1. Urgency of theswas:
In our country, Chief Nurse System (CNS) is the first management level
of the hospital. Chief Nurse is responsible for implementing the medical
command of doctor, management of human resources and department
administration. Efficient quality of care, patient service, use of resources
depends significantly on CNS. According to survey in year 2007 of the Viet
Nam Nursing Association, Chief Nurse has had generally intermediate level
84.8%, College 7.2%, University 7.8% and postgraduate 0.2%. Have been
trained the nursing management with the rate of 37.8%, the effectiveness of
executive leadership, participation in the activities of training, guidance and
specialization guidance has been only done good 33.7% , .
In Nghe An (2008), Number of Chief Nurse has been more than 400
people, intermediate professional qualification has been 91.9%; college 8.1%;
Trained on nursing management 19.2% , . In recent years, Nghe An has
gradually strengthened and perfected the nursing management system. However
in fact revealed a certain number of limitations, such as low-level professional
qualification, management capacity was not effective, management system was
insufficient, has been influenced on the quality of patient care.
With the challenges in health care, hospital overcrowding has increased
the shortage of nursing manpower, limitation of proficiency was barrier in
whole patient care. This was that the role and responsibility of the Chief Nurse
became very important in the planning, coordination of the work, the thesis was
the key to solve the above challenges, became more urgent and meaningful
Proceeding from the above requirements we have carried out
implementation of the project: Status and effect of Chief Nurse ability
intervention in Nghe An province with the goals:
1. Describe the situation and factors that has affected the ability of Chief
Nurse at the hospitals in Nghe An province in 2010 - 2011.
2. Evaluate capacity improvement intervention effect of Chief Nurse at
the hospitals studied in 2011-2013.
2. New contributions of the thesis:
- Describe the task performance capacity status for the management of
Chief Nurse in the hospital - Nghe An province.
- Identify the factors affecting to the task performance capacity for the
management of Chief Nurse in the hospital - Nghe An province.
- Consider about the task performance capacity status for the management
of the hospital of Chief Nurse in the hospital - Nghe An province.
- Proven intervention activities raised Nursing Management Capacity for
- Strengthen capacity of health systems (building the technical
management system, records and report system) to contribute improvement of
the nursing care service quality in the hospitals - Nghe An province.
3. Layout of thesis: Including 125 pages, Introduction 2 pages, Overview for
document 40 page, object and methodology 18 pages; Research Results 40
pages, Discussion 22 page, Conclusions 2 pages and Recommendations 1 page.
There were 18 sets, 17 figures, 02 diagrams and 159 references (Vietnamese:
110, English: 49).
Chapter 1. GENERAL
1.1 Concepts and relevant definitions:
- Management capacity has been evaluated based on the ability to apply
knowledge and skills in management operations: including knowledge for the
skills and management content. Perform proficiently management processes
and attitudes before the assigned work in a spirit of responsibility, solidarity,
self-dwascipline, sacrifice for the community .
- Nursing Management Capacity (NMC) has been expressed on the ways
of knowledge, practices and attitudes: the nursing dean (ND) has had the
excellent technical expertwase, both have has good management skills and
seriousness and responsibility before actions. However, the application of the
preeminent quality management system, supporting Manager would increase
management efficiency , , , .
1.2. Nursing management capability:
1.2.1 Nursing management competency assessment skills:
Based on the knowledge and practice of the nursing management skills,
including 16 following skills , , , , , : Organizing wholly
care for patients; Directing the hygiene work; Human resource management;
Asset - Materials Management; Participation in training, scientific research;
Planning; Plan performance organizations; Evaluation; Supportive supervision;
Application of information technology; Decwasion making; Problem solving;
Organization of meetings; Time management; Administrative documents and
drafting method of text and Records Management.
1.2.2 Nursing Management Capacity Method:
- Periodical, regular evaluation; - Extraordinary evaluation; - Periodical
evaluation interposed extraordinary , , , , .
1.2.3 Factors affecting the Nursing management capability:
Factors have affected nursing capacity, including:
- NURSE Qualifications was low , .
- The administration and documentation works of nurse occupy
percentage of time equivalent to the direct time for patient care (CP) (28%).
