护理服务人力成本综合评估模型构建及影响因素研究
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摘要
研究目的：
1.尝试建立护理服务人力成本综合评估模型,通过综合评估护理服务项目的技术难度、劳动强度、风险程度和时间耗费,测算护理服务项目传统人力成本核算的校正系数,为确定护理服务劳务价格和补偿标准提供依据。
2.分析单项护理服务劳动量的影响因素,以期在护理人力成本核算时对其进行有效控制。
研究方法：
1.采用文献分析法和Delphi法分析护理服务劳动特性。运用SPSS13.0软件对数据进行描述性分析。
2.在护理服务劳动特性分析的基础上,采用Delphi法,参考综合评价法,构建护理服务人力成本综合评估模型。运用SPSS13.0软件对数据进行描述性分析。
3.运用护理服务人力成本综合评估模型,参照成本相对值法,采用便利抽样法,选择四川省2家三级甲等综合性医院的208名护士作为调查对象,对选取的12项基础护理服务项目和14个专科的59项专科护理服务项目进行初步人力成本评估,计算其人力成本校正系数。运用SPSS13.0对数据进行描述性分析,采用EXCEL计算护理服务项目人力成本校正系数。
4.采用问卷调查法和Delphi法分析单项护理服务劳动量影响因素的结构。①初步分析单项护理服务劳动量影响因素的指标体系。首先,采用文献分析法和开放式问卷调查法进行“单项护理服务劳动量影响因素初始问卷”题目的编制。其次,采用便利抽样的方法,选取广州市三级甲等综合性医院9家,排除手术室、供应室、门诊、急诊、透析室等非临床住院科室,将非住院科室的1097名护士作为调查对象,对问卷进行探索性因素分析(n=945)和验证性因素分析(n=152),并检验其信效度。问卷信度分析采用内部一致性Cronbach's α系数与重测信度进行检验。问卷的效度采用内容效度和结构效度进行分析。其中内容效度采用专家评定CVI系数和Pearson相关系数进行检验；结构效度运用SPSS13.0进行探索性因素分析、运用LISREL8.7软件进行验证性因素分析。②为了使上述在广州市调查的影响因素指标体系在全国具有推广性,本研究进一步采用Delphi法选取全国14个省市的22名护理学专家进行咨询,进一步确定单项护理服务劳动量的影响因素结构。
研究结果：
1.护理服务劳动特性的分析结果
(1)护理服务劳动特性专家咨询结果。护理服务劳动特性表现为4个方面,即具有一定技术难度、具有一定劳动强度、具有一定风险性以及耗时性。其中采用3个条目评判护理服务技术难度,即服务项目操作步骤的繁杂程度、对操作者的知识要求和对操作者的决策能力要求；采用2个条目评判护理服务的劳动强度,即单位时间内的体力消耗程度和单位时间内的精力集中程度；采用2个条目评判护理服务的风险性,即操作给患者带来安全隐患的几率和操作给护士带来职业暴露的几率；采用测量单项护理服务平均耗时的方法评判其耗时性。第1轮调查：一级条目赞同率为81%,二级条目重要性赋值均数在2.91-4.78之间；第2轮调查：一级条目赞同率为81%,二级条目重要性赋值均数在4.41-4.89之间；第3轮调查：一级条目赞同率为86%,二级条目重要性赋值均数在4.41-4.91之间。
(2) Delphi法专家代表性及咨询结果的可靠性。选取32名护理专家作为本研究的咨询专家,其中护理教育领域专家8名,临床护理专家及临床护理管理者24名。专家来自北京、上海、广东、浙江、江苏、湖北、湖南、四川、河南、海南、安徽和新疆。专家平均年龄(43.53±4.94)岁,平均工作年限(23.22±5.42)年,平均管理年限(12.41±6.22)年；其中护士长10名占31%,护理部副主任9名占28%,护理部主任5名占16%,大学护理学教授8名占25%；专科学历2名占6%,本科学历11名占35%,硕士学历17名占53%,博士学历2名占6%；90%以上具有副高级及以上职称。3轮咨询的专家积极系数分别为：100%、84.38%和81.48%；协调系数分别为：0.315、0.135和0.126,P值均小于0.01。专家对内容的熟悉程度系数为0.86,对内容的判断依据系数为0.91,专家权威程度系数为0.89。
2.护理服务人力成本综合评估模型
(1)护理服务人力成本综合评估模型及指标体系
研究所得护理服务人力成本综合评估模型如下：
护理股务人力成本综合评估模型(相对值)=c×XnⅠ-1XnⅠ-2XnⅡ-1XnⅡ-2XnⅢ-1XnⅢ-2XnⅣ-1
其中,XnⅠ-1,-XnⅢ-2为单项护理服务人力成本综合评估各项指标的平均得分，Ⅳ为操作时间；C为单位时间护理服务人力成本。
护理服务人力成本综合评估模型包括4个一级指标,即护理服务项目的技术难度、护理服务项目的劳动强度、护理服务项目的风险程度和护理服务项目的操作时间；8个二级指标,即服务项目操作步骤的繁杂程度、对操作者的知识要求、对操作者的决策能力要求、单位时间内的体力消耗程度、单位时间内的精力集中程度、服务项目操作给患者带来安全隐患的几率、操作给护士带来职业暴露的几率和服务项目的操作时间。专家对一级指标赞同率为100%,二级指标赋值均数最小值为4.30,最大值为4.83,均值为4.60。
(2)指标体系构建过程中所选专家的代表性及咨询结果的可靠性。选取来自全国14个省市的40名护理学专家作为本研究的咨询专家,其中临床护理专家及临床护理管理人员34名,护理教育领域专家6名。其平均年龄为(44.35±5.30)年；平均工作年限为(24.05±7.06)年；平均管理工作年限为(12.75±5.83)年。其中,20名占50%的专家为总护士长或护士长,14名占35%的专家为护理部主任或副主任,6名占15%的专家为护理学院教研室主任或护理学院院长；其中37位占93%的专家为副高以上职称,14位占35%的专家为硕士及以上学历。专家积极系数为100%。专家意见协调系数为0.126(P<0.001)。专家对内容的熟悉程度系数为0.86,对内容的判断依据系数为0.92,权威程度系数为0.89。
3.综合评估模型的初步实测结果
12项基础护理服务项目和14个专科的59项专科护理服务项目传统人力成本核算的校正系数分别为：皮牵引0.23,小夹板固定技术0.33,会阴擦洗0.34,石膏绷带固定技术0.34,胎心监测0.37,阴道灌洗上药0.46,鼻腔滴药0.46,外阴湿热敷0.51,鼻腔冲洗0.53,咽喉部喷雾0.55,外耳道滴药0.56,外耳道冲洗0.65,婴儿臀部护理0.66,新生儿脐部护理0.88,测眼压0.99,口腔护理1,测基础代谢率1.03,乳腺癌患者术后功能锻炼1.1,口服葡萄糖耐量试验1.17,床上擦浴1.19,血糖监测1.19,持续闭式引流1.28,泪道冲洗1.29,结膜囊冲洗1.33,乳头内陷护理1.36,肛管排气1.37,T-型管引流护理1.57,上颌窦穿刺冲洗1.58,结合菌素试验1.63,皮下注射1.66,碘吸收试验1.68,胃肠减压1.71,腹腔灌洗1.78,肌内注射1.81,体位引流的护理1.9,负压封闭引流2.04,骨牵引2.09,吸痰2.18,鼻胆管引流护理2.2,呼气末二氧化碳监测2.21,膀胱灌注2.23,结膜下注射2.28,结肠灌洗2.4,膀胱冲洗2.55,气管切开2.61,清洁灌肠2.66,造口扩肛2.68,造口护理2.69,静脉输液2.98,脑室引流3.1,下鼻甲粘膜下注射3.14,球后注射3.16,洗胃3.45,留置导尿3.48,留置针静脉输液3.72,角膜异物取出3.74,婴幼儿灌肠3.98,新生儿抚触4.08,小儿股静脉采血4.1,胃管置管术4.25,腹膜透析4.27,小儿高压氧疗4.45,小儿头皮静脉输液4.95,结膜结石剔除术4.95,输血4.97,鼓膜穿刺5.18,呼吸功能锻炼5.19,新生儿沐浴5.2,血液透析5.33,婴幼儿先天性巨结肠清洁灌肠5.62,三腔二囊管压迫技术13.26。
4.单项护理服务劳动量影响因素的结构
(1)单项护理服务劳动量影响因素指标的初步确定
采用探索性因素分析和验证性因素分析对广州9家医院的数据进行分析得出,单项护理服务劳动量影响因素为4个方面,因素1为护理风险,包括3个条目,主要内容是护士提供护理服务时所面临的护理纠纷、职业暴露和患者发生护理意外的风险；因素2为患者病情,包括4个条目,主要内容是患者的疾病严重程度、疾病种类、自理能力和配合程度；因素3为操作环境,包括3个条目,主要内容是病区布局、护理工具先进与否以及进行护理操作时周围的环境；因素4为护理服务项目特性。包括3个条目,其主要内容是护理服务项目的技术难度、劳动强度和操作时间。问卷总体信度系数为0.827,4个因子的信度系数均大于0.70,问卷重测信度为0.831；问卷CVI系数为0.77,每个条目与领域总分的相关系数在0.231-0.713之间；4因子累积方差贡献率达67.392%;验证性因素分析显示,X2值为78.32,df为59,X2/df为1.33,RMSEA<0.05, NNFI、 CFI、IFI和GFI均在0.90以上。
(2)单项护理服务劳动量影响因素的结构
为了使上述在广州市调查的影响因素指标体系在全国范围内具有推广性,本研究进一步在全国范围内选取专家进行了咨询。确定单项护理服务劳动量影响因素指标体系包括2级指标。其中一级指标为4个,即护士的自身特征、患者情况、护理服务项目的特性和操作环境；二级指标为14个,即护士与患者沟通交流的能力、护士的技术熟练程度、护士的健康教育能力、患者的疾病严重程度、患者的自理能力、患者的配合程度、患者的疾病种类、服务项目的操作时间、服务项目的技术难度、服务项目的风险程度、服务项目的劳动强度、病区布局、护理设备与材料的合理配置、进行操作时患者床单位周围的环境。
专家代表性及咨询结果的可靠性：22名专家来自全国14个省市。其平均年龄为(44.73±4.57)年；平均工作年限为(25.82±5.47)年；平均管理工作年限为(12.91±5.98)年。其中护士长11名占50%,护理部主任5名占23%,护理学院教研室主任或院长6名占27%；硕士以上学历占30%；90.9%以上专家具有副高级及以上职称。专家对咨询内容的熟悉程度系数为0.89,对咨询内容判断依据系数为0.91,专家权威系数为0.9。
研究结论：
1.护理服务人力成本综合评估模型为：
护理服务人力成本综合评估模型(相对值)=c×XnⅠ-1XnⅠ-2XnⅠ-3XnⅡ-1XnⅡ-2XnⅢ-1XnⅢ-2XnⅣ-1其中,XnⅠ-1～XnⅢ-2为单项护理服务人力成本综合评估各项指标的平均得分,XnⅣ-1为操作时间；C为单位时间护理服务人力成本。
护理服务人力成本综合评估模型包括4个一级指标,即护理服务项目的技术难度、护理服务项目的劳动强度、护理服务项目的风险程度和护理服务项目的操作时间；8个二级指标,即服务项目操作步骤的繁杂程度、对操作者的知识要求、对操作者的决策能力要求、单位时间内的体力消耗程度、单位时间内的精力集中程度、服务项目给患者带来安全隐患的几率、服务项目给护士带来职业暴露的几率和服务项目的操作时间。在此人力成本综合评估模型的基础上,参照成本相对值法,可计算出护理服务项目传统人力成本核算的校正系数。在按照传统人力成本核算方法对各单项护理服务项目进行人力成本核算时,需乘以相应的校正系数,得到人力成本综合评估结果。
2.运用上述综合评估模型,对选取的12项基础护理服务项目和14个专科的59项专科护理服务项目进行初步人力成本评估,其传统人力成本校正系数范围在0.23～13.26之间。
3.单项护理服务劳动量影响因素指标体系包括2级指标。其中一级指标为4个,即护士的自身特征、患者情况、护理服务项目的特性和操作环境；二级指标为14个,即护士与患者沟通交流的能力、护士的技术熟练程度、护士的健康教育能力、患者的疾病严重程度、患者的自理能力、患者的配合程度、患者的疾病种类、服务项目的操作时间、服务项目的技术难度、服务项目的风险程度、服务项目的劳动强度、病区布局、护理设备与材料的合理配置、进行操作时患者床单位周围的环境。进行护理服务人力成本核算时需考虑上述因素对成本核算结果的影响。
Objective:
1. To establish a comprehensive evaluation model of the nursing manpower cost with the aim of truly reflecting the labor value of nursing care.
