分级护理制度服务内容标准研究
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摘要
目的
分级护理制度是医院的一项重要的护理制度,在医院临床护理和护理管理中发挥了重要作用。然而,随着护理学科的发展,分级护理制度服务内容的陈旧和不完善日益暴露出种种问题,产生了一些负面影响和不良后果,影响了分级护理服务质量,从某种程度上制约了护理学科的发展。本课题通过对分级护理制度服务内容标准进行研究,进一步规范了分级护理服务内容和执行标准,完善了分级护理制度体系。
对象与方法
1.第一部分分级护理服务内容实施现况调查
采用分层抽样的方法,抽取广州市某三级甲等医院的内外科各4个普通成人病区的患者和护士为调查对象。通过直接观察法记录如下内容(1)每个病区每天各级护理患者数量。(2)各病区主班(包括大/小夜班和白班、责任班、治疗班、)护士白天10h(8:00～18:00)即日班的护理工作量,包括为患者提供的所有护理项目及实施各项目所花费的时间(时间用秒表测量);每天记录一个班次。(3)每个病区随机选择一级、二级、三级护理病人各4人,记录其日班得到的所有护理项目及对应的时间(时间用秒表测量)(4)各病区护理人员日班期间对每位患者的巡视情况。每个病区调查1周;随机数字表法确定每天调查的内容。汇总调查结果后进行分析。
应用Excel文档、SPSS13.0统计软件建立数据库,进行统计与分析。计量资料采用描述性统计分析、One-Way ANOVA(多重比较采用Bonferroni法)、Two-Way ANOVA(多重比较选择SNK法)。计数资料采用构成比描述、行×列表的χ~2检验,检验水准α=0.05。
2.第二部分分级护理制度服务内容新标准的确立
在现况调查的基础上,回顾文献,访问专家,制定专家咨询问卷。通过Delphi法向全国14个省市27家三级医院的35名护理专家发放问卷。经过三轮专家咨询,从专业角度界定一级、二级和三级护理应包含的护理项目、每一项目最少执行频次和最低资质执行人员。
应用SPSS13.0统计软件建立数据库,进行数据的录入、统计与分析。统计方法包括描述性统计分析、多个相关样本的Kendall's W非参数检验,检验水准α=0.05。
结果
1.一周内,八个病区各级护理患者共计436例,其中一级护理155例(35.55%),二级护理278例(63.76%),三级护理3例(0.69%)。
2.应用行×列表χ~2检验各病区各级护理患者数量构成比,结果显示各病区一级、二级护理患者构成比有显著性差异(Pearsonχ~=106.416,P=0.000(双侧))。各病区一级护理患者所占比例为11.1%～100%,二级护理患者所占比例为42.5～82.2%,仅有一个病区有三级护理患者,数量占该病区患者总数的6.7%。
3.各病区各级护理患者日班得到的平均护理时间:一级护理为24.61min,二级护理为12.34min;各病区各级护理患者日班得到的分级护理平均时间:一级护理为12.32min,二级护理为4.81min;分级护理时数占护理总时数比例:一级护理为50%,二级护理为39%。
4.日班10h内,各病区间在执行分级护理所用时间上无显著性差异(F=1.149,P=0.344),而各班次间执行分级护理时间有显著性差异(F=163.086,P=0.000)。应用SNK进行多重比较,结果显示责任班护士执行分级护理时间显着高于其它班次护士。
5.通过记录各班次护士所执行的分级护理内容,得到临床实践中分级护理的执行项目和频次。结果与现行分级护理制度服务内容相比,项目增加较多,内容更新较快,执行频次亦更加明确。
6.各病区对患者的定时巡视是通过输液巡视的方式完成的。采用One-WayANOVA结果显示,八个病区日班护士对患者的输液巡视间隔时间存在显着性差异(F=17.750,P=0.000);多重比较(Bonferroni法)结果显示,心内科和神经外科与其它六个病区均有显着性差异,而二者之间无显着性差异(P=1.000),其余六组间均无显着性差异。
7.采用咨询问卷应用Delphi法对分级护理服务内容进行了3轮专家咨询,结果显示:研究选择的专家来自全国14个省市的27所医院及学校,具有较好的代表性;各轮有效回收率均大于85%,充分反映了专家们对本研究的关心和支持;专家对评价指标的权威系数平均在0.86以上,说明咨询结果可信;一、二、三级护理项目协调系数均具有统计学意义(P＜0.001),说明专家在确定各级护理项目上意见协调性好,预测结果可取。专家咨询结果最终确定一级护理32项,二级护理23项,三级护理19项;并确定了各级护理项目最少执行频次和最低资质执行人员。根据专家意见确定的最低资质执行频次即具有确定性又具有灵活性,以便于对患者进行常规护理和个性化护理。而对执行人员最低资质的确定是对护理人员分层级管理做出的有益尝试和探讨。
结论
1.一、二级护理患者所占比例大,三级护理护理患者所占比例甚少。
2.患者得到的分级护理时间占总护理时间的比例表明护理工作至少有一半的时间在执行医嘱;各班次间执行分级护理时间有显著性差异,以责任班护士执行分级护理内容为主。与当前分级护理制度服务内容标准相比,临床实践中执行的项目较多,内容更新较快,执行频次亦较明确,但是尚未形成完整的体系,仍未规范化。
3.一级护理巡视要求在临床实践中难以有效实施;临床实践中对患者的定时巡视是通过输液巡视的方式完成的;但是输液巡视存在不可忽视的弊端,它仍无法替代分级护理制度对患者实施的更全面的巡视要求。
4.应用Delphi法初步确立了分级护理制度服务内容标准,此标准基于对分级护理临床实践的调查,与原标准相比,增加了即体现患者需求又体现护理专业价值的项目,具有较大的实践指导意义。通过确定项目最低执行频次,使新的标准具有可操作性。通过确定各级别各项目最低资质执行人员,意在为护理人员的分层级使用和管理提供依据。此标准对完善分级护理制度体系具有积极而深远的影响。
Objective
The grading nursing system,an important part of the nursing system,played a crucial role in clinical nursing work and nursing management.However,with the development of nursing,many problems appeared in the content and during performing the system,which resulted in some negative effects and harmful consequences.All these decreased the service quality of grading nursing and restricted the development of nursing discipline.The present theme studied on the content standard of grading nursing system,which intended to contribute to the consummation of the system for practical use.
Methods
1.The cross-sectional investigation of the implementation of grading nursing system
