【作者】 张菊；

【导师】 叶文琴；

【作者基本信息】 第二军医大学 ， 护理教育与护理管理学， 2013， 博士

【摘要】 研究背景：人力资源是21世纪企业组织的战略资源，是企业组织发展的决定性因素和管理的核心力量；而基于胜任力的人力资源管理是提高企业核心竞争力的有力手段。2011年，我国卫生部印发了《中国护理事业发展规划纲要（2011-2015年）》，明确提出要以推进医院实施优质护理服务为抓手，逐步建立完善护理岗位管理制度，加强护士队伍科学化管理，全面提升医院临床护理工作水平。作为临床护理队伍的核心力量，产科母婴同室病房的责任护士负责产妇和新生儿护理，其岗位胜任力水平的高低在一定程度上影响着母婴护理的效果，决定着产科护理服务的质量，也反映了护理队伍管理的水平。研究目的：本研究拟构建一套母婴同室病房责任护士岗位胜任力的评价模型，用来描述、分析和评价母婴同室病房责任护士的岗位胜任力水平，并通过对不同等级、不同类型医院的母婴同室病房进行实证分析来验证该模型的科学性和可行性，同时找出影响责任护士岗位胜任力水平的相关因素。构建该评价模型的意义在于帮助护理管理者评价和了解产科母婴同室病房责任护士的岗位胜任力水平，为进行母婴同室病房责任护士的配置、培训、竞聘和使用等提供科学依据。研究内容和方法：在文献复习基础上，采用目的抽样法对上海市10家不同等级、不同类型医院24个产科病区的护理人员进行问卷调查，自行设计了《上海市产科病区护理人力资源配置、使用和评价情况调查表》和《上海市产科病区护理人员从业现况调查表》，了解产科病区设置现况，以及护理人员配置、使用和从业现况，为后续评价模型构建和责任护士岗位胜任力评价提供现实依据。以现况调查结果为依据，结合文献研究，采用目的抽样法对符合本研究主题的8位产科护理管理者和6位产科责任护士进行了半结构访谈。采用持续比较法进行内容分析，并结合国内相关政策，在严格遵循构建综合评价指标体系一般原则的基础上，初步拟定产科母婴同室病房责任护士岗位胜任力评价模型的基本框架。为了筛选指标，借助德尔菲法进行2轮的专家咨询，对各指标进行5个等级的重要性评价（赋予相应的量化值5、4、3、2、1）。对第一轮专家反馈的意见进行综合分析后，对各级指标进行必要的增、减、删、修，再进行第二轮专家意见咨询，运用层次分析法获得各级指标的权重值，最终构建产科母婴同室病房责任护士岗位胜任力评价的线性模型。本研究的主体方法是德尔菲法，专家的选择是影响德尔菲法成功的关键要素。因此，通过选定5个限定条件，确定咨询专家共15名。通过对专家的结构分析和权威程度分析，表明选择的咨询专家具有典型的代表性，保证了调查结果的准确性和可靠性。2轮德尔菲专家咨询法的质量控制效果主要通过计算应答率以及专家的协调系数等来反映。最后选择10家不同等级、不同类型医院的189位母婴同室病房责任护士进行问卷调查，通过对调查数据的验证性分析来评价该指标体系的科学性和可行性，并用相关性分析和多元方差分析找出重要的影响因素，最终完成评价模型研究。结果：（1）通过现况调查，了解到目前产科病区设置的复杂性和母婴同室执行的多样性，产科护理人员配置结构的不合理、工作能力自我认知的水平不同等都在一定程度上影响了护士的职业态度和满意度。（2）构建了由知识和经验、技能与能力和特征与品质3个一级指标，12个二级指标和43个三级指标构成的产科母婴同室病房责任护士岗位胜任力评价指标体系，并确定各级指标的权重，完成了指标量化。根据计算的权重结果建立的产科母婴同室病房责任护士岗位胜任力评价的初步线性模型为：Y=0.425X1+0.384X2+0.191X3.X1=0.232X11+0.075X12+0.118X13;X2=0.148X21+0.047X22+0.053X23+0.048X24+0.045X25+0.043X26;X3=0.109X31+0.037X32+0.044X33.其中，Y表示综合评价得分；X1、X2、X3分别表示三个一级指标的评价得分；分别表示第1个一级指标下3个二级指标的单项得分；分别表示第2个一级指标下6个二级指标的单项得分；分别表示第3个一级指标下3个二级指标的单项得分；依此类推……（3）运用评价指标体系对产科母婴同室病房责任护士岗位胜任力进行实际的验证评价，通过对评价问卷进行的信度和效度分析，发现所构建的评价线性模型具有较好的科学性和可行性，值得推广应用。（4）在指标体系构建和验证研究基础上，进行了产科母婴同室病房责任护士岗位胜任力与工作匹配认知水平的相关分析，结果提示两者在不同水平均有显著相关，且责任护士的年龄、专业、工作年限、个人生育史、是否为独生子女以及所在单位的等级和性质都是影响其岗位胜任力自我评价水平的显著因素。这些都为改善责任护士的岗位胜任力提供了建议。结论：本研究采用多种评价方法构建出的产科母婴同室病房责任护士岗位胜任力评价指标体系具有较好的科学性和可行性，为护理管理者评价产科母婴同室病房责任护士的岗位胜任力提供了一个系统、易操作的主观评价模型。由于研究时间和地域的限制，本研究只选择了自我评价这一形式，故研究结果存在一定的偏倚。下一步可以在已构建的指标体系基础上，采用客观、他人评价的形式，对责任护士的岗位胜任力进行多角度的评价，为科学、全面、正确评价产科母婴同室病房责任护士的岗位胜任力提供一个科学的测评工具。更多还原

【Abstract】 Background：Human resource is the strategic resource of enterprise organization in twenty-firstCentury, is the core power of decisive factors of organizational development andmanagement. And human resource management based on competency is a powerful meansof improving the core competitiveness of enterprises. In2011, Ministry of Health of Chinaissued the "outline of the nursing development plan of China (2011-2015)", clearly putforward to promote the hospital implementation of the ‘National Quality Nursing CareProject” as the starting point, and gradually establish and improve nursing postmanagement system, strengthen the scientific management of nurse team, upgrading thelevel of hospital clinical nursing work. As the core strength of clinical nurses, primarynurse conduct maternal and newborn care in obstetric rooming-in ward, whose competencylevel affects the effect of maternal and child care in a certain extent, and determines theobstetric nursing service quality, also reflects the nursing management