2. To analyze the influencing factors of nursing workload at nursing skill level with the purpose of controling these factors effectively when nursing manpower costs are accounted.
Method:
1. This article adopts the methods of documentary analysis and Delphi method to analyze the labor characteristics of nursing care. And applied descriptive statistic analysis and corresponding analysis through SPSS13.0software.
2. Adoptting Delphi method and the comprehensive evaluation method to build the comprehensive evaluation model of the nursing manpower cost. And applied descriptive statistic analysis and corresponding analysis through SPSS13.0software.
3. Using the comprehensive evaluation model of the nursing manpower cost and a relative cost method to preliminary assess the manpower costs of12basic care services and60specialist care services. And applied descriptive statistic analysis and corresponding analysis through SPSS13.0software. Computing the nursing manpower costs by Excel software.
4. Questionnaire method and Delphi method were used to analyze the factor structure of nursing workload at single nursing care. The scale was adapted according to literature review and survey.①To preliminary analyze the indicators of the factor structure of nursing workload at single nursing skill level. We used this questionnaire to investigate1097nurses from9upper first-class general hospitals. An exploratory factor analysis was used to identify the factor structure(n=945), and a confirmatory factor analysis was conducted to validate the factor structure by Linear Structural Relations8.7(n=152) to preliminary analyze the indicators of the factor structure of nursing workload at single nursing skill level.②The Delphi method was used to confirm the final factor structure of nursing workload at single nursing cares, and the Delphi consultation was sent to22experts from14provinces. Questionnaire reliability was analyzed by internal consistency, Cronbach's alpha coefficient and test-retest reliability test. The validity of the questionnaire was analyzed by content validity and construct validity analysis. The content validity was analyzed by expert assessment of CVI coefficient and the Pearson correlation coefficient test, The construct validity was analyzed by the software of SPSS13.0and software LISREL8.7.
Results:
1. Results of the labor characteristics of nursing care
(1) Consultation results of the labor characteristics of nursing care. The performance of the labor characteristics of nursing care has certain risks and labor intensity, needs certain technical skills, and nursing care is time consuming.3items can be used to judge the technical difficulty:the complexity of the nursing skill steps, the knowledge requirements for the operator and the operator's decision-making capacity requirements.2other items can be used to judge the labor intensity of nursing services:the degree of physical exertion per unit time and the degree of energy concentration per unit time. Another2items can be used to judge the risk degree of nursing care:the probability of potential safety problems to the patient and the occupational exposure probability to the nurses. The means of the second class indicators in the three rounds of the consultation were2.91-4.78,4.41-4.89and4.41-4.91respectively.
(2) The expert representative and the reliability of the consultation results. The study selected32nursing experts as the consultants, in which eight experts were in the field of nursing education and another24expers were from the fields of clinical nursing as clinical nurse specialists or clinical nurse managers. The experts come from Beijing, Shanghai, Guangdong, Zhejiang, Jiangsu, Hubei, Hunan, Sichuan, Henan, Hainan, Anhui and Xinjiang. Expert average age was (43.53±4.94) years old, and the average work experience was (23.22±5.42) years, and the average management year was (12.41±6.22) years.The positive coefficients of the experts in the three rounds of consultation were as follows:100%,84.38%and81.48%. And the coordination coefficients were:0.315,0.135and0.126. And P values were all less than0.01. The expert agreements in the three rounds of the consultation were81%,81%and86%respectively. The coefficient of expert familiar with the contents was0.86, and the coefficient of the expert judgment on the content is0.91, and the degree of expert authority coefficient was0.89.
2. Results of the comprehensive evaluation model of the manpower cost of nursing care
(1) The manpower costs of nursing care are caculated by this comprehensive evaluation model as follow:The Comprehensive Evaluation Model of the Manpower Cost of Nursing Care(score)=C×XnⅠ-1XnⅠ-2XnⅠ-3XnⅡ-1XnⅡ-2XnⅢ-2XnⅢ-2XnⅣ-1. Which, XnⅠ-1-XnⅣ-1is indicator of the comprehensive evaluation model of the manpower cost of nursing care; C was as a unit labor costs.
The comprehensive evaluation model of the nursing manpower cost includs a four first class indicators and8second class indicators. Agreed with the expert-level indicators was100%, the assignment of the second class indicators mean minimum4.30, maximum4.83, average of4.60.
(2) The expert representative and the reliability of the consultation results
The study selected40nursing experts as the consultants, in which6experts were in the field of nursing education and another34expers were from the fields of clinical nursing as clinical nurse specialists or clinical nurse managers. The experts come from different provinces. Expert average age was (44.35±5.30) years old, and the average work experience was (24.05±7.06) years, and the average management year was (12.75±5.83) years. The positive coefficients of the experts was100%, and the coordination coefficients was0.126(P<0.001), the expert agreements of the consultation was100%. The means of the second class indicators was4.30-4.83. The coefficient of expert familiar with the contents was0.86, and the coefficient of the expert judgment on the content is0.92, and the degree of expert authority coefficient was0.89.
3. The initial measurement by the comprehensive evaluation model of the manpower cost of nursing care
The correction factors of traditional manpower cost results of the72nursing services:skin traction0.23, small splint fixation0.33, perineum scrubbing0.34, gypsum bandage fixation0.34, electronic fetal heart monitoring0.37, vaginal douche and medication0.46, nasal drops0.46, vulvar cold or hot compress0.51, nasal cavity irrigation0.53, throat spraying0.55, external drops0.56, external auditory canal irrigation0.65, infant Buttock nursing0.66, neonate umbilical nursing0.88, Intraocular pressure measuring0.99, oral nursing1, basal metabolic rate measuring1.03, postoperative functional exercise for breast cancer1.1, oral glucose tolerance test1.1, sponge bath in bed1.19, glucose monitoring1.19, continuous closed drain1.28, lacrimal passage irrigationl.29, conjunctival sac irrigation1.33, papillary invagination nursing1.36, blind enema1.37, T-tube drainage nursing1.57, maxillary sinus puncture and irrigation1.58, tuberculin test1.63, subcutaneous injection1.66, iodine-131absorption test1.68, gastrointestinal decompression1.71, peritoneal lavage1.78, intramuscular injection1.81, positional drainage1.9, vacuum sealing drainage2.0, skeletal traction2.09, sputum aspiration2.18, naso-biliary drainage nursing2.2, end tidal CO2monitoring2.21, intravesical instillation2.23, subconjunctival injection2.28, colon irrigation2.4, bladder irrigation2.55, tracheotomy nursing2.61, cleaning enema2.66, opening-producing anal dilation2.68, colostomy care2.69, intravenous infusion2.98, ventricular drainage nursing3.1, inferior turbinate submucosal injection3.14, retrobulbar injection3.16, gastric lavage3.45, indwelling catheter3.48, infusion via indwelling needle3.72, removal corneal foreign body3.74, infant enema3.98, neonatal caring Touches4.08, femoral vein blood collection for infants4.1, stomach-tube intubation4.25, peritoneal dialysis4.27, hyperbaric oxygen therapy for children4.45, transfusion through children's scacp veins4.95, extirpation of lithiasis conjunctivae4.95, blood transfusion4.97, auripuncture5.18, breathing function exercise5.19, neonatal bathing5.2, hemodialysis5.33, infant congenital megacolon cleaning enema5.62, compression hemostasis via using three-channel double-balloon catheter13.26.
4. The indicators of influencing factors of nursing workload at nursing skill level
(1) Initially indicators of influencing factors of nursing workload at nursing skill level. The influnecing factors are4dimensions, including nursing risk、labor intensity、technical skills and time consuming. The amount of individual care services labor influencing factors initially identified. Exploratory factor analysis and obtained confirmatory factor analysis, influencing factors of the individual care services the amount of labor for four-dimensional structure factors for the risk of care, including three entries, primary care nurses care services disputes, the occupational exposure and patient care nursing risk of accidents; factors in patients with the disease, including four entries, the main contents of the patient's disease severity, type of illness, self-care ability and degree of cooperation with; factors as operating environment, including three entries, the main content of care services the surrounding environment, whether or not advanced ward layout and care of tools; factor for the characteristics of the nursing services. Three entries, the main content of the technical difficulty of the nursing service project, the labor intensity and time. The overall Cronbach's alpha coefficient for this questionnaire was0.827. The Cronbach's alpha coefficients for the four factors were all above0.7. and the test-retest reliability of the questionnaire was0.831. A four-factor structure for nursing workload measurement at single nursing care was extracted, accounting for67.392%of the total variance. And the confirmatory factor analysis showed a good overall fit of this four-factor model, X2=78.32, df=59, X2/df=1.33, RMSEA<0.05, NNFI、CFI、IFI and GFI were all above0.90.
(2) The factor structure of nursing workload at single nursing skill level Ultimately determine the amount of individual care services labor expert advice on the basis of impact factors for the four dimensions of the structure, which includes the four-level indicators (characteristics of the nurses, the patient's condition, care services to the project's characteristics and operating environment) and14two level indicators (the ability of nurses to communicate with patients, nurses, technical proficiency, the ability of the health education of nurses, the patient's disease severity, patient self-care ability, the patient's degree of cooperation with the patient's type of illness, the services of the time the technical difficulty of the services, the degree of risk of the services, the labor intensity of services, ward layout, nursing equipment and materials, a reasonable configuration, operation, the environment around the patient bed unit.)
