陕西省护理人力资源现状调查与分析

目的了解陕西省护理人力资源现状,探讨护理人力资源与护理质量的关系。方法于2011年1月-2012年6月,应用护理人力资源问卷、护理差错问卷、病人满意度问卷,分别对陕西省二级及以上（专科医院及中医医院除外）的20家医院的1080名临床护士和620名住院病人进行调查。结果20家医院的平均医护比均低于国家标准;平均床护比基本达国家标准;护理人员编制严重不足,需要大量聘请合同制护士;高学历护理人员严重匮乏。相关关系分析显示,总护理差错与医护比未见相关,与床护比成正相关,与编制比和学历比成负相关;病人总满意度与医护比和编制比未见相关,与床护比成负相关,与学历成正相关。结论护理人力资源可对护理质量产生较大影响,加强护理人力资源配置并优化其结构可促进护理质量持续提高。     

三甲医院对“托管”二级医院实施护理管理改革的措施及效果

目的探索三甲医院对“托管”二级医院实施护理管理改革的有效措施。方法通过调研,结合当地医院实际,采取组织培训、对被托管医院的护理管理者及护理骨干轮换到托管医院进修学习、并由托管医院委派一名护理部副主任到被托管医院具体把关、沟通交流等措施,协助被托管医院建立健全各项规章制度,落实APN排班制度、大包干责任制,开展护士床边工作制,建立和完善护理质量标准体系与安全管理体系、护理质量持续改进的长效机制、护士培训体系等。提高被托管医院优质护理服务工作。结果被托管医院管理人员及患者的满意度调查结果显示,医院管理者、医生对护理工作满意度较以前提高,医护沟通协作密切,基础护理较以前到位,护士对护理工作总体感觉满意。病区管理质量、护士技术操作、护理文书质量、护理安全管理、护理服务满意度均优于实施前（P〈0．001）,差异有统计学意义。结论有效的托管能提高二级医院的护理水平,对提高区域内护理服务水平、将优质护理服务向三级医院靠近有着积极的意义。     

公立医院高质量发展背景下平台型领导对护士创新行为影响研究

目的: 为提高公立医院护士队伍创新绩效,提升护理服务质量,推动公立医院高质量发展,本文基于实地调研,系统探索公立医院护士长平台型领导风格促进下属护士创新行为的作用机制。方法: 采用方便抽样,对J省与N省三家公立医院428名护士进行问卷调查,并通过相关分析和回归分析对护士长平台型领导风格水平与护士工作繁荣、任务相关信息处理能力和创新行为间关系进行检验。结果: 护士长平台型领导风格可以通过提升下属护士任务相关信息处理能力和工作繁荣两重机制共同促进他们的创新行为。结论和建议:公立医院应通过加强各科室护士长平台型领导风格水平,鼓励其通过这一领导风格的发挥着力提升下属护士任务相关信息处理能力和工作繁荣水平,促进下属护士展现更多创新行为,最终实现公立医院护理服务质量提升和高质量发展。     

军队大型综合性医院护患沟通与患者信任度及满意度调查

目的：调查患者对军队大型综合性医院护患沟通质量的评价、患者对医院护理人员信任度和护患沟通满意度,验证三者之间的相关性及其作用机制,并据此提出相应的建议和对策,促进护患沟通、增进护患信任、改善医患关系,维护军队医院良好形象。方法随机抽取重庆市3所军队大型综合性医院住院患者300人,调查者采用自行设计的问卷对调查对象的基本情况、护患沟通质量、患者对医院护理人员信任度、护患沟通满意度进行调查。然后,运用统计软件 SPSS 对调查数据进行描述性统计分析、方差分析、相关分析和等级回归分析。结果护士总体沟通质量比较高,具体表现为沟通技能好和沟通内容丰富,患者的信任度和满意度高。方差分析结果显示年龄、性别、教育水平、职业、护理水平对信任度和满意度都没有影响;相关分析结果显示沟通技能、沟通内容、交流沟通、信任度、满意度两两相关;等级回归分析结果显示沟通交流能够直接影响满意度,还能够通过信任度间接影响满意度。结论护士掌握并灵活运用有效的沟通技能和丰富的沟通内容,能够获得患者的信任,从而提升其满意度。     

