Bang 2 cho tha'y, dffdi gdc do quan sat ve nang life dap ffng yeu cau chuyen mdn dieu dffdng va quan ly, trong ky nang trinh do chuyen mdn dat chuan, thi DDTK d Benh vien Da khoa Si M[r]
(1)Thi/c trang nang li/c quan ly dieu du'dng tru'dng khoa
d Benh vien Da khoa Si Ma Cai
(Lao Cai)
NGOYEN V A N GY*
Tom tat
Nhdm xdc dinh vd ludng ndng lUc qudn ly, cdc kie'n thdc vd ky ndng cdn thie't dd'i vdi diiu dudng trudng khoa (DDTK) vd dd'i chieu vdi cdc ndng Ivtc yeu cdu cda DDTK de ddm bdo chdm sdc y te dqt chd't lugng cao tqi Benh vien Da khoa Si Ma Cai (Ldo Cai), tdc gid da phdt bdng hdi vi ndng Ivtc cdn thie't cda DDTK cho 44 nhdn vien, cdn bg vd bdc sy tqi Benh
vien Da khoa Si Ma Cai (gom 06 bdc sy, 10 DDTK vd 28 diiu dUdng vien) Ke't qud cho thdy, DDTK tqi Benh vien Da khoa Si Ma Cai cdn gap nhiiu khd khdn, hqn che, ddc biet Id ndng lytc trien khai ke hoqch, ndng lytc thytc hdnh chuyen mdn, qudn ly hieu qud nguon lytc, phd'i hgp vdi cdc ben lien quan vd ndng lytc tudn thd cdc nguyen tdc dqo ddc quye't dinh
vd hdnh ddng
Tuf khoa: diiu dudng trudng khoa, ndng luc qudn ly, phdn tich thd'ng ke, Benh vien Da khoa Si Ma Cai
Summary
To identify and measure managerial capacity, essential knowledge and skills for chief nurses and to compare the required skills of a chief nurse to ensure high-quality health care at Si Ma Cai General Hospital (Lao Cai), the author sent questionnaires about the crucial capacity of a chief nurse to 44 staffs and doctors at the Hospital (including 06 doctors, 10 chief nurses and 28 nurses) The result showed that chief nurses in Si Ma Cai General Hospital are facing many difficulties and limitations, especially in the capacity of plan deployment, professional practice, effective management of resources, coordination with stakeholders and compliance
with ethical principles in decision and action
Keywords: chief nurses, managerial capacity, statistical analysis Si Ma Cai General Hospital
! ^
Gl6l THIEU
Hien nay, dieu dffdng vien la ngffdi cdng tac va phd'i hdp vdi bac sy dieu tri qua trinh kham chffa benh, khdng cdn thuan la ngffdi chi lam theo y lenh ciia bac sy Tren thffc te, mdt ngffdi dieu dffdng gidi cd the chii ddng viec cham sdc, theo ddi va phat hien cac dau hieu bat thffdng ciia ngffdi benh de thdng bao vdi bac sy va xff tri kip thdi, gdp phan quan trpng vao cdng ciia dieu tri De cd dffdc mdt he thd'ng dieu dffdng td't d mdi benh vien, DDTK cd nhieu ddng gdp cdng tac td chffc
dieu phd'i chuyen mdn va la cau nd'i giffa cac phan tham gia vao qua trinh cham sdc
La mdt huyen vung cao bien gidi, Benh vien Da khoa Si Ma Cai phai phue vu mot dia ban rdng ldn di lai khd khan, tren 90% la ddng bao dan tdc thieu so', cdn nhieu hii tuc lac hau Trong bd'i canh dd, dii da cd nhieu cd' gang, song dpi ngu dieu dffdng vdi phan ldn la nhffng ngffdi cd trinh dp dao tao d bac trung cap da it nhieu gap nhffng khd khan, ban che Chinh vi vay, nghien cffu dffdc thffc hien nham xac dinh va Iffdng nang life quan ly, cac kien thffc va ky nang can thiet dd'i vdi DDTK tai Benh vien Da khoa Si Ma Cai Ddng thdi, tac gia se dffa cac khuye'n nghi thich hdp nham nang cao nang life quan ly cua DDTK nham dam bao cdng tac cham sdc y te dat chat Iffdng cao