With stratified sampling,patients and nurses in eight departments were chosen in a GradeⅢ-A General Hospital in Guangzhou as studying objects.Using the method of direct observation,(1) Recorded the number of in-patients of every grade of grading nursing system in every ward.(2) Noted the day-nursing workload of the four shifts of nurses during 8:00-18:00.The contents included all items and the corresponding time of each item which the four shifts of nurses supplying to the patients.(3) Randomized chose four patients of each grade in every chosen department and recorded all the items and the corresponding time of each item they got during daytime.(4) Collected datas about the round time of grading nursing system during the time 8am and 6pm.Every department was investigated for a week, and each task was collected randomly for every day.
The software SPSS for Windows,version 13.0 for personal computers and Excel 2003 in office 2003 were used for statistical activity.Statistical methods including descriptive statistics analysis,One-Way ANOVA,Two-Way ANOVA,Bonferroni and SNK for multiple comparisons were used for measurement data.And constituent ratio, R×C Chi-Square test for numeration data.The statistical significance was set at a level ofα=0.05.
2.Establish the new Content Standard of Grading Nursing System
Based on the results of the above investigation,reviewing references and interviewing nursing experts,expert consultation questionnaires were made.By Delphi method,35 nursing specialists in 27 GradeⅢhospitals from 14 provinces and cities were investigated for three rounds,which mainly for the basic service items of each nursing grade,the least frequency in each item and the bottom qualification line of nurse to perform each item.
The software SPSS for Windows,version 13.0 for personal computers was used for statistical activity.Statistical methods included descriptive statistics analysis,K related sample nonparametric test.The statistical significance was set at a level ofα=0.05.
Results
1.There were 436 patients totally in the 8 departments during a week,including 155(accounting for 35.55%),278(63.76%) and 3(0.69%) respectively in gradeⅠ, gradeⅡand gradeⅢ.
2.With the statistical method of R×C Chi-Square test,there were significant deviation among the 8 departments in the constituent ratio of each grade(P=0.000). The ratios for the patients of gradeⅠin 8 departments were from 11.1%to 100%, while gradeⅡwere from 42.5%to 82.2%.Only a department had gradeⅢpatients, and the ratio was 6.7%in that department.
3.The average nursing service time during a day which the patients got in 8 departments was as follows:24.61min for GradeⅠand 12.34 min for GradeⅡ.. While the average grading nursing time during a day were 12.32(accounting for 50%) for gradeⅠ.And 4.81 min(39%) for gradeⅡ.
4.There was no statistical differences in time for daytime nurses performing for grading nursing service in the 8 departments in daytime(P=0.344).However,there was significant deviation among the time offered by different shifts of nurses (P=0.000).With SNK for multiple comparisons,the time which the duty-shift nurse offered to patient was significantly higher than other shifts of nurses did.
5.From the collecting data of the nurses performing for grading nursing system, the items and the frequency with each item were organized.Comparing with the old content standard of grading nursing system,there were many changes and improvements both in the items and the corresponding frequency of each item.