门诊自备药物注射风险的管理

目的探讨门诊自备药物注射过程中医、药、护三方合作,加强风险管理,确保用药安全。方法针对门诊自备药物注射中存在的医疗文书不规范,药品质量和规格问题,药物不良反应防范,传染病患者隔离等风险,医、药、护三方合作,采取有效的防范措施,制订合理的代注流程。结果通过三方合作管理,确保了用药安全。结论门诊自备药物注射存在各方面的风险,只有医、药、护三方紧密合作,才能有效地防范风险。     

手术室优质护理服务模式临床探索与实践

目的：探索手术室护理工作新模式,实现患者满意、家属满意、医护配合好（手术医生满意、麻醉医生满意）,体现护士价值。方法：采用建立健全护理工作规章制度、加强护理培训、护士分层管理、探索排班模式、建立完善绩效考核制度、改善手术室护理服务等方法。结果：手术室护理质量、护士综合素质有明显提升,手术患者、手术医生、手术室护士满意度明显提高。结论：开展优质护理服务,能够有效提升手术室护士综合素质和能力,提高手术室护理质量,实现了手术患者满意、手术医师满意、手术室护士满意的优质护理服务目标。该模式对手术室开展优质护理工作具有指导价值。     

Hospital staffing, organization, and quality of care: cross-national findings.

OBJECTIVE: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. DESIGN: Multisite cross-sectional survey. SETTING: Adult acute-care hospitals in the United States (Pennsylvania), Canada (Ontario and British Columbia), England, and Scotland. STUDY PARTICIPANTS: 10 319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Nurse job dissatisfaction, burnout, and nurse-rated quality of care. RESULTS: Dissatisfaction, burnout, and concerns about quality of care were common among hospital nurses in all five sites. Organizational/managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurse-assessed quality of care. Multivariate results imply that nurse reports of low quality care were three times as likely in hospitals with low staffing and support for nurses as in hospitals with high staffing and support. CONCLUSION: Adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.     

The relationship between hospital unit culture and nurses' quality of work life

Turnover rates for hospital nurses have been increasing in recent years, which is partially a result of increasing pressure on nurses from higher productivity expectations in a managed care environment. Improving nurse retention is a difficult challenge to managers since the bureaucratic cultural norm of hospitals, with its hierarchical structures, rules, and regulations, and heavy emphasis on measurement of outcomes and costs, may not be the culture most conducive to enhancing nurses' job satisfaction and commitment. Accordingly, this study investigates the relationships between unit organizational culture and several important job-related variables for nurse retention in the labor and delivery units of seven hospitals. Data analysis shows that unit organizational culture does affect nurses' quality of work life factors and that human relations cultural values are positively related to organizational commitment, job involvement, empowerment, and job satisfaction, and negatively related to intent to turnover. These findings suggest that although increasing recruitment of nurses and improved compensation and benefits strategies may offset hospital nurse shortages in the short term, improving quality of work life may be a more practical and long-term approach to improving hospital nurse retention.     

Predictors of Satisfaction With Doctor and Nurse Communication: A National Study

Prior research indicates that effective communication between medical providers and patients is associated with a number of positive patient outcomes, yet little research has examined how ecological factors (e.g., hospital size, local demographics) influence patients’ reported satisfaction with doctor and nurse communication. Given the current emphasis on improving patient satisfaction in hospitals across the United States, understanding these factors is critical to interpreting patient satisfaction and improving patient-centered communication, particularly in diverse and dense populations. As such, this study examined county-level data including population density, population diversity, and hospital structural factors as predictors of patient satisfaction with doctor and nurse communication. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), U.S. Census data, and number of hospital beds were obtained from publicly available Hospital Compare, U.S. Census, and American Hospital Directory websites, respectively. Multivariate regression modeling was performed for the individual dimensions of HCAHPS scores assessing doctor and nurse communication. Standardized partial regression coefficients were used to assess strengths of county-level predictors. County-level factors accounted for 30% and 16% of variability in patient satisfaction with doctor and nurse communication, respectively. College education (β = 0.45) and White ethnicity (β = 0.25) most strongly predicted a favorable rating of doctor and nurse communication, respectively. Primary language (non-English speaking; β = ?0.50) most strongly predicted an unfavorable rating of doctor communication, while number of hospital beds (β = ?0.16) and foreign-born (β = ?0.16) most strongly predicted an unfavorable rating of nurse communication. County-level predictors should be considered when interpreting patient satisfaction with doctor and nurse communication and designing multilevel patient-centered communication improvement strategies. Discordant findings with individual-level factors should be explored further.     