*ThS., Benh vien Viet Dffc I Email: nguyenvanuy76@gmail.com
Ngdy nhdn bdi: 25/10/2018; Ngdy phdn bien: 09/11/2018; Ngdy duyet ddng: 15/11/2018
(2)BANG 1: DO CHENH LECH GICfA NANG LCTC YEO CAO VA NANG LCTC THCTC TE DOI VCJI NANG LCfC THCfC HANH QUAN LY CUA DDTK
Nang li^c thtfc hanh quan Iy (Cronbach's Aloha = 0.843) Thu thap dff li^u Phan tich va'n dl thtfc tfe'va xu htfdfng Xac dinh muc ti&u Lap kfe' hoach d^dat muc ti&u Trien khai ke' hoach Danh gia stf thtfc hien ke' hoach
1 Thu thap diJ Ueu mot each he thong va hen tuc Ket noi cac dieu du'dng vien va cac ben co Hen quan Ichac de tao nen nguon dil lieu tong hdp co moi quan he chat che giffa tdng the va bp phan, he thong va moi tnfdng
3 Su" dung cac cong cu thu thap dff lieu diTa vao bang chffng
4 Riit cac van de ton tai, van de gay tranh cai va xu hffdng van hanh tff viec phan tich dff lieu Sff dung cac md hmh va cac cong cu phii hdp de phan tich van de
6 Hdp thffc hoa cac vafn de va xu hffdng vdi cac nha cung cap dich vu cham soc sffc khoe va cac nha dau tff co the va phu hdp
7 Thuc day sff thong nhat giffa cac nguon Iffc y te, ngffdi va tai chinh de phue vu cho giai quyet van de
8 Rut cac dau ra, ke't qua can dat dffdc tff viec nhan dien cac van de ton tai, van de gay tranh cai va xu hffdng
9 Phat trien cac muc tieu hffdng tdi viec nang cao khong ngffng chat Iffdng cham sdc sffc khoe 10 Phat trien cac ke'hoach dffa cac giai phap va cdng cu phu hdp de dat muc tieu 11 Sff dung ke' hoach de truyen dat muc tieu, phffdng hffdng de'n cac dieu dffdng vien va cac ben CO lien quan khac
12 Thuc day sff tho'ng nha't cac nguon lu'c ve y te', ngffdi va tai chinh de md rong va hoan thien qua trinh lap ke hoach
13 Thffc hien ke'hoach mot each an toan, dung tie'n
14 Phoi hdp vdi cac hoat dong lien quan, cac nguon Iffc ngffdi, vat chat, tai chinh de dam bao sff thong nha't dich vu cham sdc sffc khoe 15 Thuc dav he thdng truyen thong md va minh bach 16 Ddng gop vao viec thie't ke', trien khai va danh gia cac chffdng trinh dao tao, boi dffdng can thie't cho viec trien khai ke hoach
17 Thuc day cac chffdng trinh giao due sffc khoe cho Ichach hang
18 Cung cap sif tff van de tac dong vao qua trinh thffc hien ke'hoach, tang cffdng nang lyfc va tac dong de'n sff thay ddi qua tiinh thffc hien ke hoach 19 Danh gia dung ke't qua dat dffdc vdi viec sff dung cac cong cu danh gia phu hdp
20 Truyen dat ke't qua danh gia de'n lanh dao, dieu dffdng trffdng benh vien, dieu dffdng vien mot each thich hdp
21 Sff dung ke't qua danh gia de tang cffdng sff hoan thien, ddi mdi hoat dong eua cac dieu dffdng vien va bo phan