Conclusion:
1.The comprehensive evaluation model of the nursing manpower cost includs a four first class indicators and8second class indicators. The manpower costs of nursing care are caculated by this comprehensive evaluation model as follow:The Comprehensive Evaluation Model of the Manpower Cost of Nursing Care (score)=C×XnⅠ-1XnⅠ-2XnⅠ-3XnⅡ-1XnⅡ-2XnⅢ-1XnⅢ-2XnⅣ-1. Which, XnⅠ-1XnⅣ-1is indicator of the comprehensive evaluation model of the manpower cost of nursing care; C was as a unit labor costs.
The correction factors of the traditional manpower costs of nursing cares are caculated by this comprehensive evaluation model of the nursing manpower cost and the relative value method. The comprehensive evaluation results of the nursing manpower cost are caculated by the formula which is the correction factors multiplied by the traditional manpower costs.
2. A four-factor structure for nursing workload measurement at single nursing care was extracted, which are nursing risk, patient condition, work environment and characteristic of nursing cares. The14second class indicators are nurses' communication ability with patients, the technical proficiency of the nurses, nurses' capacity of the health education, the patient's disease severity, patient self-care ability, the type of illness, the time consuming of the service, the technical difficulty of the services, the risk of the services, the labor intensity of the services, ward layout,the rational allocation of care equipment and materials and the environment around the patient bed unit.
1.尝试建立护理服务人力成本综合评估模型,通过综合评估护理服务项目的技术难度、劳动强度、风险程度和时间耗费,测算护理服务项目传统人力成本核算的校正系数,为确定护理服务劳务价格和补偿标准提供依据。
2.分析单项护理服务劳动量的影响因素,以期在护理人力成本核算时对其进行有效控制。
研究方法：
1.采用文献分析法和Delphi法分析护理服务劳动特性。运用SPSS13.0软件对数据进行描述性分析。
2.在护理服务劳动特性分析的基础上,采用Delphi法,参考综合评价法,构建护理服务人力成本综合评估模型。运用SPSS13.0软件对数据进行描述性分析。
3.运用护理服务人力成本综合评估模型,参照成本相对值法,采用便利抽样法,选择四川省2家三级甲等综合性医院的208名护士作为调查对象,对选取的12项基础护理服务项目和14个专科的59项专科护理服务项目进行初步人力成本评估,计算其人力成本校正系数。运用SPSS13.0对数据进行描述性分析,采用EXCEL计算护理服务项目人力成本校正系数。
4.采用问卷调查法和Delphi法分析单项护理服务劳动量影响因素的结构。①初步分析单项护理服务劳动量影响因素的指标体系。首先,采用文献分析法和开放式问卷调查法进行“单项护理服务劳动量影响因素初始问卷”题目的编制。其次,采用便利抽样的方法,选取广州市三级甲等综合性医院9家,排除手术室、供应室、门诊、急诊、透析室等非临床住院科室,将非住院科室的1097名护士作为调查对象,对问卷进行探索性因素分析(n=945)和验证性因素分析(n=152),并检验其信效度。问卷信度分析采用内部一致性Cronbach's α系数与重测信度进行检验。问卷的效度采用内容效度和结构效度进行分析。其中内容效度采用专家评定CVI系数和Pearson相关系数进行检验；结构效度运用SPSS13.0进行探索性因素分析、运用LISREL8.7软件进行验证性因素分析。②为了使上述在广州市调查的影响因素指标体系在全国具有推广性,本研究进一步采用Delphi法选取全国14个省市的22名护理学专家进行咨询,进一步确定单项护理服务劳动量的影响因素结构。
研究结果：
1.护理服务劳动特性的分析结果
(1)护理服务劳动特性专家咨询结果。护理服务劳动特性表现为4个方面,即具有一定技术难度、具有一定劳动强度、具有一定风险性以及耗时性。其中采用3个条目评判护理服务技术难度,即服务项目操作步骤的繁杂程度、对操作者的知识要求和对操作者的决策能力要求；采用2个条目评判护理服务的劳动强度,即单位时间内的体力消耗程度和单位时间内的精力集中程度；采用2个条目评判护理服务的风险性,即操作给患者带来安全隐患的几率和操作给护士带来职业暴露的几率；采用测量单项护理服务平均耗时的方法评判其耗时性。第1轮调查：一级条目赞同率为81%,二级条目重要性赋值均数在2.91-4.78之间；第2轮调查：一级条目赞同率为81%,二级条目重要性赋值均数在4.41-4.89之间；第3轮调查：一级条目赞同率为86%,二级条目重要性赋值均数在4.41-4.91之间。
(2) Delphi法专家代表性及咨询结果的可靠性。选取32名护理专家作为本研究的咨询专家,其中护理教育领域专家8名,临床护理专家及临床护理管理者24名。专家来自北京、上海、广东、浙江、江苏、湖北、湖南、四川、河南、海南、安徽和新疆。专家平均年龄(43.53±4.94)岁,平均工作年限(23.22±5.42)年,平均管理年限(12.41±6.22)年；其中护士长10名占31%,护理部副主任9名占28%,护理部主任5名占16%,大学护理学教授8名占25%；专科学历2名占6%,本科学历11名占35%,硕士学历17名占53%,博士学历2名占6%；90%以上具有副高级及以上职称。3轮咨询的专家积极系数分别为：100%、84.38%和81.48%；协调系数分别为：0.315、0.135和0.126,P值均小于0.01。专家对内容的熟悉程度系数为0.86,对内容的判断依据系数为0.91,专家权威程度系数为0.89。
2.护理服务人力成本综合评估模型
(1)护理服务人力成本综合评估模型及指标体系
研究所得护理服务人力成本综合评估模型如下：
护理股务人力成本综合评估模型(相对值)=c×XnⅠ-1XnⅠ-2XnⅡ-1XnⅡ-2XnⅢ-1XnⅢ-2XnⅣ-1
其中,XnⅠ-1,-XnⅢ-2为单项护理服务人力成本综合评估各项指标的平均得分，Ⅳ为操作时间；C为单位时间护理服务人力成本。
护理服务人力成本综合评估模型包括4个一级指标,即护理服务项目的技术难度、护理服务项目的劳动强度、护理服务项目的风险程度和护理服务项目的操作时间；8个二级指标,即服务项目操作步骤的繁杂程度、对操作者的知识要求、对操作者的决策能力要求、单位时间内的体力消耗程度、单位时间内的精力集中程度、服务项目操作给患者带来安全隐患的几率、操作给护士带来职业暴露的几率和服务项目的操作时间。专家对一级指标赞同率为100%,二级指标赋值均数最小值为4.30,最大值为4.83,均值为4.60。
(2)指标体系构建过程中所选专家的代表性及咨询结果的可靠性。选取来自全国14个省市的40名护理学专家作为本研究的咨询专家,其中临床护理专家及临床护理管理人员34名,护理教育领域专家6名。其平均年龄为(44.35±5.30)年；平均工作年限为(24.05±7.06)年；平均管理工作年限为(12.75±5.83)年。其中,20名占50%的专家为总护士长或护士长,14名占35%的专家为护理部主任或副主任,6名占15%的专家为护理学院教研室主任或护理学院院长；其中37位占93%的专家为副高以上职称,14位占35%的专家为硕士及以上学历。专家积极系数为100%。专家意见协调系数为0.126(P<0.001)。专家对内容的熟悉程度系数为0.86,对内容的判断依据系数为0.92,权威程度系数为0.89。
3.综合评估模型的初步实测结果
12项基础护理服务项目和14个专科的59项专科护理服务项目传统人力成本核算的校正系数分别为：皮牵引0.23,小夹板固定技术0.33,会阴擦洗0.34,石膏绷带固定技术0.34,胎心监测0.37,阴道灌洗上药0.46,鼻腔滴药0.46,外阴湿热敷0.51,鼻腔冲洗0.53,咽喉部喷雾0.55,外耳道滴药0.56,外耳道冲洗0.65,婴儿臀部护理0.66,新生儿脐部护理0.88,测眼压0.99,口腔护理1,测基础代谢率1.03,乳腺癌患者术后功能锻炼1.1,口服葡萄糖耐量试验1.17,床上擦浴1.19,血糖监测1.19,持续闭式引流1.28,泪道冲洗1.29,结膜囊冲洗1.33,乳头内陷护理1.36,肛管排气1.37,T-型管引流护理1.57,上颌窦穿刺冲洗1.58,结合菌素试验1.63,皮下注射1.66,碘吸收试验1.68,胃肠减压1.71,腹腔灌洗1.78,肌内注射1.81,体位引流的护理1.9,负压封闭引流2.04,骨牵引2.09,吸痰2.18,鼻胆管引流护理2.2,呼气末二氧化碳监测2.21,膀胱灌注2.23,结膜下注射2.28,结肠灌洗2.4,膀胱冲洗2.55,气管切开2.61,清洁灌肠2.66,造口扩肛2.68,造口护理2.69,静脉输液2.98,脑室引流3.1,下鼻甲粘膜下注射3.14,球后注射3.16,洗胃3.45,留置导尿3.48,留置针静脉输液3.72,角膜异物取出3.74,婴幼儿灌肠3.98,新生儿抚触4.08,小儿股静脉采血4.1,胃管置管术4.25,腹膜透析4.27,小儿高压氧疗4.45,小儿头皮静脉输液4.95,结膜结石剔除术4.95,输血4.97,鼓膜穿刺5.18,呼吸功能锻炼5.19,新生儿沐浴5.2,血液透析5.33,婴幼儿先天性巨结肠清洁灌肠5.62,三腔二囊管压迫技术13.26。
4.单项护理服务劳动量影响因素的结构
(1)单项护理服务劳动量影响因素指标的初步确定
采用探索性因素分析和验证性因素分析对广州9家医院的数据进行分析得出,单项护理服务劳动量影响因素为4个方面,因素1为护理风险,包括3个条目,主要内容是护士提供护理服务时所面临的护理纠纷、职业暴露和患者发生护理意外的风险；因素2为患者病情,包括4个条目,主要内容是患者的疾病严重程度、疾病种类、自理能力和配合程度；因素3为操作环境,包括3个条目,主要内容是病区布局、护理工具先进与否以及进行护理操作时周围的环境；因素4为护理服务项目特性。包括3个条目,其主要内容是护理服务项目的技术难度、劳动强度和操作时间。问卷总体信度系数为0.827,4个因子的信度系数均大于0.70,问卷重测信度为0.831；问卷CVI系数为0.77,每个条目与领域总分的相关系数在0.231-0.713之间；4因子累积方差贡献率达67.392%;验证性因素分析显示,X2值为78.32,df为59,X2/df为1.33,RMSEA<0.05, NNFI、 CFI、IFI和GFI均在0.90以上。
(2)单项护理服务劳动量影响因素的结构
为了使上述在广州市调查的影响因素指标体系在全国范围内具有推广性,本研究进一步在全国范围内选取专家进行了咨询。确定单项护理服务劳动量影响因素指标体系包括2级指标。其中一级指标为4个,即护士的自身特征、患者情况、护理服务项目的特性和操作环境；二级指标为14个,即护士与患者沟通交流的能力、护士的技术熟练程度、护士的健康教育能力、患者的疾病严重程度、患者的自理能力、患者的配合程度、患者的疾病种类、服务项目的操作时间、服务项目的技术难度、服务项目的风险程度、服务项目的劳动强度、病区布局、护理设备与材料的合理配置、进行操作时患者床单位周围的环境。
专家代表性及咨询结果的可靠性：22名专家来自全国14个省市。其平均年龄为(44.73±4.57)年；平均工作年限为(25.82±5.47)年；平均管理工作年限为(12.91±5.98)年。其中护士长11名占50%,护理部主任5名占23%,护理学院教研室主任或院长6名占27%；硕士以上学历占30%；90.9%以上专家具有副高级及以上职称。专家对咨询内容的熟悉程度系数为0.89,对咨询内容判断依据系数为0.91,专家权威系数为0.9。
研究结论：
1.护理服务人力成本综合评估模型为：
护理服务人力成本综合评估模型(相对值)=c×XnⅠ-1XnⅠ-2XnⅠ-3XnⅡ-1XnⅡ-2XnⅢ-1XnⅢ-2XnⅣ-1其中,XnⅠ-1～XnⅢ-2为单项护理服务人力成本综合评估各项指标的平均得分,XnⅣ-1为操作时间；C为单位时间护理服务人力成本。
护理服务人力成本综合评估模型包括4个一级指标,即护理服务项目的技术难度、护理服务项目的劳动强度、护理服务项目的风险程度和护理服务项目的操作时间；8个二级指标,即服务项目操作步骤的繁杂程度、对操作者的知识要求、对操作者的决策能力要求、单位时间内的体力消耗程度、单位时间内的精力集中程度、服务项目给患者带来安全隐患的几率、服务项目给护士带来职业暴露的几率和服务项目的操作时间。在此人力成本综合评估模型的基础上,参照成本相对值法,可计算出护理服务项目传统人力成本核算的校正系数。在按照传统人力成本核算方法对各单项护理服务项目进行人力成本核算时,需乘以相应的校正系数,得到人力成本综合评估结果。
2.运用上述综合评估模型,对选取的12项基础护理服务项目和14个专科的59项专科护理服务项目进行初步人力成本评估,其传统人力成本校正系数范围在0.23～13.26之间。
3.单项护理服务劳动量影响因素指标体系包括2级指标。其中一级指标为4个,即护士的自身特征、患者情况、护理服务项目的特性和操作环境；二级指标为14个,即护士与患者沟通交流的能力、护士的技术熟练程度、护士的健康教育能力、患者的疾病严重程度、患者的自理能力、患者的配合程度、患者的疾病种类、服务项目的操作时间、服务项目的技术难度、服务项目的风险程度、服务项目的劳动强度、病区布局、护理设备与材料的合理配置、进行操作时患者床单位周围的环境。进行护理服务人力成本核算时需考虑上述因素对成本核算结果的影响。
Objective:
1. To establish a comprehensive evaluation model of the nursing manpower cost with the aim of truly reflecting the labor value of nursing care.