Meanwhile, each activity, work had not guidelines, procedures work to help
management methodically and unified .
- Awareness of staff, the low self-esteem, the complacent of the medical
staff for nursing person have affected to some extent the management operation
and covering and extending level of whole patient care (WPC) in the hospitals.
The hegemony of doctor, the coordination between the nurse and each other .
- The Nursing person (Nurse) has had often passive and dependent behavior,
they have taken the initiative in the struggle for the branch. Internal branch was
often not united.
- Lack of educational opportunities, re-training for specialization and
- In addition, low-income, large number of patients, lack of equipment
and coordination of the patient and family were also factors affecting not less
the quality of nursing work.
1.3 Research for Nursing Capacity:
1.3.1 In the world:
For scientific research in the nursing, according to Tiran and colleagues at
the University of Greenwich London has shown lack of head to promote as well
as instruct the research, this was one of the reasons causing non-clinical nurse
not or reduced research capacity .
Research on knowledge, practice, attitudes of nurses, Chief Nurse of
Pamela Duffy and colleagues in the United States has shown that there was a
difference in practice perception of provincial hospital before and after training.
For skills before training rate of Nurse, Chief Nurse having confidence in
clinical practice was 46%, after training was 60% (p = 0.018), the attitude was
also similar difference (p = 0.046) .
According to Roderick’s researchers at the United States for improvement
of the patient care quality (PC)  has shown that the patients’ satisfaction
proportion for the doctor was the higher than Chief Nurse, Nurse in intensive
clinic department, but in obstetrics satisfaction for Nurse, Chief Nurse was
73%, for the doctor 71%.
1.3.2 In Viet Nam:
* For nursing management:
According to the survey results of the Vietnam Nursing Association in
2007 has shown that levels of Chief Nurse in hospitals in Vietnam have had
professional qualifications limited intermediate 90.6%, below the age of 35
accounted for 23, 9%. Rate of Chief Nurse not trained about management was
still high (62.2%) ;
Pham Duc Muc’s research , to investigate systems and human
resource for Chief Nurse in central and provincial hospitals in 2007 shown:
Trained for Nursing management was 63.3%. Implementing authorities tasks:
Organizing and directing the implementation of whole patient care (WPC):
good 72.3%; medium 22.1%; poor 4.1%; no done 1.5%. Speech, check the
implementation in accordance technical procedures hospital regulations: Good
90.0%; Average 3.2%; poor 5.2%; no done 1.5%. Organize training and rawasing
the level: good 62.4%; Average 22.5%; poor 9.2%; no done 5.9%. Join practice
guide for pupil - student: Good 35.8%; Average 31.4%; poor 26.6%; no done
6.3%. Procurement planning, test use and preservation: good 48.0%; Average
31.4%; poor 26.6%; no done 6.6%. Check the hygiene, infection protection: Good
88.2%; Average 5.5%; poor 5.2%; no done 1.1%. Join the organization,
recruitment work: Good 60.5%; Average 24.0%; poor 12.5%; no done 3.0%.
Participation in scientific research: Good 38.0%; Average 22.1%; poor 34.7%; no
done 5.2%. Participation in guidance of branch: Good 45.8%; Average 20.3%;
poor 22.8%; no done 5.2%. Sum up partially, generally: good 62.0%; Average
27.5%; poor 8.0%; no done 2.5%. Participation in propose ideas regarding the
nursing policies: good 77.9%; Average 17.0%; poor 4.1%; no done 1.1%.
According to Do Dinh Xuan’s research (2007) , has shown that
6,787 Chief Nurse were working in the public hospitals in the country,
including: Nurse 78.4%, Midwife 7.4%, Medical Engineering 8.2%, 6.0% Chief
Nurse with no professional qualification was nurse participating in nursing
management (doctors, pharmacists). Regarding the capacity status of Chief
Nurse Dean: 84% Chief Nurse Dean have assessed themself that they were able
to complete from more fairly in the contents: patient care organization;
Sanitation work guideline of departments; rooms; human resource management;
asset and materials management. Only 54.5% Chief Nurse Deans jointed in the
courses for management, in training, scientific research and direction of branch,
with 61.40% gain from the good level and more, especially, 20.20% Chief
Nurse Deans were weak in scientific research work. Weak implementation or
no organization of scientific meetings accounted for 24.40%. Still 21.10%
Chief Nurse Deans have achieved an average or less within the formulation,
organization and maintenance of wholly care work. Chief Nurse Dean was
weak or may not participate in the selection of new employees for 24.40%.