6.The transfusion round time was the mainly way serving for patient instead of the provided time in grading nursing system for each grade.With One-Way ANOVA for analysis,there was significant differences of the transfusion round time in 8 departments(P=0.000).Using SNK for multiple comparison found that the transfusion round time in the department of cardiology and neurosurgery were significant different with other 6 departments.However,there were no significant differences between the two departments,as well as the other 6 departments in transfusion round time.
7.The results of expert-consultation by Delphi method showed that:Firstly there was great representativeness as the responding experts coming from 27 hospitals in 14 provinces and cities.Secondly,the percentages of questionnaire received from the three rounds of experts were more than 85%,which showed enthusiasm and support of the theme from the experts.Thirdly,the average authority coefficient was more than 0.86 which showed that the consulting results were reliable. Fourthly,the coefficients of Kendall's W of the consultation in items of each grade were statistical differences,which provided sufficient evidence of high consistency among experts opinions.Fifthly,experts made the eventual determination of items in each grade,those were 32,23 and 19 items for gradeⅠ,ⅡandⅢrespectively. Meanwhile,the least frequency in each item and the bottom qualification line of the nurse to perform each item were established,which were more practical.
Conclusions
1.The patients quantity of gradeⅠandⅡis great respectively,while that is small in gradeⅢ.
2.The ratios of grading nursing time patients got in daytime accounting for total nursing time are small.This shows that more than half of the total time nurse serving for patients is used to perform medical orders.And the duty-shift nurse is the mainly performer of grading nursing service content.While,comparing with the old content standard of grading nursing system,there are many changes and improvements both in items and the corresponding frequency of each grade.But that is not an integrated system for practice.
3.It is difficult to implement the round time standards of the old grading nursing system for practice.As a special kind of round time,there are two sides of transfusion round time,and it could not replace the round time standards of grading nursing system.So,it is important to improve the round time standard in the new content of grading nursing system.
4.The new content standard of grading nursing system by Delphi method is good to practice.The items,the least frequency in each item and the bottom qualification line of the nurse to perform each item established in each grade are greatly meaningful and practical.
分级护理制度是医院的一项重要的护理制度,在医院临床护理和护理管理中发挥了重要作用。然而,随着护理学科的发展,分级护理制度服务内容的陈旧和不完善日益暴露出种种问题,产生了一些负面影响和不良后果,影响了分级护理服务质量,从某种程度上制约了护理学科的发展。本课题通过对分级护理制度服务内容标准进行研究,进一步规范了分级护理服务内容和执行标准,完善了分级护理制度体系。
对象与方法
1.第一部分分级护理服务内容实施现况调查
采用分层抽样的方法,抽取广州市某三级甲等医院的内外科各4个普通成人病区的患者和护士为调查对象。通过直接观察法记录如下内容(1)每个病区每天各级护理患者数量。(2)各病区主班(包括大/小夜班和白班、责任班、治疗班、)护士白天10h(8:00～18:00)即日班的护理工作量,包括为患者提供的所有护理项目及实施各项目所花费的时间(时间用秒表测量);每天记录一个班次。(3)每个病区随机选择一级、二级、三级护理病人各4人,记录其日班得到的所有护理项目及对应的时间(时间用秒表测量)(4)各病区护理人员日班期间对每位患者的巡视情况。每个病区调查1周;随机数字表法确定每天调查的内容。汇总调查结果后进行分析。
应用Excel文档、SPSS13.0统计软件建立数据库,进行统计与分析。计量资料采用描述性统计分析、One-Way ANOVA(多重比较采用Bonferroni法)、Two-Way ANOVA(多重比较选择SNK法)。计数资料采用构成比描述、行×列表的χ~2检验,检验水准α=0.05。
2.第二部分分级护理制度服务内容新标准的确立
在现况调查的基础上,回顾文献,访问专家,制定专家咨询问卷。通过Delphi法向全国14个省市27家三级医院的35名护理专家发放问卷。经过三轮专家咨询,从专业角度界定一级、二级和三级护理应包含的护理项目、每一项目最少执行频次和最低资质执行人员。
