综合医院结合自理能力重新划分护理分级的探索性研究

The exploration research of reevaluated nursing classification combining with patients' self-care ability in general hospitals

目的:将临床患者病情级别和自理能力等级相结合,重新划分护理分级,并与目前护理分级进行比较,以探讨自理能力对综合医院护理分级的影响。方法:采用方便抽样法选取全国4个省市6家三级综合医院的1808例住院患者进行调查。结果:①结合自理能力重新划分后的护理分级与目前护理分级总体的不一致率为24.46%;②病情级别越低,两种护理分级的不一致率越高(χ2=15.525,P<0.001);③功能障碍越轻,两者的不一致率越高(χ2=38.511,P<0.001)。结论:重新划分的护理分级结合了客观的Barthel指数,更加科学合理,能更全面地反映患者需求,体现护理工作量,有利于护理人力资源的合理使用。两种护理分级间的不一致性,尤其是在普通患者和功能障碍较轻患者方面较高的不一致性,提示应在综合医院推广使用结合自理能力重新划分后的护理分级。

Objectives： To reevaluate nursing classification combining with patients＇ disease condition and self-care ability, to compare the new classification with current nursing classification, and to explore the impact of self-care ability on nursing classification in general hospitals. Methods： Totally 1808 inpatients from 6 Third Grade general hospitals in 4 provinces were investigated by self-designed questionnaire using convenience sampling method. Results： ① The non-conforming ratio between reevaluated nursing classification and current nursing classification was 24.34%; ② The lower the patients＇ disease condition was, the higher non-conforming ratio was （χ2=15.525, P0.001）; ③ The better self-care ability was, the higher non-conforming ratio was （χ2=38.511, P0.001）. Conclusions： Reevaluated nursing classification combining with objective Barthel Index is more scientific and reasonable. It can reply the total needs of patients, nursing workload and be helpful to allocate nursing manpower reasonably.The non-conforming ratio between two classification methods, especially those with better self-care ability, recommends that general hospital should widely use the reevaluated nursing classification combining with self-care ability.