加護病房治療性措施計分系統與護理人員活動之關係初探

Exploring ICU Nursing Activities with TISS-28

本研究之目的在於瞭解治療性措施計分系統(therapeutic intervention scoring system, TISS-28)與加護病房護理人員活動之內容、直接護理活動的工時測試及治療性措施計分系統與護理人員活動之關係。本研究為敘述性研究，以中部某醫學中心之六個加護病房之護理人員為研究對象，採護理人員自我記錄法及觀察員觀察法收集資料。研究工具包括加護病房護理人員活動分類表及定義指引、加護病房直接護理工時測試記錄表、碼錶等。研究工具之效度採專家效度法，信度採評分者間信度。第一階段係由護理人員以自我記錄法收集加護病房護理人員活動之內容，第二階段將加護病房護理人員活動作分類，治療性措施計分系統(TISS-28)為其中一類，第三階段作每項直接護理(包括TISS-28)之工時測試。研究結果顯示：1.佔每日工作時間比例最多的護理人員活動是護理記錄（11.38%）2.白班之直接護理佔該班總護理活動之60.83%，小夜之直接護理則佔60.01%，大夜之直接護理佔66.53%。3.共測量97項加護病房直接護理的工時，以協助介入性措施或處置所花費工時較多4.每日各類護理活動的時間分配：屬於TISS-28之直接護理佔34.90%、非屬於TISS-28之直接護理佔27.5%、間接護理佔28.96%、相關護理佔2.99%、個人活動佔5.65%，以屬於TISS-28之直接護理所佔比例較多，若合併所有直接護理活動則為62.4%。此研究成果可瞭解加護病房護理人員活動之內容與直接護理之工時，可提供下一階段研究-建立加護病房治療性措施計分系統或病人分類系統之參考。

The purpose of this study is to investigate the association of the Therapeutic Intervention Scoring System, the TISS-28, with the time spent on daily nursing activities. The setting was six ICUs of a medical center in Central Taiwan and the subjects are the nursing staff therein. The collection of data stemmed from either self-recording by the participating nurses or observation by assigned independent raters. The training for the participants of this study involved the use of a list of nursing activities with coder's manual, a time chart for recording hours spent on direct nursing activities in the ICUs, timer, and so forth. The validity of this study was examined by the degree of expert validity, while the reliability of this study was assessed by the scores of inter-rater agreement. During a 3-day period, nurses on the floor were asked to record various nursing activities using a method called "work sampling." The detailed content of nursing activities were then classified into five major categories, including the TISS-28. Afterwards, over a 4-month period, assigned independent raters observed and determined the length of time to be spent on the different categories of nursing activities. The major findings are: (1)"Documenting/recording nursing activities" is the most frequent daily nursing activity (11.38%); (2) "Direct nursing activities" accounts for a great proportion of the total nursing activities in the ICUs, where 60.83% of direct patient care activities occur on day shift, 60.01% on evening shift, and 66.53% on night shift; (3) The time spent on various nursing activities, for a total of 97 items, has been measured, where "Assisting/intervening tasks" is the most time-consuming activity in the ICUs; (4) As to the proportion of time spent on various daily nursing activities, "Patient care activities in TISS-28" was 34.90%, "Patient care activities not in TISS-28" 27.50%, "Indirect patient care" 28.96%, "Organizational activities" 2.99%, and "Personal activities" 5.65%. The preliminary results of recording the average length of time allocated to various nursing activities will facilitate the research design of a full-scale investigation of the relationship between TISS-28 and nursing activities, and therefore provide a blueprint for better management of nursing manpower in the ICUs.