军队伤病员满意率调查

目的:开展军队伤病员满意率调查,不断提高对军队人员医疗保障质量和服务水平。方法:2006年两所三级甲等综合性医院1月1日至3月31日所有出院患者中检索出军队伤病员发放问卷调查表,并回收统计分析。结果:伤病员对“医师”、“护士”和“医疗质量”、“医德医风”的满意率较高,对“后勤保障”、“就诊便捷”、“军人优先”的满意率较低。讨论:要加强组织领导,提高为军队伤病员服务的自觉性;要改善医疗和后勤保障设施,优化就医环境;要发挥技术优势,提升综合服务质量。     

惠州地区综合医院与精神病医院护士流失情况探讨

目的通过比较惠州地区公立二级综合医院与二级精神病医院三年护士流失情况,分析精神病医院护士流失相关因素,初步探讨解决的对策,以巩固精神病医院的护士队伍。方法对惠州地区一所二级综合医院和一所二级精神病医院2010年6月～2013年5月三年来护士流失情况进行比较,并了解护士流失的相关原因。结果精神医院护士流失率比综合医院护士流失率高（p〈n05）;风危高、压力大、社会地位低、无成就感是精神病医院比综合医院护士流失率高的重要因素。结论应增加精神医院护士的风险防范措施,有效提高精神病医院护士的福利待遇,给予足够的情感支持,以稳定精神病医院的护士队伍,提高精神病医院的临床护理质量。     

Can doctors predict patients' satisfaction and enablement? A cross-sectional observational study

BACKGROUND: Patient satisfaction surveys are increasingly used to measure consulting quality and outcome, but little is known of how good doctors are at judging their patients' satisfaction with their consultations. OBJECTIVES: To determine if patient satisfaction and enablement following a consultation are correlated with both inexperienced and experienced doctors' predictions of patient satisfaction and doctors' own satisfaction with the consultation. METHODS: Design: Cross-sectional questionnaire-based observational study. Setting: Scottish general practices. Main outcome measures: Using a post-consultation questionnaire we compared doctors' estimates of patient satisfaction with the consultation; doctors' own satisfaction with the consultation; scores on the Patient Enablement Instrument (PEI) and the Consultation Satisfaction Questionnaire (CSQ). RESULTS: Twenty-nine doctors and 1848 patients took part. Each doctor recorded an average of 63.7 (SD: 32.1) consultations. Patient measures of satisfaction and enablement were only weakly correlated with doctor predictions of patient satisfaction (rs=0.07 for PEI and 0.13 for CSQ; both P<0.01) or doctor satisfaction (rs=0.10 for PEI and 0.12 for CSQ; both P<0.01) with the consultation. They were, however, moderately well correlated (rs=0.50 P<0.01) with one another. CONCLUSION: Doctors are poor at predicting patient satisfaction in the consultation. Further research is required to determine the reasons for this.     

东西部两所三甲医院护士现状满意度及比较研究

目的：研究东西部两所三甲医院（以下为两所医院）护士的现状满意度,以发现问题和寻找提高满意度的对策。方法：通过对两所医院328名护士采用问卷调查、自主发表意见形式,获得两所医院护士现状满意度和工作态度的资料。结果：在两所医院中,对工资和福利待遇的满意度分别为20.3%和34.6%,对工作环境与职业安全的满意度为45.9%和79.5%,对社会地位的满意度为35.5%和60.9%,对工作和精神压力满意度为4.1%和12.8%,差异均有统计学意义（P〈0.05）;获得学习提高机会的满意度为43.2%和25.6%,差异无统计学意义（P〉0.05）。两所医院60.0%以上的护士工作态度好和护理质量高,与患者的沟通和协调能力强。结论：两所医院护士对工作和精神压力、工资和福利待遇以及获得学习提高机会的满意度低。医院管理者可通过增加护理人员和提高福利待遇,以及增加学习提高的机会等措施,提高护士对现状的满意度。     