2. To analyze the influencing factors of nursing workload at nursing skill level with the purpose of controling these factors effectively when nursing manpower costs are accounted.
Method:
1. This article adopts the methods of documentary analysis and Delphi method to analyze the labor characteristics of nursing care. And applied descriptive statistic analysis and corresponding analysis through SPSS13.0software.
2. Adoptting Delphi method and the comprehensive evaluation method to build the comprehensive evaluation model of the nursing manpower cost. And applied descriptive statistic analysis and corresponding analysis through SPSS13.0software.
3. Using the comprehensive evaluation model of the nursing manpower cost and a relative cost method to preliminary assess the manpower costs of12basic care services and60specialist care services. And applied descriptive statistic analysis and corresponding analysis through SPSS13.0software. Computing the nursing manpower costs by Excel software.
4. Questionnaire method and Delphi method were used to analyze the factor structure of nursing workload at single nursing care. The scale was adapted according to literature review and survey.①To preliminary analyze the indicators of the factor structure of nursing workload at single nursing skill level. We used this questionnaire to investigate1097nurses from9upper first-class general hospitals. An exploratory factor analysis was used to identify the factor structure(n=945), and a confirmatory factor analysis was conducted to validate the factor structure by Linear Structural Relations8.7(n=152) to preliminary analyze the indicators of the factor structure of nursing workload at single nursing skill level.②The Delphi method was used to confirm the final factor structure of nursing workload at single nursing cares, and the Delphi consultation was sent to22experts from14provinces. Questionnaire reliability was analyzed by internal consistency, Cronbach's alpha coefficient and test-retest reliability test. The validity of the questionnaire was analyzed by content validity and construct validity analysis. The content validity was analyzed by expert assessment of CVI coefficient and the Pearson correlation coefficient test, The construct validity was analyzed by the software of SPSS13.0and software LISREL8.7.
Results:
1. Results of the labor characteristics of nursing care
(1) Consultation results of the labor characteristics of nursing care. The performance of the labor characteristics of nursing care has certain risks and labor intensity, needs certain technical skills, and nursing care is time consuming.3items can be used to judge the technical difficulty:the complexity of the nursing skill steps, the knowledge requirements for the operator and the operator's decision-making capacity requirements.2other items can be used to judge the labor intensity of nursing services:the degree of physical exertion per unit time and the degree of energy concentration per unit time. Another2items can be used to judge the risk degree of nursing care:the probability of potential safety problems to the patient and the occupational exposure probability to the nurses. The means of the second class indicators in the three rounds of the consultation were2.91-4.78,4.41-4.89and4.41-4.91respectively.
(2) The expert representative and the reliability of the consultation results. The study selected32nursing experts as the consultants, in which eight experts were in the field of nursing education and another24expers were from the fields of clinical nursing as clinical nurse specialists or clinical nurse managers. The experts come from Beijing, Shanghai, Guangdong, Zhejiang, Jiangsu, Hubei, Hunan, Sichuan, Henan, Hainan, Anhui and Xinjiang. Expert average age was (43.53±4.94) years old, and the average work experience was (23.22±5.42) years, and the average management year was (12.41±6.22) years.The positive coefficients of the experts in the three rounds of consultation were as follows:100%,84.38%and81.48%. And the coordination coefficients were:0.315,0.135and0.126. And P values were all less than0.01. The expert agreements in the three rounds of the consultation were81%,81%and86%respectively. The coefficient of expert familiar with the contents was0.86, and the coefficient of the expert judgment on the content is0.91, and the degree of expert authority coefficient was0.89.
2. Results of the comprehensive evaluation model of the manpower cost of nursing care
(1) The manpower costs of nursing care are caculated by this comprehensive evaluation model as follow:The Comprehensive Evaluation Model of the Manpower Cost of Nursing Care(score)=C×XnⅠ-1XnⅠ-2XnⅠ-3XnⅡ-1XnⅡ-2XnⅢ-2XnⅢ-2XnⅣ-1. Which, XnⅠ-1-XnⅣ-1is indicator of the comprehensive evaluation model of the manpower cost of nursing care; C was as a unit labor costs.
The comprehensive evaluation model of the nursing manpower cost includs a four first class indicators and8second class indicators. Agreed with the expert-level indicators was100%, the assignment of the second class indicators mean minimum4.30, maximum4.83, average of4.60.
(2) The expert representative and the reliability of the consultation results
The study selected40nursing experts as the consultants, in which6experts were in the field of nursing education and another34expers were from the fields of clinical nursing as clinical nurse specialists or clinical nurse managers. The experts come from different provinces. Expert average age was (44.35±5.30) years old, and the average work experience was (24.05±7.06) years, and the average management year was (12.75±5.83) years. The positive coefficients of the experts was100%, and the coordination coefficients was0.126(P<0.001), the expert agreements of the consultation was100%. The means of the second class indicators was4.30-4.83. The coefficient of expert familiar with the contents was0.86, and the coefficient of the expert judgment on the content is0.92, and the degree of expert authority coefficient was0.89.
3. The initial measurement by the comprehensive evaluation model of the manpower cost of nursing care
The correction factors of traditional manpower cost results of the72nursing services:skin traction0.23, small splint fixation0.33, perineum scrubbing0.34, gypsum bandage fixation0.34, electronic fetal heart monitoring0.37, vaginal douche and medication0.46, nasal drops0.46, vulvar cold or hot compress0.51, nasal cavity irrigation0.53, throat spraying0.55, external drops0.56, external auditory canal irrigation0.65, infant Buttock nursing0.66, neonate umbilical nursing0.88, Intraocular pressure measuring0.99, oral nursing1, basal metabolic rate measuring1.03, postoperative functional exercise for breast cancer1.1, oral glucose tolerance test1.1, sponge bath in bed1.19, glucose monitoring1.19, continuous closed drain1.28, lacrimal passage irrigationl.29, conjunctival sac irrigation1.33, papillary invagination nursing1.36, blind enema1.37, T-tube drainage nursing1.57, maxillary sinus puncture and irrigation1.58, tuberculin test1.63, subcutaneous injection1.66, iodine-131absorption test1.68, gastrointestinal decompression1.71, peritoneal lavage1.78, intramuscular injection1.81, positional drainage1.9, vacuum sealing drainage2.0, skeletal traction2.09, sputum aspiration2.18, naso-biliary drainage nursing2.2, end tidal CO2monitoring2.21, intravesical instillation2.23, subconjunctival injection2.28, colon irrigation2.4, bladder irrigation2.55, tracheotomy nursing2.61, cleaning enema2.66, opening-producing anal dilation2.68, colostomy care2.69, intravenous infusion2.98, ventricular drainage nursing3.1, inferior turbinate submucosal injection3.14, retrobulbar injection3.16, gastric lavage3.45, indwelling catheter3.48, infusion via indwelling needle3.72, removal corneal foreign body3.74, infant enema3.98, neonatal caring Touches4.08, femoral vein blood collection for infants4.1, stomach-tube intubation4.25, peritoneal dialysis4.27, hyperbaric oxygen therapy for children4.45, transfusion through children's scacp veins4.95, extirpation of lithiasis conjunctivae4.95, blood transfusion4.97, auripuncture5.18, breathing function exercise5.19, neonatal bathing5.2, hemodialysis5.33, infant congenital megacolon cleaning enema5.62, compression hemostasis via using three-channel double-balloon catheter13.26.
4. The indicators of influencing factors of nursing workload at nursing skill level
(1) Initially indicators of influencing factors of nursing workload at nursing skill level. The influnecing factors are4dimensions, including nursing risk、labor intensity、technical skills and time consuming. The amount of individual care services labor influencing factors initially identified. Exploratory factor analysis and obtained confirmatory factor analysis, influencing factors of the individual care services the amount of labor for four-dimensional structure factors for the risk of care, including three entries, primary care nurses care services disputes, the occupational exposure and patient care nursing risk of accidents; factors in patients with the disease, including four entries, the main contents of the patient's disease severity, type of illness, self-care ability and degree of cooperation with; factors as operating environment, including three entries, the main content of care services the surrounding environment, whether or not advanced ward layout and care of tools; factor for the characteristics of the nursing services. Three entries, the main content of the technical difficulty of the nursing service project, the labor intensity and time. The overall Cronbach's alpha coefficient for this questionnaire was0.827. The Cronbach's alpha coefficients for the four factors were all above0.7. and the test-retest reliability of the questionnaire was0.831. A four-factor structure for nursing workload measurement at single nursing care was extracted, accounting for67.392%of the total variance. And the confirmatory factor analysis showed a good overall fit of this four-factor model, X2=78.32, df=59, X2/df=1.33, RMSEA<0.05, NNFI、CFI、IFI and GFI were all above0.90.