Nang Itfc v^u c i u
3.8 3.8 3.8 3.9 3.9 3.9 4.0 3.9 4.0 4.3 4.2 4.1 4.2 4.2 4.0 4.3 4.3 4.3 3.8 4.2 4.0 NangItfc thtfc tg' 3.9 3.7 3.8 3.5 3.4 3.4 3.6 3.5 3.5 4.0 4.0 4.0 4.0 3.9 4.0 3.8 4.0 3.0 3.5 3.6 3.4 Ch6nh I$ch -0.1 0.1 0.4 0.5 0.5 0.4 0.4 0.5 0.3 0.2 0.1 0.2 0.3 0.5 0.3 1.3 0.3 0.6 0.6 N g u d n : Tinli toan cua tac gia c a s d LY THUYET VA PHL/ONG PHAP NGHIEN CLTU
Cgsdly thuyet
Tren the gidi da cd nhieu nghien cffu ve nang life va nang life quan ly cua DDTK Cu the: Brooks, B A & Barrett, S (1998) da xac dinh khung nang life quan ly cd't ldi cho cac quan ly dieu dffdng Tuy nhien, de tai chi hffdng tdi dd'i tffdng la cac nha quan ly dieu
dffdng ndi chung, chffa de cap cu the den nang life cua DDTK ndi rieng
Tai Hoa Ky, dieu dffdng dang gap phai ap life rat ldn vi phai cham sdc qua nhieu ngffdi benh, dSn de'n nhffng sai s6t khdng dang cd Ho ket luan rang, viec de xay bie'n chffng, keo dai thdi gian nam vien bay gia tang sff tai nhap vien ciia ngffdi benh la hau qua cua thie'u nhan life dieu dffdng Theo ke't qua nghien ciiu ciia Spetz, J., Donaldson, N., Aydin, C, & Brown, D S (2008), ty le tdi thieu dieu dffdng/ngffdi benh de dam bao an toan cho ngffdi benh dffOc xac dinh theo cdng thffc sau:
So dieu duang _ Tong so gia lam viec cua dieu dumg So benh nhdn So ngdy benh nhdn dieu tri X24
Vdi cac nghien cffu nffdc, tieu bieu cd nghien cffu cua Vi Nguyet Ho, Pham Dffc Muc (2005) da cho thay vi tri va nhffng tifu dat dffdc ciia dpi ngu dieu dffdng thdi gian qua Nhdm tac gia da khang dinh dieu dffdng la life IffOng tao sff thay ddi tich cffc he thdng y te Nhdm tac gia da dffa dffdc cac giai phap kha cu the ve phat trien nguon nhan life dieu dffdng Tuy vay, nghien cffu cung chi dffng lai d van de phat trien ngudn nhan life dieu dffdng vien
Trong do, de tai "Khao sat thifc trang nang life dieu dffdng lam viec tai mot so' benh vien de cai tie'n chffcfng trinh, phffdng phap dao tao va nang cao hieu qua dieu tri va cham sdc ngifdi benh" cua Le Thi'Binh (2008) tap trung danh gia nang life lam viec ciia dieu dffdng vien, chffa khao sat dffdc nang life cua cac DDTK Do dd, nghien cffu ciing chi dffng lai d va'n de nang life chuyen mdn, chff khdng de cap den nang life quan ly dieu dffdng
PhUOngphdp nghien cdu
Dffa tren dieu tra, khao sat vao thang 07/2018 dd'i vdi 44 nhan vien, can bo va bac sy tai Benh vien Da khoa Si Ma Cai (gdm 06 bac si, 10 DDTK va 28 dieu dffdng vien) ve 61 ky nang, nang life quan ly cua DDTK, tac gia sff dung thang Likert bac de thu thap sd lieu (1 den vdi mffe quan trong/can thie't tang dan) Cac ky nang dffdc suT dung khao sat chia nhdm: nhdm thff nha't lien quan de'n nang life thffc hanh quan ly va nhdm edn lai lien quan de'n nang life dap ffng yeu cau chuyen mdn dieu dffdng va quan ly (Bdi vie't sddung cdch viet sdthap phdn theo chudn qud'c te)
(3)Kinhte
BANG 2: DO CHENH LECH GICfA NANG LCfC YEO CAU VA NANG LCfC THCTC TE DOI V6l NANG LCfC DAP CfNG YEO CAO CHUYEN MON DIEU DCfONG VA Q U A N LY CUA DDTK