应用SPSS13.0统计软件建立数据库,进行数据的录入、统计与分析。统计方法包括描述性统计分析、多个相关样本的Kendall's W非参数检验,检验水准α=0.05。
结果
1.一周内,八个病区各级护理患者共计436例,其中一级护理155例(35.55%),二级护理278例(63.76%),三级护理3例(0.69%)。
2.应用行×列表χ~2检验各病区各级护理患者数量构成比,结果显示各病区一级、二级护理患者构成比有显著性差异(Pearsonχ~=106.416,P=0.000(双侧))。各病区一级护理患者所占比例为11.1%～100%,二级护理患者所占比例为42.5～82.2%,仅有一个病区有三级护理患者,数量占该病区患者总数的6.7%。
3.各病区各级护理患者日班得到的平均护理时间:一级护理为24.61min,二级护理为12.34min;各病区各级护理患者日班得到的分级护理平均时间:一级护理为12.32min,二级护理为4.81min;分级护理时数占护理总时数比例:一级护理为50%,二级护理为39%。
4.日班10h内,各病区间在执行分级护理所用时间上无显著性差异(F=1.149,P=0.344),而各班次间执行分级护理时间有显著性差异(F=163.086,P=0.000)。应用SNK进行多重比较,结果显示责任班护士执行分级护理时间显着高于其它班次护士。
5.通过记录各班次护士所执行的分级护理内容,得到临床实践中分级护理的执行项目和频次。结果与现行分级护理制度服务内容相比,项目增加较多,内容更新较快,执行频次亦更加明确。
6.各病区对患者的定时巡视是通过输液巡视的方式完成的。采用One-WayANOVA结果显示,八个病区日班护士对患者的输液巡视间隔时间存在显着性差异(F=17.750,P=0.000);多重比较(Bonferroni法)结果显示,心内科和神经外科与其它六个病区均有显着性差异,而二者之间无显着性差异(P=1.000),其余六组间均无显着性差异。
7.采用咨询问卷应用Delphi法对分级护理服务内容进行了3轮专家咨询,结果显示:研究选择的专家来自全国14个省市的27所医院及学校,具有较好的代表性;各轮有效回收率均大于85%,充分反映了专家们对本研究的关心和支持;专家对评价指标的权威系数平均在0.86以上,说明咨询结果可信;一、二、三级护理项目协调系数均具有统计学意义(P＜0.001),说明专家在确定各级护理项目上意见协调性好,预测结果可取。专家咨询结果最终确定一级护理32项,二级护理23项,三级护理19项;并确定了各级护理项目最少执行频次和最低资质执行人员。根据专家意见确定的最低资质执行频次即具有确定性又具有灵活性,以便于对患者进行常规护理和个性化护理。而对执行人员最低资质的确定是对护理人员分层级管理做出的有益尝试和探讨。
结论
1.一、二级护理患者所占比例大,三级护理护理患者所占比例甚少。
2.患者得到的分级护理时间占总护理时间的比例表明护理工作至少有一半的时间在执行医嘱;各班次间执行分级护理时间有显著性差异,以责任班护士执行分级护理内容为主。与当前分级护理制度服务内容标准相比,临床实践中执行的项目较多,内容更新较快,执行频次亦较明确,但是尚未形成完整的体系,仍未规范化。
3.一级护理巡视要求在临床实践中难以有效实施;临床实践中对患者的定时巡视是通过输液巡视的方式完成的;但是输液巡视存在不可忽视的弊端,它仍无法替代分级护理制度对患者实施的更全面的巡视要求。
4.应用Delphi法初步确立了分级护理制度服务内容标准,此标准基于对分级护理临床实践的调查,与原标准相比,增加了即体现患者需求又体现护理专业价值的项目,具有较大的实践指导意义。通过确定项目最低执行频次,使新的标准具有可操作性。通过确定各级别各项目最低资质执行人员,意在为护理人员的分层级使用和管理提供依据。此标准对完善分级护理制度体系具有积极而深远的影响。
Objective
The grading nursing system,an important part of the nursing system,played a crucial role in clinical nursing work and nursing management.However,with the development of nursing,many problems appeared in the content and during performing the system,which resulted in some negative effects and harmful consequences.All these decreased the service quality of grading nursing and restricted the development of nursing discipline.The present theme studied on the content standard of grading nursing system,which intended to contribute to the consummation of the system for practical use.
Methods
1.The cross-sectional investigation of the implementation of grading nursing system
With stratified sampling,patients and nurses in eight departments were chosen in a GradeⅢ-A General Hospital in Guangzhou as studying objects.Using the method of direct observation,(1) Recorded the number of in-patients of every grade of grading nursing system in every ward.(2) Noted the day-nursing workload of the four shifts of nurses during 8:00-18:00.The contents included all items and the corresponding time of each item which the four shifts of nurses supplying to the patients.(3) Randomized chose four patients of each grade in every chosen department and recorded all the items and the corresponding time of each item they got during daytime.(4) Collected datas about the round time of grading nursing system during the time 8am and 6pm.Every department was investigated for a week, and each task was collected randomly for every day.
The software SPSS for Windows,version 13.0 for personal computers and Excel 2003 in office 2003 were used for statistical activity.Statistical methods including descriptive statistics analysis,One-Way ANOVA,Two-Way ANOVA,Bonferroni and SNK for multiple comparisons were used for measurement data.And constituent ratio, R×C Chi-Square test for numeration data.The statistical significance was set at a level ofα=0.05.