(2) The factor structure of nursing workload at single nursing skill level Ultimately determine the amount of individual care services labor expert advice on the basis of impact factors for the four dimensions of the structure, which includes the four-level indicators (characteristics of the nurses, the patient's condition, care services to the project's characteristics and operating environment) and14two level indicators (the ability of nurses to communicate with patients, nurses, technical proficiency, the ability of the health education of nurses, the patient's disease severity, patient self-care ability, the patient's degree of cooperation with the patient's type of illness, the services of the time the technical difficulty of the services, the degree of risk of the services, the labor intensity of services, ward layout, nursing equipment and materials, a reasonable configuration, operation, the environment around the patient bed unit.)
Conclusion:
1.The comprehensive evaluation model of the nursing manpower cost includs a four first class indicators and8second class indicators. The manpower costs of nursing care are caculated by this comprehensive evaluation model as follow:The Comprehensive Evaluation Model of the Manpower Cost of Nursing Care (score)=C×XnⅠ-1XnⅠ-2XnⅠ-3XnⅡ-1XnⅡ-2XnⅢ-1XnⅢ-2XnⅣ-1. Which, XnⅠ-1XnⅣ-1is indicator of the comprehensive evaluation model of the manpower cost of nursing care; C was as a unit labor costs.
The correction factors of the traditional manpower costs of nursing cares are caculated by this comprehensive evaluation model of the nursing manpower cost and the relative value method. The comprehensive evaluation results of the nursing manpower cost are caculated by the formula which is the correction factors multiplied by the traditional manpower costs.
2. A four-factor structure for nursing workload measurement at single nursing care was extracted, which are nursing risk, patient condition, work environment and characteristic of nursing cares. The14second class indicators are nurses' communication ability with patients, the technical proficiency of the nurses, nurses' capacity of the health education, the patient's disease severity, patient self-care ability, the type of illness, the time consuming of the service, the technical difficulty of the services, the risk of the services, the labor intensity of the services, ward layout,the rational allocation of care equipment and materials and the environment around the patient bed unit.
引文
[1]娄凤兰.护理管理学[M].人民卫生出版社,2009：246.
[2]阮智富,郭忠新.现代汉语大词典[Z].上海辞书出版社,2009：642.
[3]古代汉语词典[Z].商务印书馆,2011：942.
[4]现代汉语词典[Z].商务印书馆,2011：815.
[5]中华现代汉语词典[Z].华语教学出版社,2011：742.
[6]马克思恩格斯全集：第23卷[M].人民出版社,1972：202.
[7]中华现代汉语词典[Z].华语教学出版社,2011：742.
[8]苑茜,周冰,沈士仓,等.现代劳动关系辞典[M].北京：中国劳动社会保障出版社,2000：370.
[9]马克思恩格斯全集：第23卷[M].人民出版社,1972：52.
[10]马克思恩格斯全集：第23卷[M].人民出版社,1972：58.
[11]马克思恩格斯全集：第23卷[M].人民出版社,1972：60.
[12]于长春.关于劳动量的科学分析[J].现代经济,2009,8(7)：1-7.
[13]辞海[Z]..上海辞书,2010.
[14]马克思恩格斯全集：第23卷[M].人民出版社,1972：51.
[15]马克思恩格斯全集：第23卷[M].人民出版社,1972：59.
[16]王昕,刘昂.颠覆技术价值与销售价值的畸形定位[J].医院院长论坛,2010,(2)：62-63.
[17]唐宗全.对医疗服务价格结构性调整的几点思考[J].卫生经济研究,2006,(6)：36-37.
[18]王丽平.医疗服务价格涨什么[J].中国卫生产业,2008,5(3)：22-25.
[19]孟庆跃,卞鹰,孙强,等.理顺医疗服务价格体系：问题、成因和调整方案[J].中国卫生经济,2002,21(5)：31-34.
[20]马晶晶,宋锦平,冯先琼.护理服务技术难度评价条目体系的构建[J].中华护理 杂志,2008,43(7)：625-628.
[21]刘昌用.劳动强度的历史变迁[J].湖北经济学院学报,2005,3(4)：16-18.
[22]朱武寿,卢伟华.关于国内外劳动强度研究的综述[J].北京体育大学学报,2007,30(11)：691-692.
[23]旷雄杰.基于德尔菲法的中国漂流旅游发展影响因素研究[J].旅游学刊,2011,26(6)：42-46.
[24]刘翠,叶文琴,李凤萍.等.三级综合性医院创伤骨科护士能级划分体系的研究[J].2011,46(6)：603-605.
[25]孙振球.医学综合评价方法及其应用[M].化学工业出版社,2006：13.
[26]高云.一级护理质量评价标准的构建研究[D].南方医科大学硕士学位论文,2009：14.
[27]马晶晶,宋锦平,冯先琼.护理服务技术难度评价条目体系的实测检验[J].解放军护理杂志,2008,25(3B)：1-4.
[28]WC Hsiao, DB Yntema, P Braun, et al. Measurement and Analysis of Intraservice Work,[J].JAMA,1988,260(16):2361-2370.
[29]王仙园,王惠珍.护理管理学[M].人民卫生出版社,2008：196.
[30]陈洁.医院管理学经营管理分册[M].人民卫生出版社,2003：71.
[31]陈晓阳,刘则杨,张利岩.阑尾切除术手术配合的护理成本核算方法研究[J].中国医院管理,2005,25(6)：35-36.
[32]张冬梅,刘则杨,冯慧萍.颞浅动脉旁注射护理服务项目的成本核算[J].护理管理杂志,2006,6(1)：40-43.
[33]徐长妍,张美荣,彭琳.医疗费用支付方式比较分析[J].中国病案,2008,9(12)：17-18.
[34]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)：16-18.
[35]马海红.市场经济条件下护理收费的探讨[J].护理研究,2006,20(6)：147.
[36]杨爱萍等.住院病人护理收费中存在的问题分析[J].护理管理杂 志,2006,6(12)：54-55.
[37]韩树堂.320例住院病人护理项目费用探讨[J].家庭护士,2008,6(6)：1671.
[38]彭雅君,李文燕,魏先,等.三级甲等医院分级护理成本核算与分析[J].护理实践与研究,2009,6(24)：84-86.
[39]陈红,魏先,李花林.20项护理技术服务成本核算对护理价值的体现[J].护理学报,2006,13(6)：85-86.
[40]周荣慧.北京地区部分护理服务项目价格与实际成本的对比与分析[J].护理管理杂志,2005,5(7)35-36.
[41]王燕.山东省护理项目收费现状及其对策研究[D].山东大学硕士论文,2008.
[42]陶方萍,史倩,段媛,等ARDS病人临床护理路径的实施及效果评价[J].护理研究,2011,25(4)：983-984.
[43]蒋菊芳,费静霞,姚敏红,等.临床护理路径在精神分裂症患者标准化管理中的应用[J].中华护理杂志,2011,46(10)：970-973.
[44]范媛,临床护理路径在手足口病合并病毒性脑炎患儿中的应用[J].护理实践与研究,2011,8(19)：12-14.
[45]谭峰,曹允芳,赵军燕,等.临床护理路径在内镜下大肠息肉摘除术中的应用[J].齐鲁护理杂志,2011,17(23)：20-21.
[46]瞿永凤,李玉华.临床护理路径在择期剖宫产产妇中的应用[J].护理实践与研究,2011,8(15)：34-36.
[47]陈伟菊,王妤,周佩如,罗红.30种内外科常见病整体护理路径的研究和应用[J].护理学报,2009,16(6A)：36-37.
[48]吴胜菊,杨海燕,童彩玲,等.中医临床护理路径在乳腺癌手术患者中的应用[J].护理学报,2010,17(7A)：61-63
[49]陈晓阳,刘则杨,张利岩,等.阑尾切除术配合的护理成本核算方法研究[J].中国医院管理,2005,25(6)：35-36.
[50]陈晓阳,刘则杨,张利岩,等.剖宫产术手术室护理成本核算[J].护理学报,2006,13(3)：20-22.
[51]宫克,叶文琴,朱建英.我院颈椎手术围手术期护理成本的研究[J].护理管理杂志,2005,5(12)：37-40.
[52]潘丽花,于兰贞.子宫肌瘤腹式手术护理配合成本的研究[J].护理研究,2007,21(2)：350-352.
[53]张玲娟.三级甲等医院内科及专科等级护理实际成本及标准成本研究[D].第二军医大学硕士论文,2004：40.
[54]徐南丽.护理活动单项成本分析[J].荣总护理,1985,13(1)：94-100.
[55]岳红,周兰英,卢爱荣,温雪梅.新生儿游泳护理服务项目的成本研究[J].护士进修杂志,2009,24(22)：2029-2031.
[56]何倩佞,赵惠颜,郭红英,等.第一产程活跃期护理项目成本核算研究,护理学报,2006,13(5)：89-90.
[57]刘则杨,肖飞,董新,等.我国护理成本核算体系构建[J].中国医院管理,2003,23(4)：50-52.
[58]陈宁珊,刘兴柱,董树山,等.医疗服务成本核算中间接成本的分摊方法[J].中国卫生经济,1996,15(2)：40-42.
[59]Edmund, R.B., Daniel, D., Peter, B., et al. Refinement and Expansion of the Harvard Resource-Based Relative Value Scale:The Second Phase[J]. AJPH,1990,80(7):799-803.
[60]张辉,刘兴柱,于宝荣.医疗服务项目成本相对值方法模型及其应用研究[J].中国卫生经济,1998,17(6)：46-49.
[61]陈晓阳等.不同护理人力成本核算方法的比较研究[J].中国实用护理杂志,2006,22(4).
[62]黄成礼等.以时间驱动作业成本法核算病人护理成本方法探索[J].中国医院管理,2009,29(2).
[63]宋雁宾等.影响护理操作成本因素的探讨[J].解放军护理杂志,200724(10A).
[64]李美华等.层级全责护理排班方式对护理人力成本的影响[J].中国护理管理,2005,5(5).
[65]徐友芳.婴幼儿与成人护理单项成本的核算与比较[J].护理学杂志,2007,22(11)：5-7.
[66]杨雪梅,刘则杨.我院层流病房皮肤黏膜护理项目的成本研究[J].护理管理杂志,2006,6(8)：36-37.
[67]梅俏,刘则杨.气管切开护理项目成本研究[J].中国医院管理,2003,23(8)：48-49.
[68]彭雅君,李文燕,陈瑞华.等.急诊病房分级护理服务项目成本研究[J].护理学杂志,2010,25(2)：68-70.
[69]陈晓阳,刘则杨,张利岩.等.阑尾切除手术配合的护理成本核算方法研究[J].中国医院管理,2005,25(6)：35-36.
[70]谢海燕.椎间盘髓核摘除术的手术室护理成本核算[J].当代护士,2008(12)：92-94.
[71]钟紫凤,叶锋,邵乐文.不同日常生活自理能力分级护理成本核算的研究[J].中华护理杂志,2009,44(3)：215-217.
[72]赵淑霞.等级护理收入提高背景下的护理成本分析[J].解放军医院管理杂志,2008,15(5)：494-495.