* For affected factors:
Do Dinh Xuan’s research (2007) , indicating that the factors such as
age, sex, equipment and working conditions, the coordination of patient
families and doctors as well as the work overload, etc were considered as
relevant factors and influenced directly the ability of Chief Nurse Dean.
Very little themes research factors affecting nursing capacity, might have
re-statwastic some related factors directly affecting the quality of professional
management. No analytical research has evaluated the affecting factors to give
solution to effective interventions.
* For the document, form of nursing management:
According to Vo Thi Dinh , the record, storage of document, form were
pretty good, record status surpluses or deficits, duplicate information stipulated
by the Ministry of Health that also occurred . Nguyen Thi Thanh Mai said
that recording the developments of patients recently being in the department
were less than 5%, average 73%, rather 22%; developments in the treatment
process were less 4%; average 78%, rather 18%; handling care were less 6%;
average 75%, rather 19% .
* For satisfaction of patient:
According to Vuong Kim Loc, research for the situation of nursing
management work at Saint Paul hospital in 2007, patient’s satisfaction results
have reached 55% .
Le Thi Binh’s research (2008), the Central Hospital was very satisfied by
people 42.1%; satisfied 48.2%; Provincial/ citify hospitals very satisfied 62%,
satisfied 36% . Ha Thi Soan’s research (2007) has assessed the satisfaction
of patients and their family for the medical staff about attitude >90% satisfied,
specialization >90%, patients boards 94%. However, 10-12% non-satisfied
were mainly on administrative procedures, made the test but not explain, no
dietary guidelines, patients have had to buy more medicines outside .
Survey results of Nguyen Thi Ngoc (2005) at the General Hospital Thong Nhat,
Dong Nai, the average satisfaction rate was 45.3% primarily not satisfied with
guidance, explanation and health education yet thoughtful . Hoang Thu
Nga’s research said: satisfaction rate for attitude of service 87.8%; guidance in
hospitalization 87.1%; mode of hygiene 84.8%; facilities, equipments 80.1%;
security 62.9% and expertwase 93.7% .
1.3.3 In Nghe An:
Research in 2009, Nursing staffs, midwives in Nghe An has had 1,735
workers, mostly women 84.5%. In which university degrees, college was
11.7%, foreign language level A was 12.3%, Office informatics were 24.8%,
trained nursing Management 38.5% .
According to the 2008 survey in Vinh City shown: Chief Nurse has had
intermediate level about 91.9%; Average age of 35-55 accounted for 78.8%; not
trained nursing management about 76.8%, capable of office computing and
foreign language level A accounted for 54.5 - 62.6% .
In recent years, although there have been many positive changes in the
domains of nursing, patient care in Nghe An. However, the nursing scientific
research has had still many limitation because the force of nurse, midwife and
technicians were mainly intermediate, an knowledge for research design and
methods of scientific research was weak. The major topics has used the
description method, bringing the summarization, report, very little research
analysis titles, content focuses mainly on human survey, conducted nursing
technical procedures, understanding patient service attitude. Especially
intervention research for Chief Nurse capacity did not have any topic.
Chapter 2. OBJECTS AND RESEARCH METHOD
2.1 Research objects:
- Chief Nurse was working at the hospital in Nghe An province.
- Management staff of department, research hospitals.
- The system of records, books, management forms of research hospitals;
- Patients who were inpatients in the departments, research hospitals.
2.2 Capacity investigation location of Chief Nurse: at 40 public hospitals and
private in Nghe An.
2.3 Research time:
Research time was conducted from 2010 to 2013, divided into 2 stages.
2.4 Research Methodology:
2.4.1 Research design:
Cross-sectional descriptive research analysis in combination of control
2.4.2 Research sample sizes:
Stage 1: Current status and factors affecting the status of Chief Nurse capacity.
22.214.171.124 Quantitative Research:
Chief Nurse object:
Thus, the research samples of Chief Nurse object were 403.
