| Objectives:1. To construct a nursing human resources allocation status questionnaire and nursing workload measurement framework which is suitable for Intensive Care Unit (ICU), in order to provide a scientific and effective tool for investigating the status quo of ICU nursing human resources allocation and measuring ICU nursing workload.2. To establish a mathematical model between allocation number of nursing human resources and Therapeutic Intervention Scoring System 28(TISS-28) according to ICU nursing hours measurement, TISS-28 scores assessment of the patients of ICU,and the number of nursing human resources allocation formula, so as to provide a basis for estimating the needs of nursing human resources validly, simply and rapidly.Methods:1. Preliminary drafted a ICU nursing human resources allocation status questionnaire,and the project framework of direct nursing, indirect nursing, and individual activities by literature review and field observation, then designed an"expert consultation questionnaire of ICU nursing human resources allocation status questionnaire and ICU nursing project framework", 10 nursing experts were selected from Level 3 hospitals in Kunming for two rounds of Delphi expert consultation Performed statistical analysis of the experts consultation results and the situation of appraisal experts, after that "ICU nursing human resources allocation status questionnaire","Direct nursing project framework of ICU","Indirect nursing project framework of ICU","Individual activities project framework of ICU" had been determined finally.2. Using the convenience sampling method to select a general ICU of a level 3 general hospital in Kunming as the research object, then using "ICU nursing human resources allocation status questionnaire" which is determined by Delphi experts consultation to survey the current situation of nursing human resources allocation of ICU.3. The in-service and on guard nurses of that slected ICU were treated as the research object, measuring the operation time of the direct nursing projects, indirect nursing hours and personal activities hours of the nurses. Each direct nursing project was measured 30 operating times, including the operating times that provided by nurses with different professional title for patients with different severity level, the average time of the 30 times is the operating time of the direct nuring project. Indirect nursing hours and individual activities hours were measured continuously from Monday to Sunday. Five weeks in June 2016 to August 2016 were sampled randomly, a total of 133 patients were treated in ICU in these five weeks, TISS-28 points and the number of operations of every direct nursing project of the 133 patients were recorded.Established the model between direct nursing hours and TISS-28 scores by Pearson linear correlation analysis and simple linear regression analysis, then constructed mathematical model between the number of nurses and TISS-28 points according to the number of nursing human resources allocation formula.4. Using Microsoft Excel 2010, Microsoft Word 2010 to set up a database, using SPSS 17.0 to perform statistical analysis. Using mean±standard deviation, frequency,composition ratio, rate for statistical description. The single factor analysis of variance, LSD-t test, S-N-K test, rank sum test and two independent samples t-test were used for statistical inference. Pearson linear correlation analysis and simple linear regression analysis were used for establishing the mathematical model. P<0.05 was statistically significant.Results:1. The Delphi expert consultation: (1) The positive coefficient of the experts was 100%, the personal authority coefficient of the experts are between 0.825 ～1,overall authority coefficient is 0.91. (2) Nursing human resources allocation status questionnaire of ICU including five parts: basic situation of the hospital (3 items),basic situation of the ward (4 items), the basic situation of the head nurse (7 items),the basic information about the nursing staffs (9 items) and the basic situation of the orderly (4 items). (3) Nursing project framework of ICU is divided into direct nursing framework (three first-level index, a total of 98 direct nursing projects), indirect nursing project framework (63 indirect nursing projects) and individual activities project framework (3 individual activities projects).2. Nursing human resources allocation status: (1) The actual bed nurse ratio of ICU is 1:1.83. (2) Rest coefficient of nursing staff is 1.398. (3) Nursing staffs aged between 26 to 30 accounted for the largest propotion, which is 57.14%, (4) Nursing staffs who worked less than 5 years accounted for 26.19%. (5) The ratio of nursing staffs with senior, medium-grade and junior professional title is 0:14.29:85.72. (6) Nursing staffs with college degree, bachelor degree are 47.62% and 52.38% respectively. (7) There are 5 male nurses of all the 42 nurses, the proportion of male nurses is 11.90%. (8)The ratio of in-staff and off-staff members are 28.57% and 71.43% respectively, the demission rate of the off-staff is 4.65% from 2013 to 2015, but there is no in-staffleft.(9) The professional title and the education level of the head nurse could be further improved. (10) All the nursing assistants are middage-aged female, who were normally without higher education.3. Nursing workload measurement and allocation model construction: (1) The most time-consuming direct and indirect nursing projects are hemodialysis and critically ill patient records list written separately. (2) The operating frequency of that nursing projects which associated with intravenous infusion is higher and also more time-consuming. (3) There is no difference among direct nursing hours, indirect nursing hours, and individual activities hours of per patient from Monday to Sunday.(4) Direct nursing hours and individual activities hours in the day-shift are higher than the night shift. (5) The proportion of direct nursing hours, indirect nursing hours, and individual activities hours are 55.25%, 36.46%, and 8.29% respectively, indirect nursing hour is higher. (6) The theoretical bed nurse ratio of ICU should be 1:3.2,nursers are in a state of overload. (7) The higher the TISS-28 points, the more direct nursing hours the patient needs. (8) The Pearson correlation coefficient between direct nursing hour and TISS-28 points is 0.811, the direct nursing hour had a positive correlation with TISS-28 scores. (9) The mathematical model is: the demand of nurses=(?)(42.5 × TISS- 28i - 124.3)/286,12 , TISS-28i means the TISS-28 score of theith patient, n maens the total number of the patients.Conclusions:1. With the development of the society, the requirements and the demands of patients are increasing, the number of nursing projects is also growing, and nursing project framework is also has a difference among different specialized wards, so it is necessary to define the nursing project framework of ICU.2. The "ICU nursing human resources allocation status questionnaire" and "ICU nursing project framework" which constructed by Delphi expert consultation are representative and effectiveness, they can be used for status investigation and nursing hour measurement.3. Nursing human resources allocation of the general ICU of a level 3 general hospital in Kunming has some problems, managers should increase the allocation number,optimize the allocation structure of nursing human resources, determine the entry criteria of the nursing assistant and imlplement team management of nursing assistant to improve the overall quality of nursing team more,in order to provide better service for patients.4. To measure time-consuming of every single nursing project could reveal specialized features of ICU. Nursing hours that ICU patients need have no difference between ordinary times and holidays, so managers should not blindly reduce the number of scheduling in holidays. Nursing hours of day-shift are higher than night-shift in ICU, therefore the number of scheduling of night-shift could be less than day-shift.5. Nursers are in a state of overload, Strengthen educational training of nursing staffs to replace quantity with quality, and using flexible shift arrangement system at the same time could ease the overload of nurses to a certain extent, but allocating reasonable nursing human resources based on the workload of the ward could only solve the problem foundamentally.6. The mathematical model between allocation number of nursing human resources and TISS-28 points that established through therapeutic intervention scoring system-28(TISS-28) and nursing hour measuring could predict the demand of nurses of ICU validly, simply and rapidly. It is convenient for the managers to manage nursing human resources dynamically so that the patients could obtain timely,accurately and safely nursing service better. |
PDF Full Text Request