译英文版NAS,评价其信度、效度及文化相关性。2006年1～4月,对所有入住中国医科大学附属第一医院ICU的病人,应用NAS评价护理工作量。结果该院ICU病人因入住ICU时间不同、转归不同,其护理工作量也不同,并与疾病种类无关。结论中文版护理工作量评估表是一种具有较高信度和效度的ICU专用护理工作量评估量表,可以为护理管理者提供可靠的理论依据和数据支持。     

运用TISS-28评分系统评价外科ICU护理工作量的研究

目的分析外科ICU不同时间段的护理工作量,探索合理安排护理人力、提高护理效率的方法。方法应用TISS-28评分系统对北京市某综合医院外科ICU患者的护理工作量进行测定。结果护士人均工作量较大,为（61．31±6．71）分;各班次护士人均工作量存在差别,其中夜班护士人均工作量较高;1周护理工作量周三得分最高。结论应用TISS-28评分系统进行护理工作量测定,为护理人力资源有效管理提供了依据。     

护理活动评分表的信度和效度研究

[目的]翻译“护理活动评估量表”(NAS),评价其信度、效度及文化相关性,提供一种有效方便的护理工作量评估的中文版问卷。[方法]应用专家小组评定法进行问卷文化相关性、语言一致性及内容效度的评价。对126例重症监护病房(ICU)病人应用问卷对其结构效度进行评价,对其中30例病人进行重测信度评价。[结果]中文版NAS问卷中所有条目均具有较好的文化相关性,其中1个条目重新修订,且具有较好的信度和效度。因子分析显示中文版NAS具有与原英文版量表一致的结构效度。[结论]中文版护理工作量评估表是一种具有较高信度、效度的ICU专用护理工作量评估量表,可以为广大护理管理者提供可靠的理论依据和数据支持。     

ICU病人ABCD护理分级与人力资源分配有效性研究

目的 验证基于ABCD法的临床护理人力分配方法的有效性,在现有人力的基础上最大程度地满足病人的护理需求,提高护理人力的使用效率和临床护士对临床护理人力分配的满意度.方法 同时应用ICU病人ABCD护理分级和治疗干预评分简化版(TISS-28)评分进行研究资料收集,根据病人ABCD护理分级进行合理的床位分配,观察ABCD分级,病人所需的护理工作量与其同时进行的TISS-28评分是否呈正相关;干预方案使用前后护士满意度、患者并发症发生率的变化.结果 ABCD法能够有效地区分病人所需的护理工作量,与其同时进行的TISS-28评分呈正相关;使用干预方案前后护士满意度、患者并发症发生率均有明显差异,P＜0.05,差异有显著意义.结论 应用ICU病人ABCD护理分级进行护理人力资源分配,能均衡护士间的工作量,减少护士过重负荷的比例,提高护理人力的使用效率.     

Nursing activities score (NAS): A proposal for practical application in intensive care units

For over 30 years in an attempt to demonstrate the cost-benefit ratio of the intensive care unit (ICU) a variety of tools have been developed to measure not only the severity of illness of the patient but also to capture the true cost of nursing workload. In this context, the nursing activities score (NAS) was developed as a result of modifications to the therapeutic interventions scoring system-28 (TISS-28). The NAS is a tool to measure nursing workload ICU and it has been shown to be twice as effective in measuring how nurses spend their time caring for critically ill patients than the TISS-28. This paper discuss the introduction of the NAS into everyday use in an intensive care unit in Brazil and highlights the challenges of standardisation of operational definitions, training requirements and accurate completion of the documentation when using such a tool. The rationale and steps undertaken to achieve this are outlined and the benefits of such a process are highlighted.     

治疗干预评分系统在重症监护室护理人力资源配置中的应用

目的探讨治疗干预评分系统(therapeutic intervention scoring system-28,TISS-28)在重症监护室(intensive care unit,ICU)护理人力资源配置中的应用效果。方法 2011年4-5月,采用TISS-28对北京市某三级甲等医院神经外科、神经内科、胸血管外科、呼吸科、心脏科等5个ICU进行测评,每个月随机抽取1周(2个月共计14d)进行测评,共评估患者716例次合计1432个班次的护理工作量。结果 5个ICU工作总量由高到低依次为神经外科、神经内科、胸血管外科、心脏科、呼吸科,分别为(405.14±32.15)、(230.07±13.92)、(213.64±47.15)、(122.14±12.23)、(153.00±35.60)分;平均每班护士工作量由高到低依次为神经外科、呼吸科、胸血管外科、心脏科、神经内科,分别为(62.96±9.22)、(48.86±4.89)、(46.62±9.38)、(44.64±8.81)、(38.35±2.32)分。神经外科ICU护士缺编较为严重。结论部分ICU护士处于超负荷工作状态;护理管理者应合理有效地配置各ICU护理人力资源,以确保护理工作质量。     

Nursing Activities Score in the intensive care unit: analysis of the related factors.

BACKGROUND: High costs of intensive care as well as quality of care and patient safety demand measurement of nursing workload in order to determine nursing staff requirements. It is also important to be aware of the factors related to high patient care demands in order to help forecast staff requirements in intensive care units (ICUs). OBJECTIVES: To describe nursing workload using the Nursing Activities Score (NAS); to explore the association between NAS and patients variables, i.e. gender, age, length of stay (LOS), ICU discharge, treatment in the ICU, Simplified Acute Physiology Score II (SAPS II) and Therapeutic Interventions Scoring System-28 (TISS-28). METHODS: NAS, demographic data, SAPS II and TISS-28 were analysed among 200 patients from four different ICUs in a private hospital in S?o Paulo, Brazil. RESULTS: NAS median were 66.4%. High NAS scores (> 66.4%) were associated with death (p-value 0.006) and LOS (p-value 0.015). Logistic regression analysis demonstrated that TISS-28 scores above 23 and SAPS II scores above 46.5 points, classified as high, increased 5.45 and 2.78 times, respectively, the possibility of a high workload as compared to lower values of the same indexes. CONCLUSION: This study shows that the highest NAS scores were associated with increased mortality, LOS, severity of the patient illness (SAPS II), and particularly to TISS-28 in the ICU.     