2.Establish the new Content Standard of Grading Nursing System
Based on the results of the above investigation,reviewing references and interviewing nursing experts,expert consultation questionnaires were made.By Delphi method,35 nursing specialists in 27 GradeⅢhospitals from 14 provinces and cities were investigated for three rounds,which mainly for the basic service items of each nursing grade,the least frequency in each item and the bottom qualification line of nurse to perform each item.
The software SPSS for Windows,version 13.0 for personal computers was used for statistical activity.Statistical methods included descriptive statistics analysis,K related sample nonparametric test.The statistical significance was set at a level ofα=0.05.
Results
1.There were 436 patients totally in the 8 departments during a week,including 155(accounting for 35.55%),278(63.76%) and 3(0.69%) respectively in gradeⅠ, gradeⅡand gradeⅢ.
2.With the statistical method of R×C Chi-Square test,there were significant deviation among the 8 departments in the constituent ratio of each grade(P=0.000). The ratios for the patients of gradeⅠin 8 departments were from 11.1%to 100%, while gradeⅡwere from 42.5%to 82.2%.Only a department had gradeⅢpatients, and the ratio was 6.7%in that department.
3.The average nursing service time during a day which the patients got in 8 departments was as follows:24.61min for GradeⅠand 12.34 min for GradeⅡ.. While the average grading nursing time during a day were 12.32(accounting for 50%) for gradeⅠ.And 4.81 min(39%) for gradeⅡ.
4.There was no statistical differences in time for daytime nurses performing for grading nursing service in the 8 departments in daytime(P=0.344).However,there was significant deviation among the time offered by different shifts of nurses (P=0.000).With SNK for multiple comparisons,the time which the duty-shift nurse offered to patient was significantly higher than other shifts of nurses did.
5.From the collecting data of the nurses performing for grading nursing system, the items and the frequency with each item were organized.Comparing with the old content standard of grading nursing system,there were many changes and improvements both in the items and the corresponding frequency of each item.
6.The transfusion round time was the mainly way serving for patient instead of the provided time in grading nursing system for each grade.With One-Way ANOVA for analysis,there was significant differences of the transfusion round time in 8 departments(P=0.000).Using SNK for multiple comparison found that the transfusion round time in the department of cardiology and neurosurgery were significant different with other 6 departments.However,there were no significant differences between the two departments,as well as the other 6 departments in transfusion round time.
7.The results of expert-consultation by Delphi method showed that:Firstly there was great representativeness as the responding experts coming from 27 hospitals in 14 provinces and cities.Secondly,the percentages of questionnaire received from the three rounds of experts were more than 85%,which showed enthusiasm and support of the theme from the experts.Thirdly,the average authority coefficient was more than 0.86 which showed that the consulting results were reliable. Fourthly,the coefficients of Kendall's W of the consultation in items of each grade were statistical differences,which provided sufficient evidence of high consistency among experts opinions.Fifthly,experts made the eventual determination of items in each grade,those were 32,23 and 19 items for gradeⅠ,ⅡandⅢrespectively. Meanwhile,the least frequency in each item and the bottom qualification line of the nurse to perform each item were established,which were more practical.
Conclusions
1.The patients quantity of gradeⅠandⅡis great respectively,while that is small in gradeⅢ.
2.The ratios of grading nursing time patients got in daytime accounting for total nursing time are small.This shows that more than half of the total time nurse serving for patients is used to perform medical orders.And the duty-shift nurse is the mainly performer of grading nursing service content.While,comparing with the old content standard of grading nursing system,there are many changes and improvements both in items and the corresponding frequency of each grade.But that is not an integrated system for practice.
3.It is difficult to implement the round time standards of the old grading nursing system for practice.As a special kind of round time,there are two sides of transfusion round time,and it could not replace the round time standards of grading nursing system.So,it is important to improve the round time standard in the new content of grading nursing system.
4.The new content standard of grading nursing system by Delphi method is good to practice.The items,the least frequency in each item and the bottom qualification line of the nurse to perform each item established in each grade are greatly meaningful and practical.
引文
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[2]陈亚梅,施雁.对我国分级护理制度现状的思考[J].中华护理杂志,2008,43(9):830-832.
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[4]李丽传.护理管理[M].北京:科学技术文献出版社,1998:103-111,275-277.
[5]杨洁.介绍日本分级护理制度[J].中华护理杂志,2004,39(9):680.
[6]陈亚梅,施雁.对我国分级护理制度现状的思考[J].中华护理杂志,2008,43(9):830-832.
[7]刘义兰.对分级护理制的商榷[J].护理学杂志,2006,21(23):44-45.
[8]吴庆凤.等级护理实施中存在的问题与建议[J].护理管理杂志,2005,5(3):25-27.