level.Objective:This study intends to construct a set of rooming-in wards primary nurse’s postcompetency evaluation model, which is used to describe, analyze and evaluate therooming-in wards primary nurse post competency level, and according to the differentlevels and different types hospital of rooming-in wards empirical analysis to verify themodel is scientific and feasible, and at the same time, to find the influential primary nursepost competency level of important factors.The evaluation model significance lies in the ability to help nurse managers toevaluate and understand the nurses’ job in rooming-in ward, provide the scientific basis forthe rooming-in ward nurses’ configuration, training, competition and use.Methods：On the basis of the literature review, obstetrics nursing staff from24ObstetricDepartments of10different level and type hospitals was accepted the questionnaire surveyin Shanghai by means of objective sampling method. Using self-designed the "ShanghaiDepartment of Obstetrics Nursing Human Resource Allocation, Use and EvaluationQuestionnaire" and "Shanghai Department of Obstetrics Nursing Staff Questionnaire" to investigate the setting status of the Department of Obstetrics, the status of the nursing staffallocation, use and working. It also helps to build the follow-up evaluation model andprovides the realistic basis for post competency evaluation of the primary nurse.Based on the investigation results and the literature research,8obstetric nursingleaders and educators and6obstetric primary nurses, who chose by purpose samplingmethod in accordance with the subject of this study, were conducted semi-structuredinterviews. Data were analyzed by the constant comparison method, and combined withthe relevant policies. Based on strictly follow the construction of comprehensive evaluationsystem of general principles, the basic framework of obstetric rooming-in ward primarynurse’s post competency evaluation model was drawn up.In order to screening indicators, two rounds of Delphi method were conducted for theexpert consultation of each item’s importance in five levels (give correspondingquantitative value5,4,3,2,1). After a comprehensive analysis of the first round of expertfeedback opinion, the items were modified by adding, subtracting, deleting or repairing atall levels. And then a second round of expert consultation was conducted, using AHP togain each index weight value. Finally the obstetric rooming-in wards primary nurse’s postcompetency evaluation linear model was constructed. In this part of the research, Delphimethod is the main method, and the selection of experts is the key factors influencing thesuccess of Delphi method. Therefore, through selecting the5limit conditions, to determine15consultant experts. Through the structure analysis and the authority analysis of experts,the results suggested that consultant experts selected were typical representative, whichensuring the accuracy and reliability of the survey results. In the2rounds of Delphi expertconsultations, the effect of quality control was mainly reflected through calculating theresponse rate as well as the expert coordination coefficient.Finally, the choice of10different levels,189different types of hospitals rooming-inward primary