Nang Itfc dap tfng ydu c i u chuydn mdn dieu dtfSng va quan Iy (Cronbach's Alpha = 0.901)
Trinh chuydn mdn dat chuin
Hoc hoi va sang tao khong ngtfng
Danh gia va ttf danh gia
Nghien ctfu khoa hoc va tfng dung ke't qua nghien ctfu
Phd'i hdp va phat trien d6ng nghiep
Cong tac \6i cac ben CO lien quan
Quan Iy hieu qua cac ngu6n Itfc
Lanh dao
Tuan thu cac nguyen tac dao dtfc quyd't dinh va hanh ddng Tudn thu
phap ludt
22 Thffc hanh lam sang
23 Thie't ke'cac mo hinh cham soc sffc khoe ngffdi benh 24 Kinh te y te
25 Thffc hanh dffa vao bang chffng 26 Dam bao an toan cho ngffdi benh 27 Kiem soat nhiem khuan benh vien 28 Quan ly rui ro dieu dffdng 29 Lap ke hoach hoc tap cho ban than
30 Khong ngffng hoc tap nang cao trinh chuyen mon va quan ly
31 Dffa cac sang kie'n cai thien chat Iffdng dich vu dieu dffdng va quan ly
32 Gan sff tif danh gia cua ban than vdi cac tieu chuan cd ban, nhan bie't nhffng diem manh cflng nhff diem ye'u va cd cac hanh dong cai thien phu hdp
33 Thu thap phan hoi tff cac nguon khong chinh thffc nhff ngffdi benh, dong nghiep va cac ben co lien quan khac
34 Tham gia danh gia cap dffdi, dong nghiep mot each hdp ly
35 Tan ditng mot each tot nha't cac ket qua nghien cffu de ap dung vao cac quye't dinh thffc tien
36 Chu dong tham gia vao cac hoat dong nghien cffu
37 Thu thap thong tin, chia se cac nghien cffu vdi dong nghiep va dd'i tffdng khac 38 Ke't hdp chat che nghien cffu vdi viec hoc tap
39 Duy tri sff cam thdng, phat trien md'i quan he vdi dong nghiep
40 Chia se Icie'n thffc, ky nang vdi dong nghiep va cung cap phan hoi lien quan de'n cong viec dieu dffdng
41 Tang cffdng chuyen mdn va thffc hanh dieu dffdng cho cac dieu dffdng vien 42 Khuye'n khich sff sang tao cua nhan vien
43 Gdp phan tao mdi trffdng lam viec hieu qua va nang cao sff phoi hdp to chffc 44 Giao tie'p hieu qua va xay dffng tot cac moi quan he vdi cac trffdng dai hpc y, nha quan ly, nha dau tff
45 Cong tac vdi cac ben khac de tac dong de'n sff thay doi va tao ke't qua dau tich cffc 46 tJng dung ky thuat dam phan vdi khach hang va dong nghiep
47 Thuc day cdng tac quan ly xung dot va sff doan ke't
48 Danh gia nhu cau cham sdc sffc khoe cua khach hang va cac nguon life cd the huy dong de dat dffdc ket qua mong mud'n
49 tJng ho sff dung cac nguon life cdng nghe giup tang cffdng chat Iffdng dieu dffdng 50 Giam sat viec ghi chep ho sd benh an theo quy dinh ciia Bp Y te
51 Quan ly sff dung hieu qua cac trang thie't bi, vat tff y te
52 Thie't lap mdi trffdng lam viec an toan (an toan lao ddng, an toan kiem soat nhap khuan, chat thai y te, phong chay nd)
53 Quan ly va suf dung hieu qua he thd'ng cdng nghe thong tin
54 The hien kha nang dffa tam nhin, muc tieu rd rang, ke hoach de trien Ichai va Iffdng sff tie'n bp