Nursing workload in intensive care units: a study using the Therapeutic Intervention Scoring System-28 (TISS-28).

The Therapeutic Intervention Scoring System-28 (TISS-28) is an instrument that has been used to measure severity of illness and nursing workload in intensive care units (ICUs). OBJECTIVES: To characterize the severity of illness and nursing workload using the TISS-28 in 11 ICUs of a university hospital in the city of S?o Paulo, Brazil. METHODS: In a prospective study, data were collected from 271 patients admitted to the ICUs in December 2000 and the patients were followed up for 1 week. RESULTS AND CONCLUSIONS: Most of the patients were males (60.0%) and their mean age was 51(+20.6) years. Surgical treatment (66.8%) and admissions from the operating room were predominant. The mortality rate was 25.0% and the average length of stay was 7.7 (+10.4) days. The mean TISS-28 score was 23 (range: 14-32 points). The lowest mean score was observed for patients from the Burn ICU and the highest mean score was obtained for patients from the Liver Transplant ICU. A change in TISS-28 scores was observed in the same ICU over the 7-day study period. Units differed in terms of severity of illness and nursing workload. Patients who died received a higher TISS-28 score than patients who survived (p=0.00). As the nursing staff are the largest economic investment in an ICU, so measuring nursing workload in different ICUs from different centres can contribute to the estimation of nursing staff required according to the specific demands of the units.     

应用治疗干预评分系统评估肝胆外科监护室护理工作量的分析

目的运用治疗干预计评分系统对肝胆外科监护室护理工作量进行评估,对管理者合理排班提供指导意义。方法利用治疗干预评分量表-76每日分3个班次统计当班时患者病情最重时的评分,并统计1周不同工作日的治疗干预计评分系统总分,对1周不同工作日的总分及每个班次的治疗干预计评分系统评分进行比较。结果1周中不同工作日之间的护理工作量比较差异无统计学意义;白班与小夜班工作量差异无统计学意义(P0.05),白班与大夜班及小夜班与大夜班工作量差异有统计学意义(P0.01)。结论护理管理者应根据专科监护室的特点合理调整周末及夜班护理人力资源,以满足护理工作量需求。     

Validation of “nine equivalents of nursing manpower use score” on an independent data sample

Objective: To compare the recently developed “nine equivalents of nursing manpower use score” (NEMS) with the simplified Therapeutic Intervention Scoring System (TISS-28). Design: Prospective single centre study. Setting: Adult 30-bed medical-surgical intensive care unit (ICU) in a tertiary care university hospital. Patients: Data from all patients admitted in 1997 to the ICU were included in the study. Methods and results: NEMS and TISS-28 items were recorded prospectively for each nursing shift. There were three shifts per day. The Simplified Acute Physiology Score (SAPS) II was calculated for the first 24 h of ICU stay and each patient's basic demographic data were collected. The agreement between NEMS and TISS-28 was assessed by calculating the mean difference and the standard deviation of the differences between the two measures. Further, regression techniques and Pearson's correlation were used. Altogether, 2743 patients with a total of 28'220 nursing shifts were included; 62 % of the shifts were used for postoperative/trauma patients and 38 % for medical patients. Mean NEMS was 26.0 ± 8.1 and mean TISS-28 was 26.5 ± 7.9. The scores differed by K 3 points in 49 % of all shifts. The bias was −0.5 ± 5.3 (95 % confidence interval −0.47 to −0.60) and the limits of agreement were −11.1 to +10.1. The relation between the two systems was NEMS = 4.7 ± 0.8 · TISS-28 (r = 0.78, r ² = 0.62, p < 0.001). Including postoperative/trauma patients only: NEMS = 1.9 + 0.9 · TISS-28, for medical patients this equation was: NEMS = 6.0 + 0.8 · TISS-28. First-day SAPS II explained 11 % of the variability in first-shift NEMS and 5 % of the variability in first-shift TISS-28. Conclusions: This study confirms a good agreement between TISS-28 and NEMS in a large, independent sample. However, as shown by the differences between medical and postoperative/trauma patients, a change in case mix may result in different regression equations. Further, wide limits of agreement indicate that there may be a rather large variability between the two measures at the individual level. Received: 9 October 1998 Accepted: 16 March 1999     

护理分级影响因素的多分类Logistic回归分析

目的：探讨患者病情级别和自理能力对护理分级的影响。方法：采用方便抽样法,按照＂医院-病区-患者＂进行三级取样,选取6省市11家医院的120个病区共3171例住院患者,采用自设的＂患者护理分级调查表＂对其进行调查。结果：①病情级别（r=0.550,P〈0.001）、自理能力（r=0.619,P〈0.001）与护理分级呈正相关;②多分类Logistic回归分析显示,不同病情级别和中、重度功能障碍对护理分级均有影响（P〈0.01）,轻度功能障碍对特级护理无影响（P=0.082）。结论：在临床工作中,护理分级评定需全面考虑患者的病情和自理能力,以更好地适应临床护理工作的需要。