我国危重症患者护理分级系统构建与护理人力资源配置平台研发

Under the background of national new medical health system reform, the medical care model gradually tends to be more standardization and normalization. With the increased number of critically ill patients caused by various factors, the nursing grading management which is one of the most important issues needs to be improved. Nursing grading research for critically ill patients in China is still in its infancy, since there are still no relevant guidelines and standards. Recent research shows that the critical care nursing grading is in the stage of experience management. The specific standards, methods and strategies are to be determined by further study. This project is based on the previous for cardiology critical patients and normal inpatients as related research foundation, according to the theory of norm group and the top design principles to guide the construction of critical care nursing grading system. Our project also attends to develop one kind of "situation-simulation" critical care nursing human resource disposition network platform. Achievements of this project will be applied for critically ill patients in the clinical nursing field. The achievements not only could bring the objective classification for critical ill patients, rational disposition of critical care nursing human resources, but also might improve the nursing quality of critically ill patients, together with improving the efficiency of nursing practice. The achievements will help to implement standardization and systematization of critical nursing grading by providing important basis for our country.

在国家新医药卫生体制改革背景下，各项诊疗护理模式逐步趋于标准化、规范化，随着各种因素所致危重症患者数量增多，作为护理管理工作重要内容的护理分级标准亟待完善。我国危重症患者护理分级研究尚处于起步阶段，未出台相关指南与标准。近期研究表明，危重症护理分级多为经验管理，其具体标准、方法及策略均亟待通过研究确定。本项目基于前期开展的普通住院患者与心内科重症患者分级的研究工作基础，以常模团体理论和顶层设计法则为指导构建危重症患者护理分级系统，并研发“情境-应对”型危重症护理人力资源配置平台。本研究成果将直接指导危重症患者科学客观地分级分类、规范临床护理，对合理配置危重症护理人力资源、提高危重症患者安全、提升护理工作效率与质量具有重要意义，并将为我国推行护理分级的标准化和系统化提供重要依据。

项目研究团队基于患者大数据收集分别构建了ICU患者病情分级子系统和护理工作量分级子系统：1）项目组首先比较了APACHEⅡ、SAPSⅡ和 MPMⅡ三种病情评分系统对ICU患者进行护理分级的效果，紧接着筛选出与危重症患者病情评估相关的八个变量，进而通过聚类分析法结合PLS回归建立了基于病情评估的ICU患者护理分级系统并探索了分级范围。该子系统可单独使用，将指导临床医护工作者对危重症患者科学客观地分级分类、规范临床护理，对合理配置危重症护理人力资源、提高危重症患者安全、提升护理工作效率与质量具有重要意义。2）项目组通过对护理活动评估量表（NAS）的修订，最终确定的修订版NAS具有较好的信、效度，可精确、客观地评估ICU护理工时，更进一步为护理管理者提供了符合我国护理特色的ICU护理工时测评工具。团队基于修订版NAS收集ICU患者的工时评估资料，根据聚类分析法将患者的护理级别根据评分标准划分为三级，客观依据充分，且可由护士主导对ICU患者进行分级。最后，项目组基于两个子系统的建立，继续收集300例危重患者的资料，根据机器学习算法的指导，通过降维、训练子集的建立等方法提取了6个公因子得分进行K-均值聚类分析，结合个案的病情严重程度与其所需的护理护理工时，将危重患者分为特A级、特B级以及特C级护理。至此，ICU护理分级系统已经构建完成。