55 The hien kha nang sang tao, linh hoat vdi sif thay ddi 56 Xay dffng va tri cac nhom lam viec nang ddng, hieu qua 57 Quye't dinh va hanh dong dffa tren cac nguyen tac ve y dffc 58 Thffc hien va lam theo 12 dieu y dffc
59 Cd cac hanh dong thich hdp de xufly cac hanh vi khdng phu hdp, trai phap luat va y dffc 60 Gdp phan giai quyet cac van de cdn tdn tai lien quan de'n y dffc
61 Thffc hanh theo quy dinh cua luat cham sdc sffc khoe nhan dan, cac quy dinh cua Bd Y te'va Benh vien
Nang Itfc y§u c i u
4 4 4 3.9 4 4.1 4 4 4 4 3.7 3.7 3.8 3.9 4 3.9 3.9 4.2 4.2 4.3 4.2 4.2 4 4 4 4 4 4 4 4 4 4 4 4.1 3.9 4.3 4.5 4.2 4.2 4.8
NangItfc thtfc te' 4.1 3.8 4 3.8 4 4.1 4 4 3.9 3.8 3.9 3.9 3.9 3.1 3.2 3 3.2 4 3.8 3.8 3.8 3.7 3.7 3.7 3.7 3.7 3.7 3.7 3.8 3.6 3.7 3.7 4 4 4 4 4.2 4 4 4.3
ChSnh Idch
-0.1 0.2 0.1 0 0 0.1 0.2 -0.2 -0.2 -0.1 0.8 0.8 0.9 0.7 0.2 0.4 0.5 0.4 0.5 0.3 0.3 0.3 0.3 0.3 0.3 0.2 0.4 0.3 0.3 0.1 -0.1 0.3 0.3 0.2 0.2 0.5 Ngudn: Tinh toan cua tac gia KET QUA NGHIEN CLfU dang bi thieu khuyet nhat ddi vdi ddi ngu DDTK la:
Phan tich van de thife te va xu hffdng (Sff dung cac Ve ndng li/c thUc hdnh qudn ly md hinh va cae cdng eu phu hdp de phan tich van de Bang cho tha'y, ve mffe chenh lech (do chech lenh la 0.5)); Phan tich van de thffc te'va xu giffa diem trung binh cua cae nang life hffdng (Thuc day sff thd'ng nha't giffa cac ngudn life y te, thifc te' eu the, cd the tha'y cac ky nang ngffdi va tai chinh de phue vu cho giai quyet van
(4)de (0.4)); Xac dinh muc tieu (Rut cac dau ra, ke't qua can dat dffdc tff viec nban dien eac van de cdn ton tai, van de gay tranh cai va xu hffdng (0.4); Phat trien cac muc tieu hffdng tdi viec nang cao khdng ngffng chat IffOng cham sdc sffc khide (0.5)); Trien khai ke hoach (Ddng gdp vao viec thiet ke, trien khai va danh gia cac chffdng trinh dao tao, bdi dffdng can thie't cho viec trien khai ke hoach (do chenh lech la 0.5))
Ngoai ra, vdi hau bet cac ky nang cdn lai, cac DDTK tai Benh vien Da khoa Si Ma Cai du ddi chd tha'p hdn mffe dffdc yeu cau mot chut, nhffng cd ban deu dffdc danh gia la dap ffng va du nang life de hoan yeu cau (Bang 1) Mot phan nguyen nhan cua dieu nay, cd the giai thich mffe yeu cau tffdng dd'i tha'p vdi cac ky nang nang life thffc hanh quan ly tai Benh vien Da khoa Si Ma Cai
Ve ndng lUc dap dng yeu cdu chuyen mdn dieu dudng vd qudn ly
Bang cho tha'y, dffdi gdc quan sat ve nang life dap ffng yeu cau chuyen mdn dieu dffdng va quan ly, ky nang trinh chuyen mdn dat chuan, thi DDTK d Benh vien Da khoa Si Ma Cai cdn ban che d cac nang life sau: Nghien cffu khoa hoc va ffng dung ket qua nghien cffu; Phd'i hdp va phat trien ddng nghiep; Quan ly hieu qua cac ngudn life (Quan ly sff dung hieu qua cac trang thie't bi, vat tff y te); Tuan thu phap luat (Thffc hanh theo quy dinh cua Luat Bao ve sffc khoe nhan dan, cac quy dinh cua Bd Y te' va Benh vien)