Records, books, saving reports:
Analysis of records, books and reports related to the nursing care and
nursing management works of the years 2009 - 2013, including: case history,
monitoring sheet, care vote, the management books of materials, manpower,
plans, preliminary reports and summarization ...
Patients’ inpatient treatment:
Thus, the samples have selected to research of patient object were 400.
126.96.36.199 Qualitative Research:
- Depth interview: Director/Vice Director of the hospitals: 8 persons.
- Discussion under groups: 02 groups, each group was 8 head or deputy
Stage 2: Evaluation of effectiveness of intervention "improvement of Chief
188.8.131.52 Intervention research:
Total of Chief Nurse required to research 100 (Intervention group 100
and control group 100).
2.4.4 Research sample selection method:
184.108.40.206 Cross-sectional descriptive research:
- For the Chief Nurse:
Choose whole Chief Nurse working in 40 public hospitals, non-public in
Nghe An province.
- For inpatients: Select samples with 02 stages:
- Stage 1: Divise the provincial, district, citify hospitals into two
ecoregions (advantages and disavantages).
- Stage 2: Each ecoregion randomly has selected in proportion,
disavantage 3/12 hospital and advantage 7/28 hospital to conduct an
investigation, in each hospital investige 40 patients.
220.127.116.11 Qualitative Research:
Intentionally select 8 above research hospitals: Depth interviews with 8
Director/ Vice Director. Organize Discussion into 2 groups, each has been 8
head or deputy department.
18.104.22.168 Intervention research:
Step 1: Select the research locations: Select 21 hospitals/ 32 public hospitals
randomly assign the intervention group and control group.
Step 2: Pre-intervention assessment: Assess capacity of Chief Nurse; The
success indexes before the intervention:
Step 3: Implement intervention situations to improve the capacity of Chief Nurse:
* Develop a plan of implementation, inspection and evaluation;
* Carry out the service supply and longitudinal inspection of research
indexes during the intervention time, was 02 years (24 months):
- Implement training solutions in Nursing Management , :
Training Program: issued by Ministry of Health attaching the Text No.
5909/YT-K2DT dated 16/08/2004 of the Ministry of Health, including 16 skills
for nursing management , ; Develop and use procedures, guidelines
and forms for nursing management.
- Organize the application of knowledge, skills and forms of Nursing
Management in daily activities of Chief Nurse.
- Implement periodic supervision: 1 month/time to support supervision, 3
months/time meetings, learn from experience.
Step 4: Collect, process data, and post-intervention effectiveness.
- Collect post-intervention data.
- Evaluation in comparison with post-intervention: Two intervention and
non-intervention groups was initially the same (ptct and ptc), any difference (the
index) was later through the horizontal invertigation in psct and psc that could
relate the impact of intervention method.
+ The result index of intervention group = (psct - ptct )/ptct x 100%
+ The result index of control group = (psc - ptc)/ptc x 100%
+ Effective intervention = The result index of intervention group - The
result index of control group
In which: The result index: Performance Index; ptct: The pre-intervention
research index of intervention group; psct: The post-intervention research index
of intervention group; ptc: The pre-intervention research index of control group;
psc: The post-intervention research index of control group.
The result index of intervention group > 0 and Intervention result = The result
index of intervention group - The result index of control group > 0, so the
intervention was effective.
2.5 Data collection and processing method:
2.5.2 Data processing:
- Quantitative data processing: software EpiData 3.1 software and SPSS
16.0 with the test t; test 2.
+ Comparison 2 rates: If 2 calculation > 2 table, so there was different
between the two rates (index), means statistical significant at level p < 0.05 or 0.01.
+ Comparing two average values: Testing test t, no duplex, independent
observation, homogeneity variance and net distribution .
+ Influencing factors: Recurrent analysis of logistis to analysis of
multivariate relationship, based on a stepwise process. The dependent variable,
independent variables have brought into the binary variable form.
Chapter 3. RESEARCH RESULT
3.1 Status and factors affecting the Chief Nurse management capacity:
3.1.1 Characteristics of the research subjects:
Results for General Information about Chief Nurse: Sex: Mostly female
(81.6%); under age 40 was 57.1% higher; Main ethnic was Kinh (95.1%); Main
professional qualifications was Intermediate (62.9%); Nursing specialization
accounted for 68.4%; trained nursing management was 25.7%; Foreign
language levels were mainly A, B (58.0%); Computer levels A, B (70.6%) and
overseas study tours most (98.3%) have not been away.