[73]彭雅君,魏先,阳世伟,等.急诊I C U一级护理服务项目单项成本研究[J].中国护理管理,2006,6(7)：28-30.
[74]张玲娟,曹洁,叶文琴.上海市某三级甲等医院等级护理实际成本核算与分析[J].解放军护理杂志,2008,25(5 B)：3-6.
[75]刘雪莲,姚诠,洪国灿.等.上海市某三级医院等级护理项目实际成本核算研究[J].中国医院管理,2008,28(1)：40-42.
[76]叶文琴,刘玮琳,宫克.上海市三级甲等医院外科等级护理项目成本研究[J].中华护理杂志,2005,40(11)：812-815.
[77]周荣慧,刘坤,康占菊.等.一级护理成本测算的方法与分析[J].护理管理杂志,2002,2(4).
[78]蓝惠兰,黄碧灵,工首红.等.不同呼吸机湿化管道系统护理成本分析[J].护理 学报,2007,14(6)：1-4.
[79]冯晓敏,王桂荣.颈部半介入术治疗脑血管病两种穿刺法的护理成本及效果[J].护理管理杂志,2005,5(1)：12-14.
[80]张雅丽,陈方蕾,蔡俊萍,秦秀芳.耳穴贴压与常规通便治疗肾脏疾病便秘效果及成本比较[J].护理学杂志,2010,25(1)：45-47.
[81]阮洪,刘明,周曾同.基础护理项目成本核算分析[J].中国卫生资源,2000,3(4)：185-187.
[82]王泓,三所军队三甲医院心胸外科ICU监护项目实际成本及标准成本的研究[D].第二军医大学,2004：25.
[83]戴淑杰,孔凡圣.对医改后医院开展全成本核算方法的探讨[J].经济研究导刊,2011,(11)：123-124.
[84]韩璐,凌莉,吴圣明,等.某省医疗服务项目成本测算结果分析[J].中国医院管理,2004,24(3)：28-31.
[85]Welton J M, Harris K. Hospital Billing and Reimbursement:Charging for Inpatient Nursing Care [J].J Nurs Adm,2007,37(4):164-166.
[86]Welton J M, Fischer M H, Degrace S,et al.Hospital Nursing Costs, Billing, and Reimbursement[J].Nursing Economics,2006,24(5):227-262.
[87]Chiang B.Estimating Nursing Costs--A Methodological Review[J]. International Journal of Nursing Studies,2009,46(5):716-722.
[88]Welton J M, Unruh L, Halloran E J.Nurse Staffing, Nursing Intensity, Staff Mix, and Direct Nursing Care Costs Across Massachusetts Hospitals[J].J Nurs Adm,2006,36(9):416-425.
[89]Moss J, Saba V.Costing Nursing Care:Using the Clinical Care Classification System to Value Nursing Intervention in an Acute-Care Setting[J]. Comput Inform Nurs,2011,29(8):455-460.
[90]Padilha K G, Sousa R M, Kimura M, et al.Nursing Workload in Intensive Care Units:A Study Using the Therapeutic Intervention Scoring System-28 (TISS-28)[J]. Intensive Crit Care Nurs,2007,23(3):162-169.
[91]Young G, Zavelina L, Hooper V. Assessment of Workload Using NASA Task Load Index in Perianesthesia Nursing[J].J Perianesth Nurs,2008,23(2):102-110.
[92]Twigg D, Duffield C. A Review of Workload Measures:A Context for a New Staffing Methodology in Western Australia[J].International Journal of Nursing Studies,2009,46(1):131-139.
[93]Padilha K G, De Sousa R M, Garcia P C, et al. Nursing Workload and Staff Allocation in an Intensive Care Unit:A Pilot Study According to Nursing Activities Score (NAS) [JJ.Intensive Crit Care Nurs,2010,26(2):108-113.
[94]孙振球.医学综合评价方法及其应用[M].化学工业出版社,2006：22.
[95]谭红专.洪灾的危害及其综合评价模型的研究[D].中南大学博士学位论文,2004：65.
[96]黄鹏.湖南浏阳农村慢性病疾病负担综合评价模型的构建及其实证研究[D].中南大学博士学位论文,2010：111.
[97]孙振球.医学综合评价方法及其应用[M].化学工业出版社,2006：11.
[98]赵光红.护理工作量与质量综合评价体系的研究[D].华中科技大学博士学位论文,2008：95-119.
[99]宋瑰琪,江启成,胡传来.安徽省某三级甲等医院护理工作量测算研究[J2.中国护理管理,2007,7(6)：27-30.
[100]李尊柱,姜亚芳,康晓凤,等.ICU护理工作量相关因素调查分析[J].护理学杂志,2010,25(14)：75-77.
[101]尚少梅.护理工作量测量的影响因素[J].护理学杂志,2007,22(4)：72-74.
[102]赵芹芹,孙红,蔡虻,等.单项直接护理操作工作时间测量的影响因素研究[J].护理管理杂志,2008,8(4)1-3.
[103]刘霞,莫蓓蓉,阮宏兵.护理工作量标准化指标的测定与评价[J].医学理论与实践,2010,23(11)：1425-1427.
[104]蔡秋香,李广红,刘静,等.我院产科护理工作量的调查与分析[J].哈尔滨医药,2009,29(5)：116-117.
[105]杨莘,邵文利,张海洋,等.运用TISS-28评分系统评价外科ICU护理工作量的 研究[J].护理管理杂志,2009,9(2)：6-10.
[106]Padilha K G, Cardoso de Sousa R M, Miyadahira A M.et al.Therapeutic intervention scoring system-28 (TISS-28):directions for application[J].Revista Da Escola De Enfermagem Da Usp,2005,39(2):229-233.
[107]Kiekkas P, Brokalaki H, Manolis E.Patient severity as an indicator of nursing workload in the intensive care unit[J].Nurs Crit Care,2007,12(1):34-41.
[108]吴明隆SPSS统计应用实务[M].北京：中国铁道出版社,2001：35-36.
[109]Spence K, Tarnow-Mordi W, Duncan Get al. Measuring nursing workload in neonatal intensive care[J].J Nurs Manag,2006,14,(3):227-234.
[110]Morris R,MacNeela P,Scott A,et al.Reconsidering the conceptualization of nursing workload:literature review[J].J Adv Nurs,2007,57(5):463-471.
[111]Goj K, Knapik P, Kucewicz-Czech E, et al. The TISS-28 scoring system for assessment of cardiac surgical postoperative intensive care[J].Anestezjol Intens Ter,2009,41(1):37-40.
[112]Conishi R M, Gaidzinski R R. Evaluation of the Nursing Activities Score (NAS) as a nursing workload measurement tool in an adult ICU[J].Revista Da Escola De Enfermagem Da Usp,2007,41(3):346-354.
[113]O'Brien A, Benger J. Patient dependency in emergency care:do we have the nurses we need? [J]. J Clin Nurs 2007,16(11):2081-2087.
[114]Harrison J.Addressing increasing patient acuity and nursing workload [J].Nurs Manag,2004,11(4):20-25.
[115]万宏伟,李金平,李小昕,等.临床护理工作量化方法的研究[J].解放军护理杂志,2004,21(11)：10-11.
[116]崔爽,韩成禄.浅析技术劳务价值在医疗服务条目价格中的体现[J].卫生经济研究,2004,(3)：47.
[1]张玲娟.三级甲等医院内科及专科等级护理实际成本及标准成本研究[D].第二军医大学硕士论文,2004：40.
[2]徐南艇.护理活动单项成本分析[J].荣总护理,1985,13(1)：94-100.
[3]岳红,周兰英,卢爱荣,温雪梅.新生儿游泳护理服务项目的成本研究[J].护士进修杂志,2009,24(22)：2029-2031.
[4]刘则杨,肖飞,董新,等.我国护理成本核算体系构建[J].中国医院管 理,2003,23(4)：50-52.
[5]陈红,魏先,李花林.20项护理技术服务成本核算对护理价值的体现[J].护理学报,2006,13(6)：85-86.
[6]周荣慧.北京地区部分护理服务项目价格与实际成本的对比与分析[J].护理管理杂志,2005,5(7)：35-36.
[7]宋雁宾,陆龙,吴雁鸣.护理服务单项成本核算的研究[J].中华护理杂志,2005,40(3)：172-174.
[8]徐友芳.婴幼儿与成人护理单项成本的核算与比较[J].护理学杂志,2007,22(11)：5-7.
[9]杨雪梅,刘则杨.我院层流病房皮肤黏膜护理项目的成本研究[J].护理管理杂志,2006,6(8)：36-37.
[10]张冬梅,刘则杨,冯慧萍.颞浅动脉旁注射护理服务项目的成本核算[J].护理管理杂志,2006,6(1)：40-43.
[11]赵淑霞.等级护理收入提高背景下的护理成本分析[J].解放军医院管理杂志,2008,15(5)：494-495.
[12]彭雅君,魏先,阳世伟,等.急诊I C U一级护理服务项目单项成本研究[J].中国护理管理,2006,6(7)：28-30.
[13]张玲娟,曹洁,叶文琴.上海市某三级甲等医院等级护理实际成本核算与分析[J].解放军护理杂志,2008,25(5 B)：3-6.
[14]刘雪莲,姚诠,洪国灿.等.上海市某三级医院等级护理项目实际成本核算研究[J].中国医院管理,2008,28(1)：40-42.
[15]叶文琴,刘玮琳,宫克.上海市三级甲等医院外科等级护理项目成本研究[J].中华护理杂志,2005,40(11)：812-815.
[16]陈晓阳,刘则杨,张利岩.等.阑尾切除手术配合的护理成本核算方法研究[J].中国医院管理,2005,25(6)：35-36.
[17]陈晓阳,刘则杨.剖宫产术手术室护理成本核算[J].护理学报,2006,13(3)：20-22.
[18]宫克等.我院颈椎手术围手术期护理成本的研究[J].护理管理杂志,2005,5(12)：37-40.
[19]潘丽花.子宫肌瘤腹式手术护理配合成本的研究[J].护理研究,2007,21(2A)：350-352.
[20]谢海燕.椎间盘髓核摘除术的手术室护理成本核算[J].当代护士,2008(12)：92-94.
[21]宋雁宾,吴雁鸣,刘则杨.等.护理服务成本核算研究体系的思路与模型[J].护理研究,2004,18(8)：1317-1319.
[22]孙丽敏.变动成本法-我国医疗卫生服务成本核算的改革方向[J].中国卫生经济,2004,7(7)：72.
[23]阎向东,赵利民.变动成本法应成为公立医院成本核算的主要方法[J].中国卫生资源,2004,7(6)：267.
[24]冯晓敏,王桂荣.颈部半介入术治疗脑血管病两种穿刺法的护理成本及效果[J].护理管理杂志,2005,5(1)：12-14.
[25]张雅丽,陈方蕾,蔡俊萍,秦秀芳.耳穴贴压与常规通便治疗肾脏疾病便秘效果及成本比较[J].护理学杂志,2010,25(1)：45-47.
[26]陈宁珊,刘兴柱,董树山,等.医疗服务成本核算中间接成本的分摊方法[J].中国卫生经济,1996,15(2)：40-42.
[27]张辉,刘兴柱,于宝荣.医疗服务项目成本相对值方法模型及其应用研究[J].中国卫生经济,1998,17(6)：46-49.
