灾害救援过负荷医院护理人力资源配置研究

The study aims to develop a dynamic nursing human resources allocation strategy in disaster-responded surge hospitals by using the methods of Epidemiology, Management and Nursing Science. Firstly, by analyzing the data of Hainan Province storm disaster rescue and Wenchuan earthquake rescue retrospectively, the study group is to summarize the distribution pattern of the time-related and space-related victims and to know how the medical human resources were allocated. The Gini Coefficent then will be used to assess if medical human resources allocation was equitable or not during Hainan Province storm disaster rescue and Wenchuan earthquake rescue period and then be used to adjust the medical human resources allocation method developed by study group. Secondly, a revised Rush Medicus Tool-Patient Classification System(RMT-PCS) will be developed to assess the nursing workload in surge hospital. One of the key step for establishing this new version of RMT-PCT(surge hospital version) is to define all related nursing activities in surge hospital using experts group method. By observing the nurses working in the different units of a simulated surge hospital and recording their operating time for every nursing activity and then to ask for the advice of the experts by using Delphi method, the study group will determine the ideal nursing time and the frequency of a nursing activity done to a patient in a specific unit. Then the surge hospital version RMT-PCS workload-analyzing method will be adopted to form a dynamic nursing human resources allocation instrument which can be used in different stage of the disaster rescue, different affected area. The study may not only fill in the blank of nursing human resource allocation research, but only encourage the similar research in the area of medical human resources allocation, and finally provide scientific evidence for the work of surge hospitals.

本研究拟采用流行病学、管理学、护理学理论，开展灾害救援过负荷医院护理人力资源动态配置方案研究。首先回顾性分析海南暴风雨及汶川地震灾害所致伤病员时空分布规律及卫生人力资源分配状况；采取基尼系数法，评价海南暴风雨灾害救援及汶川地震中卫生人力资源分配状况的合理性，进而对初步拟定的方案进行调整，形成卫生人力数优化配置方案。其次修订RMT-PCS量表，发展过负荷医院护理工作量评价工具。评价工具中护理工作项目通过专家小组会议界定，理想护理工时和单位时间内理想操作频次则借助过负荷医院模拟环境、采用护理工时测量的观察法以及Delphi专家咨询法确定。最后，基于修订的RMT-PCS量表，构建可根据灾害救援阶段、地区及伤病员因素调整的过负荷医院护理人力结构配置工具。预期研究成果不仅可填补灾害救援护理人力资源管理研究空白，还可推广至灾害救援条件下其他卫生人力资源配置研究领域，为过负荷医院有效运转提供科学依据。

过负荷医院作为重大灾害医疗救援的主体，其医疗质量关乎总体救援效果。为优化灾害救援过负荷医院护理人力资源动态配置方案，填补灾害救援护理人力资源管理研究空白，并推广至灾害救援条件下其他卫生人力资源配置研究领域，为过负荷医院有效运转提供科学依据。本研究采用流行病学、管理学、护理学理论，回顾性分析了海南暴风雨及汶川地震灾害所致伤病员时空分布规律及卫生人力资源分配状况；采取基尼系数法，评价了海南暴风雨灾害救援及汶川地震中卫生人力资源分配状况的合理性，并对初步拟定的方案进行调整，形成卫生人力数优化配置方案，改良后护理应急管理系统及人力资源配置方法为成立分层应急护理管理小组，制定灾害护理相关制度与职责、报告程序、预案及流程、培训及考核，有计划地进行院内院外的轮转及培训，科学实施人力资源管理，合理动态调配护士以应对突发事件，并将此方案运用到台风灾害救护中，规范了应急救护过程的护理管理制度与流程，显著缩短了院内反应时间、检伤分类时间及转运分流时间，使整个救护过程具有连续性，对减少台风灾害事件造成的人员伤亡有重要意义，值得在临床推广应用。.课题研究期间培养硕士研究生 7 名，其中毕业 4 人，在读 3 人；发表相关论文 7 篇，其中中文论文 6 篇（3 篇为中文核心）、SCI 论文 1 篇；参与书籍编写 7 部，均已出版；参与主办 5 次会议，在国内外学术会议中进行会议报告 8 次。