3.1.2 Management capacity status of Chief Nurse:
22.214.171.124 Chief Nurse’s management knowledge:
Classification of Chief Nurse’s management knowledge under the
qualification: The results have shown that 412 Chief Nurse, the rate of general
management knowledge graded fair, good 72.5%; in the group from College
degree and more account for 26.4%, Intermediate group 46.1%. According to
the provincial and district branches: General management knowledge rate
grades fairly, good at provincial group was 29.4% ( x = 65.43), the district
group was 43.2% ( x = 64.32). According to public hospitals and private: rate of
general management knowledge grades fairly, good in public group was 65.1%
( x = 66.22), non-public group was 7.5% ( x = 57.16). According to the
disadvantage and advantages regions: rate of general management knowledge
grades fairly, good in disadvantage regions was 23.5%, advantages was 49.0%.
Grade point average for general management knowledge according to
qualification: of 153 Chief Nurse having college degree or more was 65.36
(standard deviation = 15.2), of 259 Chief Nurse having intermediate degree
was 64.73 (standard deviation = 15.7). The results have shown that the college
degree or more higher than intermediate degree was 0.63 with confidence
intervals 95% (-2.49 to 3.74). This difference did not mean the statistics with p
= 0.693. According to the provincial and district branches: Grade point average
for general management knowledge of 173 Chief Nurse in provincial branches
was 64.32 (standard deviation = 15.2), the 239 Chief Nurse in district branches
was 65.43 (standard deviation = 15.8 ). The results shown that the provincial
branches were lower than district branches, was 1.10 with confidence intervals
95% (-4:16 to 1.94). This difference did not mean the statistics with p = 0.476.
According to public, non-public: Grade point average for general management
knowledge of 355 public Chief Nurse was 66.22 (standard deviation = 14.7), of
57 non-public Chief Nurse was 57.16 (standard deviation = 18.3). Public > nonpublic was 9.06 with confidence interval 95% (3.99 to 14.14). This difference
meant the statistics with p = 0.001. According to the disadvantage and advantage
regions: Grade point average for general management knowledge of 121 Chief
Nurse in disadvantage regions was 69.14 (standard deviation = 14.6), of 291
Chief Nurse in advantage region was 63.23 (standard deviation = 15.6).
Disadvantage region higher than advantage region was 5.91 with confidence
interval 95% (2.65 to 9.17). This difference meant the statistics with p = 0.0001.
126.96.36.199 Chief Nurse’s management Practices:
Research results classify Chief Nurse’s management practices according
to qualification: rate of general management practices was classified fair, good
accounting for 72.5%; at group from college degree or more (26.4%),
intermediate group (46.1%). Head under the provincial and district branches:
the rate of general management practices was classified average in provincial
branch group was 19.7%, and in district branch group was 17.0%. According to
public and non-public: In 412 Chief Nurse, the rate of the general management
practices have classified average in the public group was 34.0%, non-public
group was 2.7%. According to disadvantage, advantage regions: The rate of
general management practices was classified average in disadvantaged regions
was 11.4%, advantage regions 25.2%.
Research result of grade point average for Chief Nurse’s management
practice under qualification: of 173 Chief Nurse having college degree or more
was 64.4 (standard deviation = 17.4), of 239 having intermediate degree was
64.5 (standard deviation = 16.1). Results shown that the college degree or more
and intermediate degree were approximately equivalent with confidence
interval 95% (-3.51 to 3.28). This difference did not mean the statistics with p =
0.945. According to the provincial and district branches: Grade point average
for management practices of 173 Chief Nurse in provincial branches was 69.78
(standard deviation = 16.3), the 239 Chief Nurse in district branches was 60.64
(standard deviation = 15.7). The results shown that the provincial branches
were higher than district branches, was 9.14 with confidence interval 95% (6.01
to 12.27). This difference has meant the statistics with p = 0.0001. According to
Public, non-public hospitals: Grade point average for management practices of
355 public Chief Nurse was 65.39 (standard deviation = 16.9), of 57 non-public
was 58.77 (standard deviation = 13.4). The results shown that the public group
higher non-public group was 6.62 with confidence interval 95% (2.66 to 10.58).