[28]方杰,简伟研.相对值法测量眼科医生工作量的实证研究[J].中国医院管理,2009,29(1)：10-12.
[29]简伟研,胡牧,张修梅.临床信息标准——以相对值法测量医生工作量的基础条件[J].2009,29(1)：13-14.
[30]简伟研,胡牧,郭岩.用相对值法研究公立医院的产出规模初探[J].中国医院管理,2007,27(4)：29-31.
[31]陈翠萍,刘菁芸,杨丽英.等.应用护理工作量点数统计软件配置护理人力资源 的研究[J].护理研究,2008,22(8)：2038-2040.
[32]戴淑杰,孔凡圣.对医改后医院开展全成本核算方法的探讨[J].经济研究导刊,2011,(11)：123-124
[33]韩璐,凌莉,吴圣明,等.某省医疗服务项目成本测算结果分析[J].中国医院管理,2004,24(3)：28-31.
[34]王泓,三所军队三甲医院心胸外科ICU监护项目实际成本及标准成本的研究[D].第二军医大学,2004：25.
[2]阮智富,郭忠新.现代汉语大词典[Z].上海辞书出版社,2009：642.
[3]古代汉语词典[Z].商务印书馆,2011：942.
[4]现代汉语词典[Z].商务印书馆,2011：815.
[5]中华现代汉语词典[Z].华语教学出版社,2011：742.
[6]马克思恩格斯全集：第23卷[M].人民出版社,1972：202.
[7]中华现代汉语词典[Z].华语教学出版社,2011：742.
[8]苑茜,周冰,沈士仓,等.现代劳动关系辞典[M].北京：中国劳动社会保障出版社,2000：370.
[9]马克思恩格斯全集：第23卷[M].人民出版社,1972：52.
[10]马克思恩格斯全集：第23卷[M].人民出版社,1972：58.
[11]马克思恩格斯全集：第23卷[M].人民出版社,1972：60.
[12]于长春.关于劳动量的科学分析[J].现代经济,2009,8(7)：1-7.
[13]辞海[Z]..上海辞书,2010.
[14]马克思恩格斯全集：第23卷[M].人民出版社,1972：51.
[15]马克思恩格斯全集：第23卷[M].人民出版社,1972：59.
[16]王昕,刘昂.颠覆技术价值与销售价值的畸形定位[J].医院院长论坛,2010,(2)：62-63.
[17]唐宗全.对医疗服务价格结构性调整的几点思考[J].卫生经济研究,2006,(6)：36-37.
[18]王丽平.医疗服务价格涨什么[J].中国卫生产业,2008,5(3)：22-25.
[19]孟庆跃,卞鹰,孙强,等.理顺医疗服务价格体系：问题、成因和调整方案[J].中国卫生经济,2002,21(5)：31-34.
[20]马晶晶,宋锦平,冯先琼.护理服务技术难度评价条目体系的构建[J].中华护理 杂志,2008,43(7)：625-628.
[21]刘昌用.劳动强度的历史变迁[J].湖北经济学院学报,2005,3(4)：16-18.
[22]朱武寿,卢伟华.关于国内外劳动强度研究的综述[J].北京体育大学学报,2007,30(11)：691-692.
[23]旷雄杰.基于德尔菲法的中国漂流旅游发展影响因素研究[J].旅游学刊,2011,26(6)：42-46.
[24]刘翠,叶文琴,李凤萍.等.三级综合性医院创伤骨科护士能级划分体系的研究[J].2011,46(6)：603-605.
[25]孙振球.医学综合评价方法及其应用[M].化学工业出版社,2006：13.
[26]高云.一级护理质量评价标准的构建研究[D].南方医科大学硕士学位论文,2009：14.
[27]马晶晶,宋锦平,冯先琼.护理服务技术难度评价条目体系的实测检验[J].解放军护理杂志,2008,25(3B)：1-4.
[28]WC Hsiao, DB Yntema, P Braun, et al. Measurement and Analysis of Intraservice Work,[J].JAMA,1988,260(16):2361-2370.
[29]王仙园,王惠珍.护理管理学[M].人民卫生出版社,2008：196.
[30]陈洁.医院管理学经营管理分册[M].人民卫生出版社,2003：71.
[31]陈晓阳,刘则杨,张利岩.阑尾切除术手术配合的护理成本核算方法研究[J].中国医院管理,2005,25(6)：35-36.
[32]张冬梅,刘则杨,冯慧萍.颞浅动脉旁注射护理服务项目的成本核算[J].护理管理杂志,2006,6(1)：40-43.
[33]徐长妍,张美荣,彭琳.医疗费用支付方式比较分析[J].中国病案,2008,9(12)：17-18.
[34]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)：16-18.
[35]马海红.市场经济条件下护理收费的探讨[J].护理研究,2006,20(6)：147.
[36]杨爱萍等.住院病人护理收费中存在的问题分析[J].护理管理杂 志,2006,6(12)：54-55.
[37]韩树堂.320例住院病人护理项目费用探讨[J].家庭护士,2008,6(6)：1671.
[38]彭雅君,李文燕,魏先,等.三级甲等医院分级护理成本核算与分析[J].护理实践与研究,2009,6(24)：84-86.
[39]陈红,魏先,李花林.20项护理技术服务成本核算对护理价值的体现[J].护理学报,2006,13(6)：85-86.
[40]周荣慧.北京地区部分护理服务项目价格与实际成本的对比与分析[J].护理管理杂志,2005,5(7)35-36.
[41]王燕.山东省护理项目收费现状及其对策研究[D].山东大学硕士论文,2008.
[42]陶方萍,史倩,段媛,等ARDS病人临床护理路径的实施及效果评价[J].护理研究,2011,25(4)：983-984.
[43]蒋菊芳,费静霞,姚敏红,等.临床护理路径在精神分裂症患者标准化管理中的应用[J].中华护理杂志,2011,46(10)：970-973.
[44]范媛,临床护理路径在手足口病合并病毒性脑炎患儿中的应用[J].护理实践与研究,2011,8(19)：12-14.
[45]谭峰,曹允芳,赵军燕,等.临床护理路径在内镜下大肠息肉摘除术中的应用[J].齐鲁护理杂志,2011,17(23)：20-21.
[46]瞿永凤,李玉华.临床护理路径在择期剖宫产产妇中的应用[J].护理实践与研究,2011,8(15)：34-36.
[47]陈伟菊,王妤,周佩如,罗红.30种内外科常见病整体护理路径的研究和应用[J].护理学报,2009,16(6A)：36-37.
[48]吴胜菊,杨海燕,童彩玲,等.中医临床护理路径在乳腺癌手术患者中的应用[J].护理学报,2010,17(7A)：61-63
[49]陈晓阳,刘则杨,张利岩,等.阑尾切除术配合的护理成本核算方法研究[J].中国医院管理,2005,25(6)：35-36.
[50]陈晓阳,刘则杨,张利岩,等.剖宫产术手术室护理成本核算[J].护理学报,2006,13(3)：20-22.
[51]宫克,叶文琴,朱建英.我院颈椎手术围手术期护理成本的研究[J].护理管理杂志,2005,5(12)：37-40.
[52]潘丽花,于兰贞.子宫肌瘤腹式手术护理配合成本的研究[J].护理研究,2007,21(2)：350-352.
[53]张玲娟.三级甲等医院内科及专科等级护理实际成本及标准成本研究[D].第二军医大学硕士论文,2004：40.
[54]徐南丽.护理活动单项成本分析[J].荣总护理,1985,13(1)：94-100.
[55]岳红,周兰英,卢爱荣,温雪梅.新生儿游泳护理服务项目的成本研究[J].护士进修杂志,2009,24(22)：2029-2031.
[56]何倩佞,赵惠颜,郭红英,等.第一产程活跃期护理项目成本核算研究,护理学报,2006,13(5)：89-90.
[57]刘则杨,肖飞,董新,等.我国护理成本核算体系构建[J].中国医院管理,2003,23(4)：50-52.
[58]陈宁珊,刘兴柱,董树山,等.医疗服务成本核算中间接成本的分摊方法[J].中国卫生经济,1996,15(2)：40-42.
[59]Edmund, R.B., Daniel, D., Peter, B., et al. Refinement and Expansion of the Harvard Resource-Based Relative Value Scale:The Second Phase[J]. AJPH,1990,80(7):799-803.
[60]张辉,刘兴柱,于宝荣.医疗服务项目成本相对值方法模型及其应用研究[J].中国卫生经济,1998,17(6)：46-49.
[61]陈晓阳等.不同护理人力成本核算方法的比较研究[J].中国实用护理杂志,2006,22(4).
[62]黄成礼等.以时间驱动作业成本法核算病人护理成本方法探索[J].中国医院管理,2009,29(2).
[63]宋雁宾等.影响护理操作成本因素的探讨[J].解放军护理杂志,200724(10A).
[64]李美华等.层级全责护理排班方式对护理人力成本的影响[J].中国护理管理,2005,5(5).
[65]徐友芳.婴幼儿与成人护理单项成本的核算与比较[J].护理学杂志,2007,22(11)：5-7.
[66]杨雪梅,刘则杨.我院层流病房皮肤黏膜护理项目的成本研究[J].护理管理杂志,2006,6(8)：36-37.
[67]梅俏,刘则杨.气管切开护理项目成本研究[J].中国医院管理,2003,23(8)：48-49.
[68]彭雅君,李文燕,陈瑞华.等.急诊病房分级护理服务项目成本研究[J].护理学杂志,2010,25(2)：68-70.
[69]陈晓阳,刘则杨,张利岩.等.阑尾切除手术配合的护理成本核算方法研究[J].中国医院管理,2005,25(6)：35-36.
[70]谢海燕.椎间盘髓核摘除术的手术室护理成本核算[J].当代护士,2008(12)：92-94.
[71]钟紫凤,叶锋,邵乐文.不同日常生活自理能力分级护理成本核算的研究[J].中华护理杂志,2009,44(3)：215-217.
[72]赵淑霞.等级护理收入提高背景下的护理成本分析[J].解放军医院管理杂志,2008,15(5)：494-495.
[73]彭雅君,魏先,阳世伟,等.急诊I C U一级护理服务项目单项成本研究[J].中国护理管理,2006,6(7)：28-30.
[74]张玲娟,曹洁,叶文琴.上海市某三级甲等医院等级护理实际成本核算与分析[J].解放军护理杂志,2008,25(5 B)：3-6.
[75]刘雪莲,姚诠,洪国灿.等.上海市某三级医院等级护理项目实际成本核算研究[J].中国医院管理,2008,28(1)：40-42.
[76]叶文琴,刘玮琳,宫克.上海市三级甲等医院外科等级护理项目成本研究[J].中华护理杂志,2005,40(11)：812-815.
[77]周荣慧,刘坤,康占菊.等.一级护理成本测算的方法与分析[J].护理管理杂志,2002,2(4).
[78]蓝惠兰,黄碧灵,工首红.等.不同呼吸机湿化管道系统护理成本分析[J].护理 学报,2007,14(6)：1-4.
[79]冯晓敏,王桂荣.颈部半介入术治疗脑血管病两种穿刺法的护理成本及效果[J].护理管理杂志,2005,5(1)：12-14.