[9]王淑琴,刘雁梅,汤红梅,等.临床分级护理现状及存在问题的调查研究[J].护理管理杂志,2005,5(7):15-17.
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[11]朱宣,童远清.对分级护理的商榷[J].家庭护士,2006,4(2B):64.
[12]和书玲.分级护理制度执行中的难点讨论[J].护理研究,2006,20(6C):166421665.
[13]李晓松.护理理论[M].北京:人民卫生出版社,2002:113.
[14]王晓梅.护理收费标准对分级护理质量的影响[J].护理管理杂志,2002,2(2):16218.
[15]宋娟.分级护理制度执行中的困难分析[J].实用医技杂志,2006,13(19):3455.
[16]胡斌春,黄丽华.分级护理制度实施中的问题与建议[J]中国实用护理杂志,2006,22(1B):57-58.
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[18]肖小文.基层医院护理级别现状的调查分析[J].中国护理管理,2006,6(4):19-20.
[19]刘华平.国外护士人力资源配置及护理工作量测量研究的进展[J].中国护理管理,2003,3(1):51-54.
[20]赵光红.我国护理工作量测量方法的研究进展[J].护理研究,2005,19(11):2265-2267.
[21]黎明、周异明、李雪球,等.普通病区护理工作量调查与人力配备测算[J].实用护理杂志,2002,18(8):64.
[22]魏畅.军队三级甲等医院分级护理服务体系研究中国优秀硕士学位论文全文数据库.
[23]彭刚艺,刘雪琴.当前护理人力资源管理的突出问题及应对策略[J].中国护理管理,2008,8(9):11-14.
[24]张莹,冯正仪,程晓明,等.上海市5家三级综合性医院护理工作量调查分析[J].上海护理,2003,3(2):13-16.
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[26]李丽.全夜制排班中护士的压力及管理[J].护理研究,2005,(23):2149-2150.
[27]应莉,王彩萍.弹性排班在产科全程护理管理中的应用[J].中国实用护理杂志,2006,22(1):69.
[28]熊淑芳,王霞。模式病房排班方式探讨[J].中华护理杂志,2001,(05):394-395.
[29]张莉,彭刚艺,刘雪琴,等.连续性排班模式有助于推动护士分层级管理.中华护理杂志,2009,44(2):118-121.
[30]李亚洁,彭刚艺.护理工作管理规范[M].第1版。广州:广东科技出版社, 2006:43.
[31]仲剑平.医疗护理技术操作常规[M].第4版.北京:人民军医出版社,1998:276-277.
[32]戴宝珍,陶祥玲.护理常规[M].3版.上海:上海科学技术出版社,2003:2-4.
[33]刘雪琴,陈玉平.护理人力资源短缺现状研究[J].中华护理杂志,2004,39(12):928-929.
[34]刘华平,巩玉秀,么莉,等.护士人力资源现状分析和配置标准研究[J].中国护理管理,2005,15(4):22-25.
[35]郭彩霞,孔祥桂,马成云.静脉输液巡视卡的临床应用[J].护理管理杂志,2003,3(3):53-55.
[36]彭刚艺.广东省护理人力资源管理现状与对策[J].中国护理管理,2004,4(2):15-19.
[37]吴桂杰,赵慧敏,殷艳玲.新形势下分级护理面临的问题及对策[J].护理研究,2007,21(4):1018-1019.
[38]曾光.现代流行病学方法与应用[M].北京:北京医科大学中国协和医科大学联合出版,1994.250-269.
[39]魏颖.卫生经济学与卫生经济管理,北京:人民卫生出版社,1998.
[40]郭子衡.医院管理学(第三版),人民卫生出版社,1989:165.
[41]杜萍,叶文琴.上海市护理人员学历职称结构需求研究[J].护理学报,2008,15(2):14-16.
[42]魏丽丽,何仲,刘华平,等.三级甲等综合医院“护士助理”任职资格和工作描述的研究[J].中华护理杂志,2006,41(4):340-342.
[43]李平,田晓丽,王仙园,等.以工作量为基础配备护理人力的研究[J].护理学报,2006,13(1):78-79.
[44]Gordon SC,Barry CD.Development of a school nursing research agenda in Florida:a Delphi study[J].J Sch Nurs,2006,22(2):114-119.
[45]Hardy DJ,Brien AP,Gaskin CJ.Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand[J].Adv Nurs,2004,46(1):95-109.
[46]Brown B.Delphi Process:a Methodology Using for the Elicitation of Opinions of Experts[J].The Rand Corporation,1987,9:3925.
[47]Strang DG,Gagnon M,Molloy DM.Development of a standardized,comprehensive "ideal drug detail"[J].Can J Clin Pharnaco,2001.
[48]Fink A,Kosecoff J,Chassin M,Brook RH.Consensus methods:characteristics and guidelines for use[J].Am J Public Health,1984,74(9):979-983.