This difference had meant the statistics with p = 0.001. According to the
disadvantage and advantage regions: Grade point average for management
practices of 121 Chief Nurse in disadvantage regions was 63.21 (standard
deviation = 17.79), the 291 Chief Nurse in advantage region was 65.01
(standard deviation = 16.04). The results shown that disadvantage regions lower
than advantage region was 1.80 with confidence intervals 95% (- 5:49 to 1.89).
This difference did not mean the statistics with p = 0.337. Classification results
of Chief Nurse’s Management Capacity shown that the fair, good rate for
general management knowledge was 72.6%; x = 64.97 (Std: 15.5); Fair, good
rate for general management practices was 0%, average 36.6%; x = 64.48 (Std:
16.6); Fair management capacity was 13.8%, mainly average (67.7%); x =
129.44 (Std: 23.2).
188.8.131.52 Satisfaction assessment of patient for Chief Nurse:
Assessment of patients by satisfaction, very satisfaction with Chief Nurse capacity
at a high level. However, there were still dissatisfaction, very dissatisfaction for
professional performance planning and effective 25.6%; Speech 23.6%; Gesture
23.5%; Examination procedures and hospitalizations 23.1%.
184.108.40.206 Factors affecting the ability of DDT:
Factors related to the management capacity of Chief Nurse in the univariant
model: The Chief Nurse respond to be supported the factors so the nursing
management capacity was higher than of Chief Nurse who were not supported
this: Direction table, scheme (1.98 times); Workflows (0.28 times); Discussion
with colleagues (2.25 times).
Table 3:13: Factors affecting the Chief Nurse’s ability after bring into a
multivariate model to adjust jammed control:
p = 0.12
p = 0.002
Discussion with colleagues
p = 0.177
p = 0.423
Comment: In a logistic multivariate regression model to control jamming
factors, the results shown that factors supporting profession has helped really
Chief Nurse, was factor of Workflows. The Chief Nurse had answered to be
supported for the Workflows have had capacity less greater than 0.29 times the
Chief Nurse being not supported this. That was more supported for workflows,
the Chief Nurse has had higher capacities.
3.2 Evaluate the effectiveness of interventions:
3.2.1 The assessment results before and after training:
Chief Nurse’s knowledge assessment before and after training: After training,
Chief Nurse’s knowledge met requirement (100%) higher than before training.
Effective training = 42.1 Effective intervention.
3.2.2 Chief Nurse’s management knowledge:
Evaluation of Chief Nurse’s management knowledge before and after
intervention: Before intervention Chief Nurse’s management knowledge between
two intervention groups (good, fair 7.5%) and controls (good, fair 5.2%) have
not had differences with p > 005. After intervention Chief Nurse’s management
knowledge of intervention group (good, fair 48.0%) > control group (7.9%), the
difference has meant the statistics with p <001.
Result Index of intervention group = 540%; Result Index of control group
= 50%; Intervention efficiency = 490%. So, intervention was effective.
The discussions under group has shown also a similar opinion, knowledge
for nursing management of Nursing deans has had limited, often done under
medical command and made administrative duties of the department mainly, the
deployment tasks through content of meetings.
After a period trained about nursing management, still be perplexed at
first, subsequently be monitored and supported so Chief Nurse understant now
the concepts, contents of management activities process. Opinions of hospital
managers have given more positive comments.
Generally, the assessment for Chief Nurse’s management knowledge has
been recognizes well by the hospital managers/ departments, complete assigned
works with better quality. Thus, assessment of intervention activities was
effective initially have contributed to improving the quality of healthcare services.
3.2.3 Chief Nurse’s management skills practices:
Assessment of Chief Nurse’s Management Practice: Before intervention
assessment for Chief Nurse’s management practice between the two groups of
intervention (good, fair 5.7%) and control (good, fair 7.5%) have not had the
differences with p > 0.05. After intervention, Chief Nurse’s management
practices of intervention group (good, fair 41.5%) higher than the control group
(good, fair 4.8%), the difference has meant the statistics with p < 0.001. Result
index of intervention group = 630%; Result index of control group = - 40%;
Intervention result = 670%. So intervention was effective.
