3种评分系统在ICU护士个人管床分配中的应用及效果评价

Application and Effect Assessment of Three Scoring Systems in Allocation of Patients Responsible by ICU Nurses

目的探讨3种评分系统,即改良版护理活动评分系统、治疗干预评分系统-28、急性生理与慢性健康状况评分系统-IV比较预测重症监护室中每个护士在不同班次合理准确的患者管理数量,并评价其应用效果。为重症监护室护理管理者能够科学、准确、公平、公正的分配每个护士在各班次的患者管理数量提供参考依据。方法分别采用3种评分系统,于2016年12月—2017年6月对贵州省某大型三级甲等医院内的重症监护室共计360个班次的护理工作量进行评分,共评估患者330例,根据各量表的评估分数计算各班次每个护士合理的患者管理数量。结果改良版护理活动评分系统与治疗干预评分系统-28所评估得分差异有统计学意义(P<0.001);改良版护理活动评分系统在重症监护室护士的患者管理分配上优于治疗干预评分-28以及急性生理与慢性健康状况评分-IV,即改良版护理活动评分系统预测分数段在40.9～52.8可参考护患比为1.0∶2.5,分数段在52.9～62.3可参考1.0∶2.0,分数段在62.4～67.9可参考1.0∶1.5,分数段在68.0～98.4可参考1.0∶1.0。结论基础护理工作在重症监护室护理工作量中占有较大比例,改良版护理活动评分系统更好地反映了直接和间接护理工作量,包含了更详细的基础护理评分条目,且护患比计算方法相对简便,因此改良版护理活动评分系统对护理内容评估更广泛,在评估重症监护室护士的患者管理分配上更具有适用性。

Objective To explore the value of modified Nursing Activities Score（NAS）, Therapeutic Intervention Scoring System-28（TISS-28） and Acute Physiology and Chronic Health Evaluation（APCHE）-IV to predict the reasonable number of patients responsible by nurses in ICU, and to provide reference for scientific and flexible allocation of patients in each shift. Methods From December2016 to June 2017 of ICU, a total of 360 shifts of nursing workload in ICU in a third-level first-class hospital in Guizhou Province was assessed by using three scoring systems involving 330 cases of patients. The reasonable number of patients responsible by each ICU nurses was calculated by the scores predicted from 3 scoring systems. Results The score difference between the modified NAS and TISS-28 were statistically significant（P〈0.001） and the modified NAS was superior to TISS-28 and APCHE-IV regarding to the allocation of patients. When the score of modified NAS ranged from 40.9 to 52.8, the nurse-patient ratio could be 1.0 ∶2.5; when that from 52.9 to 62.3, the nurse-patient ratio 1.0∶2.0; when that from 62.4 to 67.9, the nurse-patient ratio 1.0∶1.5 and when that from 68.0 to98.4, the nurse-patient ratio 1.0∶1.0. Conclusion Basic nursing accounts for a large proportion of ICU nursing. With direct and indirect reflection of nursing workload, more detailed basic nursing items, simple nurse-patient ratio calculation method, modified NAS is effective for assessing the allocation of patients in ICU.