军队医院聘用护士睡眠质量及其影响因素调查

目的：调查军队医院聘用护士的睡眠情况及其影响因素,为改善护理人员的睡眠质量,提高工作绩效提供参考。方法随机抽取某三甲军队医院220名聘用护士,采用匹兹堡睡眠质量指数量表（ pittsburgh sleep quality index , PSQI）调查睡眠质量,用自制的调查表进行基本情况调查,分析其对睡眠质量的影响。结果①军队医院聘用护士PSQI总分为7．63±3．85;②军队医院聘用护士PSQI各因子中,以入睡时间延长为最高,占32．1％,以日间功能影响为最低,占15．7％;③职务、护龄、身体不适、环境因素和不良认知是影响军队医院聘用护士睡眠质量的最主要因素（P＜0．05或P＜0．01）。结论军队医院聘用护士存在不同程度的睡眠质量问题,加强心理健康教育,提高护理人员主人翁意识,有利于改善其睡眠质量。     

2019年我国公立医院患者满意度调查

目的调查我国公立医院患者满意度情况,为提高医院医疗服务质量提供依据。方法以微信为载体,调查2019年1月1日-12月31日全国二级及以上公立医院门诊和住院患者满意度。采用得分描述数据结果。结果共调查了7 145家二级及以上公立医院,共采集门诊患者有效样本262.10万份,住院患者有效样本276.21万份。门诊患者总满意度得分为84.69分,对“护士沟通”和“医生沟通”满意度相对较高,对“环境与标识”满意度最低;住院患者总满意度得分为90.18分,对“对亲友态度”“医务人员回应”“医生沟通”和“护士沟通”满意度相对较高,对“餐饮服务”满意度最低。不同地区、等级、类型医院患者满意度存在差异。结论我国公立医院患者总满意度较高,人文关怀得到加强。但后勤服务能力需进一步提升,妇幼保健院需进一步加强患者疼痛管理。     

"The nurse satisfaction,service quality and nurse retention chain": implications for management of recruitment and retention

This paper presents the findings of a qualitative study, based on interviews with over 130 nurses and midwives in four London Trust hospitals on: the main factors influencing nurse satisfaction and retention; empirical support for the robustness of a conceptual framework or model "the nurse satisfaction, service quality and nurse retention chain"; and some managerial considerations for recruitment and retention. The three main factors influencing job satisfaction were patients, the inherent characteristics of nursing and the nursing team; the two main sources of job dissatisfaction were staff shortages and poor management and amongst nurse retention strategies improving working conditions was more important than increased pay. For recruitment, as well as retention, improving the image and reputation of nursing along with improvements in work-life balance were pre-requisites for meeting the challenging target of an additional 20,000 nurses on the wards by 2004.     

2015年-2017年全国三级医院护理质量分析

目的分析2015年-2017年我国三级医院护理质量现状,为质量持续改进提供依据。方法从国家护理质量数据平台提取2015年-2017年护理质量相关数据,分析各指标数据的变化情况。结果（1）截止2017年,所有指标的完整性均超过98%。（2）床护比、护患比与24小时平均护理时数3项指标3年均保持相对稳定。（3）2015年-2017年三级医院本科及以上护士占比增长明显,3年增加8.12%;5年及以上年资护士占比稳步提升,3年增加5.36%;2015年-2017年三级医院护士离职率稳步下降,3年下降0.24%。（4）2015年-2017年三级医院住院患者身体约束率中位数分别为1.38%、1.36%、1.60%,呈现波动变化,2017年增长较为明显。（5）护士执业环境中的“医院管理参与度”“薪酬待遇”与“社会地位”等维度得分较低。结论（1）经过两年护理敏感质量指标理念与数据收集的培训,三级医院护理质量指标数据变异度逐渐减小,数据完整性与可靠性得到提升;（2）护理人员绝对数量的增加并未改善护理人员相对不足的现状;（3）护理人力结构得到优化,队伍稳定性增强;（4）约束、跌倒等指标逐年升高,侧面印证了数据上报文化逐步形成和数据逐渐趋于真实与可靠;（5）护士执业环境测评结果表明,薪酬待遇及社会地位是制约护理行业的关键因素。     