The opinion for depth interviews and group discussions also have turned
around comments on nursing management skills of Chief Nurse was clearly
improved. Thus, for the management skills of Chief Nurse has been highly
appreciated by the hospital managers/ departments, the significant improvement
for the quality and effectiveness of patient care.
3.2.4 Chief Nurse’s management capacity:
Table 3.16: Assessment for Chief Nurse’s management capacity:
n = Rate n = Rate
n = Rate n = Rate
11 4.8 0.00
5 2.2 0.00
7 3.1 0.00
Comments: Before general management capacity intervention of intervention
group (good, fair 3.5%) lower than the control group (good, fair 6.1%), the
difference has meant the statistics with p < 0.005. After the general
management capacity intervention of Chief Nurse in the intervention group
(good, fair 47.2%) higher than the control group (good, fair 7.9%), the
difference has meant the statistics with p <0.001.
Result index of intervention group = 1250%; Result index of control group =
30%; intervention result = 1220% → intervention was effective.
The depth interviews and concentrated group discussions have confirmed that:
To improve the quality of patient care, strengthening nursing management
capacity, overcoming the existence of the actual management status, we have had
to pay attention synchronously to conditions: Material basic, medical equipment;
Improving the quality of professional qualifications, attitudes, responsibilities
and professional conscience of Chief Nurse. Thus, to improve the nursing
management capacity, education in improving, training, updating knowledge,
skills, dissemination for medical ethics for Chief Nurse was necessary.
3.2.5 Documents, form of nursing management:
The pre-intervention research results of current documents, forms of
nursing management of intervention group (good, fair 20.5%), control group
(good, fair 20.1%), the difference between the two groups did not mean
statistics with p> 0.05. post-intervention current document, forms of nursing
management of intervention group (good, fair 44.1%) higher than the control
group (good, fair 22.8%), this difference has meant statistics with p <.05.
Result index of intervention group = 120%; Result index of control group
= 10%; Intervention result = 110% → intervention was effective.
For the storage condition, the hospital managers said that the storage
situation was in confusion, unscientific, the classification of document list, the
time helps to manage, search, lookup if necessary were having many
difficulties. To meet the demand for improving the quality of health care,
should have the right solution, scientific, safety, quality and efficiency in
document work and management forms.
3.2.7 Satisfaction of patient:
Before the intervention, the patient's satisfaction with Chief Nurse
between the two groups of intervention and control: difference (Regarding
gestures; Respond immediately; Visit, encourage; Professional knowledge,
Professional Engineering; examination procedures and hospitalization;
Implement the profession successfully and efficiently with p < 0.05); no
difference (For speech; Consulting, health education: care layout method,
treatment with p > 0.05). After the intervention, patients' satisfaction for Chief
Nurse in intervention group was higher than control group; This difference has
meant the statistics with p < 0.001.
Chapter 4. DISCUSSION
4.1 Status and factors affect Chief Nurse’s management capacity:
4.1.1 Chief Nurse’s management knowledge:
In accordance with research results showing that good classification rate
for patient care knowledge was 68%; hygiene work (54.6%); Asset
management (65.5%); Investigation - scientific research, directing the branch
(18.0%); human resource management (61.4%); rate of general management
knowledge grades fair, good accounting for 72.5%.
According to Pham Duc Muc’s research (2007)  patient care in good
(72.3%); hygiene work (88.2%); asset management (90.0%); Investigation scientific research, directing the branch (35.8 to 45.8%); human resource
management (60.5%). Do Dinh Xuan (2007)  research on 6787 Chief
Nurses for the public hospitals in the country (914 Nursing Deans) shown that
84% Nursing Deans were able to completion of works from fair level or more.