[80]张雅丽,陈方蕾,蔡俊萍,秦秀芳.耳穴贴压与常规通便治疗肾脏疾病便秘效果及成本比较[J].护理学杂志,2010,25(1)：45-47.
[81]阮洪,刘明,周曾同.基础护理项目成本核算分析[J].中国卫生资源,2000,3(4)：185-187.
[82]王泓,三所军队三甲医院心胸外科ICU监护项目实际成本及标准成本的研究[D].第二军医大学,2004：25.
[83]戴淑杰,孔凡圣.对医改后医院开展全成本核算方法的探讨[J].经济研究导刊,2011,(11)：123-124.
[84]韩璐,凌莉,吴圣明,等.某省医疗服务项目成本测算结果分析[J].中国医院管理,2004,24(3)：28-31.
[85]Welton J M, Harris K. Hospital Billing and Reimbursement:Charging for Inpatient Nursing Care [J].J Nurs Adm,2007,37(4):164-166.
[86]Welton J M, Fischer M H, Degrace S,et al.Hospital Nursing Costs, Billing, and Reimbursement[J].Nursing Economics,2006,24(5):227-262.
[87]Chiang B.Estimating Nursing Costs--A Methodological Review[J]. International Journal of Nursing Studies,2009,46(5):716-722.
[88]Welton J M, Unruh L, Halloran E J.Nurse Staffing, Nursing Intensity, Staff Mix, and Direct Nursing Care Costs Across Massachusetts Hospitals[J].J Nurs Adm,2006,36(9):416-425.
[89]Moss J, Saba V.Costing Nursing Care:Using the Clinical Care Classification System to Value Nursing Intervention in an Acute-Care Setting[J]. Comput Inform Nurs,2011,29(8):455-460.
[90]Padilha K G, Sousa R M, Kimura M, et al.Nursing Workload in Intensive Care Units:A Study Using the Therapeutic Intervention Scoring System-28 (TISS-28)[J]. Intensive Crit Care Nurs,2007,23(3):162-169.
[91]Young G, Zavelina L, Hooper V. Assessment of Workload Using NASA Task Load Index in Perianesthesia Nursing[J].J Perianesth Nurs,2008,23(2):102-110.
[92]Twigg D, Duffield C. A Review of Workload Measures:A Context for a New Staffing Methodology in Western Australia[J].International Journal of Nursing Studies,2009,46(1):131-139.
[93]Padilha K G, De Sousa R M, Garcia P C, et al. Nursing Workload and Staff Allocation in an Intensive Care Unit:A Pilot Study According to Nursing Activities Score (NAS) [JJ.Intensive Crit Care Nurs,2010,26(2):108-113.
[94]孙振球.医学综合评价方法及其应用[M].化学工业出版社,2006：22.
[95]谭红专.洪灾的危害及其综合评价模型的研究[D].中南大学博士学位论文,2004：65.
[96]黄鹏.湖南浏阳农村慢性病疾病负担综合评价模型的构建及其实证研究[D].中南大学博士学位论文,2010：111.
[97]孙振球.医学综合评价方法及其应用[M].化学工业出版社,2006：11.
[98]赵光红.护理工作量与质量综合评价体系的研究[D].华中科技大学博士学位论文,2008：95-119.
[99]宋瑰琪,江启成,胡传来.安徽省某三级甲等医院护理工作量测算研究[J2.中国护理管理,2007,7(6)：27-30.
[100]李尊柱,姜亚芳,康晓凤,等.ICU护理工作量相关因素调查分析[J].护理学杂志,2010,25(14)：75-77.
[101]尚少梅.护理工作量测量的影响因素[J].护理学杂志,2007,22(4)：72-74.
[102]赵芹芹,孙红,蔡虻,等.单项直接护理操作工作时间测量的影响因素研究[J].护理管理杂志,2008,8(4)1-3.
[103]刘霞,莫蓓蓉,阮宏兵.护理工作量标准化指标的测定与评价[J].医学理论与实践,2010,23(11)：1425-1427.
[104]蔡秋香,李广红,刘静,等.我院产科护理工作量的调查与分析[J].哈尔滨医药,2009,29(5)：116-117.
[105]杨莘,邵文利,张海洋,等.运用TISS-28评分系统评价外科ICU护理工作量的 研究[J].护理管理杂志,2009,9(2)：6-10.
[106]Padilha K G, Cardoso de Sousa R M, Miyadahira A M.et al.Therapeutic intervention scoring system-28 (TISS-28):directions for application[J].Revista Da Escola De Enfermagem Da Usp,2005,39(2):229-233.
[107]Kiekkas P, Brokalaki H, Manolis E.Patient severity as an indicator of nursing workload in the intensive care unit[J].Nurs Crit Care,2007,12(1):34-41.
[108]吴明隆SPSS统计应用实务[M].北京：中国铁道出版社,2001：35-36.
[109]Spence K, Tarnow-Mordi W, Duncan Get al. Measuring nursing workload in neonatal intensive care[J].J Nurs Manag,2006,14,(3):227-234.
[110]Morris R,MacNeela P,Scott A,et al.Reconsidering the conceptualization of nursing workload:literature review[J].J Adv Nurs,2007,57(5):463-471.
[111]Goj K, Knapik P, Kucewicz-Czech E, et al. The TISS-28 scoring system for assessment of cardiac surgical postoperative intensive care[J].Anestezjol Intens Ter,2009,41(1):37-40.
[112]Conishi R M, Gaidzinski R R. Evaluation of the Nursing Activities Score (NAS) as a nursing workload measurement tool in an adult ICU[J].Revista Da Escola De Enfermagem Da Usp,2007,41(3):346-354.
[113]O'Brien A, Benger J. Patient dependency in emergency care:do we have the nurses we need? [J]. J Clin Nurs 2007,16(11):2081-2087.
[114]Harrison J.Addressing increasing patient acuity and nursing workload [J].Nurs Manag,2004,11(4):20-25.
[115]万宏伟,李金平,李小昕,等.临床护理工作量化方法的研究[J].解放军护理杂志,2004,21(11)：10-11.
[116]崔爽,韩成禄.浅析技术劳务价值在医疗服务条目价格中的体现[J].卫生经济研究,2004,(3)：47.
[1]张玲娟.三级甲等医院内科及专科等级护理实际成本及标准成本研究[D].第二军医大学硕士论文,2004：40.
[2]徐南艇.护理活动单项成本分析[J].荣总护理,1985,13(1)：94-100.
[3]岳红,周兰英,卢爱荣,温雪梅.新生儿游泳护理服务项目的成本研究[J].护士进修杂志,2009,24(22)：2029-2031.
[4]刘则杨,肖飞,董新,等.我国护理成本核算体系构建[J].中国医院管 理,2003,23(4)：50-52.
[5]陈红,魏先,李花林.20项护理技术服务成本核算对护理价值的体现[J].护理学报,2006,13(6)：85-86.
[6]周荣慧.北京地区部分护理服务项目价格与实际成本的对比与分析[J].护理管理杂志,2005,5(7)：35-36.
[7]宋雁宾,陆龙,吴雁鸣.护理服务单项成本核算的研究[J].中华护理杂志,2005,40(3)：172-174.
[8]徐友芳.婴幼儿与成人护理单项成本的核算与比较[J].护理学杂志,2007,22(11)：5-7.
[9]杨雪梅,刘则杨.我院层流病房皮肤黏膜护理项目的成本研究[J].护理管理杂志,2006,6(8)：36-37.
[10]张冬梅,刘则杨,冯慧萍.颞浅动脉旁注射护理服务项目的成本核算[J].护理管理杂志,2006,6(1)：40-43.
[11]赵淑霞.等级护理收入提高背景下的护理成本分析[J].解放军医院管理杂志,2008,15(5)：494-495.
[12]彭雅君,魏先,阳世伟,等.急诊I C U一级护理服务项目单项成本研究[J].中国护理管理,2006,6(7)：28-30.
[13]张玲娟,曹洁,叶文琴.上海市某三级甲等医院等级护理实际成本核算与分析[J].解放军护理杂志,2008,25(5 B)：3-6.
[14]刘雪莲,姚诠,洪国灿.等.上海市某三级医院等级护理项目实际成本核算研究[J].中国医院管理,2008,28(1)：40-42.
[15]叶文琴,刘玮琳,宫克.上海市三级甲等医院外科等级护理项目成本研究[J].中华护理杂志,2005,40(11)：812-815.
[16]陈晓阳,刘则杨,张利岩.等.阑尾切除手术配合的护理成本核算方法研究[J].中国医院管理,2005,25(6)：35-36.
[17]陈晓阳,刘则杨.剖宫产术手术室护理成本核算[J].护理学报,2006,13(3)：20-22.
[18]宫克等.我院颈椎手术围手术期护理成本的研究[J].护理管理杂志,2005,5(12)：37-40.
[19]潘丽花.子宫肌瘤腹式手术护理配合成本的研究[J].护理研究,2007,21(2A)：350-352.
[20]谢海燕.椎间盘髓核摘除术的手术室护理成本核算[J].当代护士,2008(12)：92-94.
[21]宋雁宾,吴雁鸣,刘则杨.等.护理服务成本核算研究体系的思路与模型[J].护理研究,2004,18(8)：1317-1319.
[22]孙丽敏.变动成本法-我国医疗卫生服务成本核算的改革方向[J].中国卫生经济,2004,7(7)：72.
[23]阎向东,赵利民.变动成本法应成为公立医院成本核算的主要方法[J].中国卫生资源,2004,7(6)：267.
[24]冯晓敏,王桂荣.颈部半介入术治疗脑血管病两种穿刺法的护理成本及效果[J].护理管理杂志,2005,5(1)：12-14.
[25]张雅丽,陈方蕾,蔡俊萍,秦秀芳.耳穴贴压与常规通便治疗肾脏疾病便秘效果及成本比较[J].护理学杂志,2010,25(1)：45-47.
[26]陈宁珊,刘兴柱,董树山,等.医疗服务成本核算中间接成本的分摊方法[J].中国卫生经济,1996,15(2)：40-42.
[27]张辉,刘兴柱,于宝荣.医疗服务项目成本相对值方法模型及其应用研究[J].中国卫生经济,1998,17(6)：46-49.
[28]方杰,简伟研.相对值法测量眼科医生工作量的实证研究[J].中国医院管理,2009,29(1)：10-12.
[29]简伟研,胡牧,张修梅.临床信息标准——以相对值法测量医生工作量的基础条件[J].2009,29(1)：13-14.
[30]简伟研,胡牧,郭岩.用相对值法研究公立医院的产出规模初探[J].中国医院管理,2007,27(4)：29-31.
[31]陈翠萍,刘菁芸,杨丽英.等.应用护理工作量点数统计软件配置护理人力资源 的研究[J].护理研究,2008,22(8)：2038-2040.
[32]戴淑杰,孔凡圣.对医改后医院开展全成本核算方法的探讨[J].经济研究导刊,2011,(11)：123-124
[33]韩璐,凌莉,吴圣明,等.某省医疗服务项目成本测算结果分析[J].中国医院管理,2004,24(3)：28-31.
[34]王泓,三所军队三甲医院心胸外科ICU监护项目实际成本及标准成本的研究[D].第二军医大学,2004：25.
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