江苏省乡镇卫生院卫生人力资源现状分析

目的 对江苏省乡镇卫生院的卫生人力资源现状进行分析,为加强基层卫生人才队伍建设提供参考依据。方法 采用分层随机抽样,根据地域及经济发展水平,按苏南、苏中、苏北将江苏省分成3个不同经济发展地区,随机抽取257个乡镇卫生院,自行设计调查问卷,对抽取的乡镇卫生院卫生人力资源现况进行调查。结果 江苏乡镇卫生院平均有在岗职工87.94人,其中卫生技术人员75.32人,每千人卫生技术人员为1.62人,每万人口全科医生数3.73人。执业（助理）医师中级及以上职称占53.40%,本科及以上学历占38.43%,公共卫生人员3.33人,检验技师(士)3.23人,注册护士24.00人,医护比1∶0.70。苏南的卫生技术人员数、执业（助理）医师数、家庭医生团队数、岗位培训人次数均高于苏中和苏北（P＜0.05）。结论 江苏省乡镇卫生院卫生、卫技人员总量比较充足,但岗位分布不合理,公共卫生人员、护士和医技人员短缺,且地区差异明显。     

The association between maternal ratings of child health interviews and maternal and child characteristics

BACKGROUND: Doctors develop the skills needed to interview parents and children in paediatric settings by practice and by receiving feedback during their medical training. Interviewed parents are ideally placed to provide evaluations of these skills. If parents, as consumers of health care services, are to be consulted, it is important to determine whether factors other than interview skills affect their evaluations. OBJECTIVES: Our aim was to examine the relationship between maternal satisfaction ratings of student doctor interviews, and maternal and child characteristics. METHODS: Sixty mothers of children attending the paediatric medical out-patient clinic at the Women's and Children's Hospital, South Australia were allocated randomly to rate one of four video-taped final year student doctor interviews (15 mothers per interview). The level of skills displayed by the student doctor differed in each interview. Maternal satisfaction was measured using the Medical Interview Satisfaction Scale (MISS) and the Interpersonal Skills Rating Scale (IPS), and interview ratings were compared for a number of maternal and child characteristics. RESULTS: No significant associations were observed between maternal satisfaction ratings and any maternal or child characteristics other than lower satisfaction associated with previous experience of a real student doctor interview (P <0.01). The interview seen by mothers predicted 53% (MISS) and 65% (IPS) of the variance in maternal satisfaction ratings. After controlling for the interview type, the maternal and child characteristics studied predicted 17% additional variance in MISS scores and 7% in IPS scores. CONCLUSION: The quality of the interview skills demonstrated was the principle determinant of maternal satisfaction ratings.     

Consultants' attitudes to clinical governance: barriers and incentives to engagement

OBJECTIVE: To explore medical specialists' attitudes to clinical governance in acute hospitals and factors influencing these attitudes. METHODS: A semi-structured interview study with a purposeful sample of 24 medical specialists from two contrasting hospitals. Hospital A had a low level of consultant involvement in quality improvement initiatives and Hospital B had higher levels of engagement. RESULTS: Specialists from both hospitals acknowledged that quality improvement was a major part of their role. Among specialists from Hospital A, the lack of a commonly held focus on quality-improvement, poor inter-professional relationships and little clinical engagement in management were the main factors generating negative attitudes towards clinical governance. Effective communication of the hospital's goal of continuous quality improvement to all staff groups, a sense of being able to get issues affecting the quality of care heard by senior management, and a perception that there were clear structures and processes to support clinical governance, were factors that resulted in a more positive attitude to clinical governance among specialists in Hospital B. Specialists from both hospitals identified lack of time across all professional groups and availability of accurate data as barriers to involvement in clinical governance activities. CONCLUSION: The cultural context, level of technical support available, ability to communicate clear goals and strategies and the presence of structures to support delivery, all contribute to shaping specialists' attitudes to clinical governance and in turn influence levels of engagement and ultimately the success of quality improvement initiatives.