[49]Hasson F,Keeney S,Mc Kenna H.Research guidelines for the Delphi survey technique.J Adv Nurs,2000,32:1008-1015.
[50]Murphy MK,Black N,Lamping DL,et al.Consensus development methods and their use in clinical guideline development.Health Technology Assessment,1998:2(3).
[51]Reid N.The Delphi technique:its contribution to the evaluation of professional practice.In Profession Competence and Quality Assurance in the Caring Professions(Ellis R.ed.).London:Chapman & Hall,1998.
[52]冯志英,王建荣.应用专家咨询法设计患者对医院护理工作满意度量表[J].护理管理杂志,2007,7(2):6-9.
[53]吴欣娟,李玉乐,谢瑶洁.我国分级护理实施现状及建议[J].中国护理管理,2008,8(2):5-7.
[54]朱宣,童远清.对分级护理的商榷[J].家庭护士,2006,4(2B):64.
[55]徐志晶,夏海鸥,徐筱萍,等.建立上海市护理人员分级和能力标准的研究[J].中华护理杂志,2008,43(7):581-584.
[56]张洪君,苏春燕,周玉洁等.分层管理模式对提高护理质量的效果研究[J].中华护理杂志,2006,41(5):399-401.
[57]陈秀云,安玉洁,张琰等.病房护理人员的分层使用和管理[J].中国护理 管理,2008,8(6):17-20.
[58]张洪君,潘玉芹,孙宏玉.分级管理模式病房和普通病房护士工作满意度对照分析[J].中国护理管理,2005,5(5):23-25.
[59]李俊漪,白玫,刘华平,等.Delphi法在护理岗位任务分析及人才需求预测研究中的应用[J].护理管理杂志,2004,4(6):35-37.
[2]陈亚梅,施雁.对我国分级护理制度现状的思考[J].中华护理杂志,2008,43(9):830-832.
[3]Lazerowich V.Development of a patient classification system for a home based hospice program[J].Journal of Community Health Nursing,1995,12(2):121-126.
[4]李丽传.护理管理[M].北京:科学技术文献出版社,1998:103-111,275-277.
[5]杨洁.介绍日本分级护理制度[J].中华护理杂志,2004,39(9):680.
[6]陈亚梅,施雁.对我国分级护理制度现状的思考[J].中华护理杂志,2008,43(9):830-832.
[7]刘义兰.对分级护理制的商榷[J].护理学杂志,2006,21(23):44-45.
[8]吴庆凤.等级护理实施中存在的问题与建议[J].护理管理杂志,2005,5(3):25-27.
[9]王淑琴,刘雁梅,汤红梅,等.临床分级护理现状及存在问题的调查研究[J].护理管理杂志,2005,5(7):15-17.
[10]殷磊.护理学基础[M].3版.北京:人民卫生出版社,2002:141-142.
[11]朱宣,童远清.对分级护理的商榷[J].家庭护士,2006,4(2B):64.
[12]和书玲.分级护理制度执行中的难点讨论[J].护理研究,2006,20(6C):166421665.
[13]李晓松.护理理论[M].北京:人民卫生出版社,2002:113.
[14]王晓梅.护理收费标准对分级护理质量的影响[J].护理管理杂志,2002,2(2):16218.
[15]宋娟.分级护理制度执行中的困难分析[J].实用医技杂志,2006,13(19):3455.
[16]胡斌春,黄丽华.分级护理制度实施中的问题与建议[J]中国实用护理杂志,2006,22(1B):57-58.
[17]毕慧敏,吴箭,史雅轩,等.护理人员对分级护理的认知调查[J].护理研究,2005,19(6A):9662968.
[18]肖小文.基层医院护理级别现状的调查分析[J].中国护理管理,2006,6(4):19-20.
[19]刘华平.国外护士人力资源配置及护理工作量测量研究的进展[J].中国护理管理,2003,3(1):51-54.
[20]赵光红.我国护理工作量测量方法的研究进展[J].护理研究,2005,19(11):2265-2267.
[21]黎明、周异明、李雪球,等.普通病区护理工作量调查与人力配备测算[J].实用护理杂志,2002,18(8):64.
[22]魏畅.军队三级甲等医院分级护理服务体系研究中国优秀硕士学位论文全文数据库.
[23]彭刚艺,刘雪琴.当前护理人力资源管理的突出问题及应对策略[J].中国护理管理,2008,8(9):11-14.
[24]张莹,冯正仪,程晓明,等.上海市5家三级综合性医院护理工作量调查分析[J].上海护理,2003,3(2):13-16.
[25]邹恂.护理程序入门.北京:北京医科大学中国协和医科大学联合出版社,1992:13-17.
[26]李丽.全夜制排班中护士的压力及管理[J].护理研究,2005,(23):2149-2150.
