急诊病房护理工作负荷评估与护理人力资源配置的关系研究

Relationship between nursing workload and human resource allocation in emergency ward

目的结合急诊病房专科特点,探索急诊病房不同区域护理工作负荷与人力资源的关系,评价基于护理工作负荷的人力资源配置方法的效果。方法以医院信息系统医嘱平台为基础,调取2019年6月至12月急诊病房不同区域护理工作负荷项目,运用德尔菲法,由10名专家通过2轮问卷调查确立纳入护理项目指标,用负荷权重法确立护理项目权重,形成科室护理工作负荷计算公式,进行人力资源配置优化。比较实施前后急诊病房护理质量、不良事件发生率、医护及患者满意度。结果抢救室与观察室护理级别类(Z=8.571,P=0.010)、抢救类(Z=9.825,P=0.010)、治疗类(Z=10.182,P=0.014)、呼吸支持类(Z=6.000,P=0.019)护理单元工作当量比较差异均有统计学意义,观察室患者的护理工作量均低于抢救室。实施人力资源调整措施前、后半年科室上报的护理不良事件发生率由0.63‰(12/18864)下降至0.10‰(2/19805)(χ^(2)=4.183,P=0.002),调整后医护人员及患者的总满意度及满意度评分均较调整前明显提高(均P<0.001)。结论急诊病房不同护理区域在患者病情严重程度和护理工作量方面存在差异,尤其抢救室与观察室,人员配备应基于多种因素进行配比。基于科室护理工作负荷测算标准的护理人力资源配置优化方法可提高护理质量,减少不良事件发生,提高满意度,为三级医院急诊病房人力资源配置提供参考与借鉴。

Objective To explore the relationship between nursing workload and human resources in different areas of emergency ward according to the characteristics of emergency ward and to evaluate the effect of optimized nursing human resource allocation based on nursing workload.Methods The nursing workload items in different areas of emergency wards from June to December,2019 were retrieved from the doctors'order platform of Hospital Information System.Ten experts were investigated twice by questionnaire to identify the nursing procedures using the Delphi method.Researchers employed load weighting method to determine the weights of nursing procedures and find out the coefficient of workload in each area of emergency ward,the human resource allocation was optimized.The nursing clinical quality,incidences of adverse events,and patients'and nurses'satisfaction in the emergency ward before and after the implementation were compared.Results The workloads of nursing grade type(Z=8.571,P=0.010),rescue type(Z=9.825,P=0.010),treatment type(Z=10.182,P=0.014),and respiratory support type(Z=6.000,P=0.019)were higher in the rescue room than in the observation room.The incidence of nursing adverse events decreased from 0.63‰(12/18864)to 0.10‰(2/19805)(χ^(2)=4.183,P=0.002)and the nurses'and the patients'satisfaction increased significantly(all P<0.01).Conclusion There are differences in the severity and workload of patients in nursing areas of emergency ward,especially in rescue and observation rooms.The optimized nursing human resource allocation,which uses the coefficient of workload as the core measurement standard,can improve the nursing quality and nurses'and patients'satisfaction,and reduce adverse events,which provides references for nursing human resource allocation in emergency wards of tertiary hospitals.