nurses conducted a questionnaire survey, evaluation of scientific andfeasibility of the index system is verified through the analysis of survey data, and usingcorrelation analysis and multiple one-way ANOVA method to find out the importantfactors, finally complete the evaluation model’s research.Results：(1)Through the survey, understand the diversity of the rooming-in, complexity settingof the Obstetrics Department, allocation structure of obstetric nursing staff isn’t reasonable, work ability self-perceptions of different levels, to a certain extent affect the nurse’soccupation attitude and satisfaction.(2)Constructed by the knowledge and experience, skills, abilities and characteristicsand quality of three first-level indicators,12secondary indicators and43tertiary indicatorsof obstetric rooming-in wards primary nurse post competency evaluation indicators system,and to determine the weight of indicators at all levels, to complete the quantitativeindicators. According to the calculation of the weight results, obstetric rooming-in wardsprimary nurse’s post competency evaluation preliminary linear model was established,which as follows:Y=0.425X1+0.384X2+0.191X3.X1=0.232X11+0.075X12+0.118X13;X2=0.148X21+0.047X22+0.053X23+0.048X24+0.045X25+0.043X26;X3=0.109X31+0.037X32+0.044X33.Wherein, Y represents the comprehensive evaluation score;X1, X2, X3, respectively denote the score of three first level indicators:Firstly denote the second level scores which combined with three individualindicators.Secondly denote the second level scores which comprised six individual indicators;Thirdly denote the second level scores which combined with three individualindicators;And so on...(3)By the use of the evaluation model to assess the obstetric rooming-in ward primarynurse’s post competency level, and through the evaluation to analyze the reliability andvalidity of the questionnaire, it is found that the evaluation linear model is scientific andfeasible, and it is worthy of popularization and application.(4)On the basis of index system construction and empirical research, it is found thatthe obstetric rooming-in wards primary nurse post competency significantly related to thelevel of perceived ability-job fit scale，nevertheless, the nurses’ age, professional, workingyears, personal reproductive history, whether for the one-child influence as well as thelevel and nature of the work unit are the significant factors of post competencyself-assessment level, which help to put forward the relevant recommendations to improvetheir competencies. Conclusions:In this study, the obstetric rooming-in ward primary nurse’s competency evaluationmodel, which constructed by using a variety of evaluation methods, is scientific andfeasible. And it also provides a systematic, easy and operational subjective evaluationmodel for the nursing leaders to evaluate the obstetric rooming-in ward primary nurse’spost competency. Because of the time limited and geographical constraints, this studyselected self evaluation as the only method, so the research results have some bias. For theproblems above, and to provide a scientifically, comprehensively and correctly assessmenttools, it is need to assess the primary nurse’s post competency by multi-angle forms.更多还原