[27]应莉,王彩萍.弹性排班在产科全程护理管理中的应用[J].中国实用护理杂志,2006,22(1):69.
[28]熊淑芳,王霞。模式病房排班方式探讨[J].中华护理杂志,2001,(05):394-395.
[29]张莉,彭刚艺,刘雪琴,等.连续性排班模式有助于推动护士分层级管理.中华护理杂志,2009,44(2):118-121.
[30]李亚洁,彭刚艺.护理工作管理规范[M].第1版。广州:广东科技出版社, 2006:43.
[31]仲剑平.医疗护理技术操作常规[M].第4版.北京:人民军医出版社,1998:276-277.
[32]戴宝珍,陶祥玲.护理常规[M].3版.上海:上海科学技术出版社,2003:2-4.
[33]刘雪琴,陈玉平.护理人力资源短缺现状研究[J].中华护理杂志,2004,39(12):928-929.
[34]刘华平,巩玉秀,么莉,等.护士人力资源现状分析和配置标准研究[J].中国护理管理,2005,15(4):22-25.
[35]郭彩霞,孔祥桂,马成云.静脉输液巡视卡的临床应用[J].护理管理杂志,2003,3(3):53-55.
[36]彭刚艺.广东省护理人力资源管理现状与对策[J].中国护理管理,2004,4(2):15-19.
[37]吴桂杰,赵慧敏,殷艳玲.新形势下分级护理面临的问题及对策[J].护理研究,2007,21(4):1018-1019.
[38]曾光.现代流行病学方法与应用[M].北京:北京医科大学中国协和医科大学联合出版,1994.250-269.
[39]魏颖.卫生经济学与卫生经济管理,北京:人民卫生出版社,1998.
[40]郭子衡.医院管理学(第三版),人民卫生出版社,1989:165.
[41]杜萍,叶文琴.上海市护理人员学历职称结构需求研究[J].护理学报,2008,15(2):14-16.
[42]魏丽丽,何仲,刘华平,等.三级甲等综合医院“护士助理”任职资格和工作描述的研究[J].中华护理杂志,2006,41(4):340-342.
[43]李平,田晓丽,王仙园,等.以工作量为基础配备护理人力的研究[J].护理学报,2006,13(1):78-79.
[44]Gordon SC,Barry CD.Development of a school nursing research agenda in Florida:a Delphi study[J].J Sch Nurs,2006,22(2):114-119.
[45]Hardy DJ,Brien AP,Gaskin CJ.Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand[J].Adv Nurs,2004,46(1):95-109.
[46]Brown B.Delphi Process:a Methodology Using for the Elicitation of Opinions of Experts[J].The Rand Corporation,1987,9:3925.
[47]Strang DG,Gagnon M,Molloy DM.Development of a standardized,comprehensive "ideal drug detail"[J].Can J Clin Pharnaco,2001.
[48]Fink A,Kosecoff J,Chassin M,Brook RH.Consensus methods:characteristics and guidelines for use[J].Am J Public Health,1984,74(9):979-983.
[49]Hasson F,Keeney S,Mc Kenna H.Research guidelines for the Delphi survey technique.J Adv Nurs,2000,32:1008-1015.
[50]Murphy MK,Black N,Lamping DL,et al.Consensus development methods and their use in clinical guideline development.Health Technology Assessment,1998:2(3).
[51]Reid N.The Delphi technique:its contribution to the evaluation of professional practice.In Profession Competence and Quality Assurance in the Caring Professions(Ellis R.ed.).London:Chapman & Hall,1998.
[52]冯志英,王建荣.应用专家咨询法设计患者对医院护理工作满意度量表[J].护理管理杂志,2007,7(2):6-9.
[53]吴欣娟,李玉乐,谢瑶洁.我国分级护理实施现状及建议[J].中国护理管理,2008,8(2):5-7.
[54]朱宣,童远清.对分级护理的商榷[J].家庭护士,2006,4(2B):64.
[55]徐志晶,夏海鸥,徐筱萍,等.建立上海市护理人员分级和能力标准的研究[J].中华护理杂志,2008,43(7):581-584.
[56]张洪君,苏春燕,周玉洁等.分层管理模式对提高护理质量的效果研究[J].中华护理杂志,2006,41(5):399-401.
[57]陈秀云,安玉洁,张琰等.病房护理人员的分层使用和管理[J].中国护理 管理,2008,8(6):17-20.
[58]张洪君,潘玉芹,孙宏玉.分级管理模式病房和普通病房护士工作满意度对照分析[J].中国护理管理,2005,5(5):23-25.
[59]李俊漪,白玫,刘华平,等.Delphi法在护理岗位任务分析及人才需求预测研究中的应用[J].护理管理杂志,2004,4(6):35-37.