Trong đ, dang chu y, ca 04 ky nang cua Nghien cffu khoa hoc va ffng dung két qua nghien cffu la: Tan dung mot each td't nhát cae ket qua nghien cffu de ap dung vao cac quyét dinh thffc tien, Chu đng tham gia vao eac boat đng nghien effu, Thu thap thdng tin, chia se cac nghien cffu vdi đng nghiep va đ'i tffdng khac, Ket hdp chat che nghien cffu vdi viec hoc tap deu cd mffe chenh lech ldn (dao đng 0.7-0.9) giffa nang life yeu cau va nang life thffc tệ Dieu dffdc ly giai la do, trinh dao tao cua ngu ĐTK d Benh vien Da khoa Si Ma Cai hau bet d bac trung cap, lai cdng tac d đn vi vung cao, nen dieu kien de nghien cffu khoa hoc va ffng dung két qua nghien cffu vao thffc te la khd khan
Tuy nhien, ben canh nhffng han che ndi tren, nang life dap ffng yeu cau chuyen mdn dieu dffdng va quan ly cua doi ngu DDTK d Benh vien Da khoa Si Ma Cai cung cd nhffng mat manh, the hien d cae nang life ve: Trinh d6 chuyen mdn dat chuan thffe hanh lam sang vdi da so' cac ky nang cd nang life thffc te bang hoac cao hdn so vdi nang life yeu cau (-0.1-0.2); Hoc hdi va sang tao khdng ngffng (0-0.2); Danh gia va tiT danh gia (-0.2 de'n -0.1); Lanh dao (-0.1-0) Dieu cho tha'y, du lam viec mdi trffdng edn nhieu khd khan, nhffng doi ngu DDTK da khdng ngffng cd gang, nd life cung nhff tif trau ddi, hoc hdi de hoan td't cdng viec eua minh
KET LUAN VA M O T SO DE XUAT Ket qua nghien cffu cho tha'y, dpi ngii DDTK ve can ban cd nang life dap iJng kha td't dieu kien va mong mudn ciia Benh vien Da khoa Si Ma Cai Tuy nhien, cac nang life lien quan den phan tich van de, xac dinh muc tieu, nghien cffu va ffng dung nghien cffu, phd'i bdp phat trien ddng nghiep va tuan thu phap luat van la cac diem can lffu tam tang cffdng
Ben canh do, can thffdng xuyen to chffc cac boat dong giao lffu, trao ddi nhan vien, phue vu viec hoc tap, hpc hoi kinh nghiem danh cho DDTK cac benh vien vung cao tai cac benh vien ldn co be day kinh nghiem va doi ngu DDTK manh nham nang cao kie'n thffc va thong tin cho cac dd'i tffdng ndi tren
Ngoai ra, can tang cffdng bdi dffdng, tao lap them nhieu cd hoi trao ddi, giao lffu hoc tap cua dpi ngu vdi cac benh vien cd be day kinh nghiem va nang life quanly td't.Q
TAI LIEU THAM KHAO
1 Le Thi Binh (2008) Ddnh gid thuc trqng ndng lite chdm sdc ngUdi benh cda diiu dudng vien Benh vien vd di xudt gidiphdp can thiep, De tai nghien cffu khoa hpc cap bd, Bd Y te
2 Vi Nguyet Hd, Pham Dffc Muc (2005) Hien trqng nguon nhdn lytc diiu dudng, nhvtng thdch thdc vd tuang lai ngUdi diiu dudng Viet Nam, Tai lieu dao tao quan ly dieu dffdng, Cue Quan ly kham chffa benh Bd Y te
3 Nguyin Van Uy (2012) Ndng cao ndng Ivtc qudn ly cda DDTK tqi Benh vien Viet Ddc, Luan van thac sy, Trffdng Dai hpc Kinh te Qud'c dan
4 Brooks, B A & Barrett, S (1998) Core competencies for outcomes management in nursing Outcomes management for nursing practice, 2(2), 87-89
5 Spetz, J., Donaldson, N., Aydin, C & Brown, D S (2008) How many nurses per patient? Measurements of nurse staffing in health services research Health Services Research 43(51),
1674-1692