Pamela Duffy and colleagues’ research in the United States shown that there
was a difference in perception of the practice of provincial hospitals before and
after training. For pre-training skills rate of Nurse, Chief Nurse having
confidence in clinical practice was 46%, after training was 60% (p = 0.018), for
the attitude was also similar difference (p = 0.046) . Dao Thanh’s research
(2007) has shown that the implementation of scientific research experience was
weak, in which 7.7% did not perform this task . Tran Thi Chau's research
(2007) has suggested that Chief Nurse was trained about nursing management
41.6%, performing main function for administrative management .
our research results were lower than with above researchs. Nghe An was
North Central provincial region, social - economic conditions have had still
more to differences than the national average. On the other hand, rate of Chief
Nurse has had intermediate degree as a proportion of 62.9%, higher than the
country (59.7%) . Meanwhile nursing management training organization in
the recent years has had developed but the results have not been lot (25.7%).
Therefore, lower knowledge for nursing management reflects reality.
According to professional qualifications classification of the general
management knowledge for 412 Chief Nurse (Table 3.2), results in groups from
colleges or more rate of management knowledge grades fair, good (26.4%),
intermediate degree (46.1%). Grade point average of management knowledge
(Figure 3.1) of 153 Chief Nurse having intermediate degree or more was 65.36, of
259 Chief Nurse in intermediate degree was 64.73. The results have shown that
the grade point average for knowledge of Chief Nurse having colleges or more
higher than intermediate degree was 0.63 with confidence intervals 95% (-2:49 to
3.74). This difference did not meant the statistics with p = 0.693. Between the two
groups by this qualification no difference in knowledge was due not trained,
familiar with the nursing management skills. Therefore, management knowledge
did not depend on professional qualifications. So implementation of nursing
management training plan was a very important and necessary issue.
Management knowledge in accordance with district and provincial
branches (Table 3.3), the rate of general management knowledge grades fair,
good in group of provincial branches 29.4%, in group of district branches
43.2%. Grade point average (GPA) of management knowledge (Figure 3.2) of
173 Chief Nurse in provincial branches was 65.43; of 239 Chief Nurse in
district branches was 64.32. The results have shown that GPA of management
knowledge of Chief Nurse in provincial branches higher than district branches
was 1.10 with confidence intervals 95% (-4:16 to 1.94). This difference did not
mean the statistics with p = 0.476. Comparison of knowledge between provincial
and district branch, at first sight could show that provincial branches would have
higher knowledge than district branch but in our research there was no difference
between the two groups under branches. The reason to explain about this
problem not to training for nursing management training remains highly (74.3%).
In Table 3.4 the results have shown the percentage of general management
knowledge grades fair, good in public group was 65.1%, and non-public group
7.5%. GPA of general management knowledge (Figure 3.3) of 355 public Chief
Nurse was 66.22; of 57 non-public Chief Nurse was 57.16. The results shown
that GPA of general management knowledge of public Chief Nurse higher than
non-public was 9.06 with confidence interval 95% (3.99 to 14.14). This
difference has meant the statistics with p = 0.001. In fact, the amount of Chief
Nurse working in the area of non-public hospitals were recruited from two new
sources of and recruitment of retirees. This force was not trained on nursing
management; on the other hand they were interested mainly in profession and in
management under boss model.
The research results in Table 3.5 has shown that the proportion of general
management knowledge grades fair, good in disadvantage regions was 23.5%, in
advantage regions 49.0%. GPA of management knowledge (Figure 3.4) of 121
Chief Nurse in disadvantage regions higher than in advantage regions was 69.14;
of 291 Chief Nurse in advantage regions was 63.23. GPA of general management
knowledge of Chief Nurse in disadvantage regions higher than in advantage
regions was 5.91 with confidence interval 95% (2.65 to 9.17). This difference has
meant the statistics with p = 0.0001. this difference could be caused by differences
in professional qualifications, in disadvantaged regions with rate of Chief Nurse
with intermediate accounts for 17.2%, in advantage regions was 45.6%. Besides,
in Nghe An Chief Nurse with intermediate degree was the majority (62.9%),
meanwhile the amount of Chief Nurse in the advantage regions was 291 people
more large than in disadvantaged regions (121 persons).
According to Do Dinh Xuan (2007) , GPA of management under the
branches (oscillating from 72.64 ± 18.29 to 95.90 ± 7.55) and under region
(oscillating from 80.19 ± 13.08 to 89.15 ± 11.28). Meanwhile our research
results achieved only GPA of lower management knowledge (oscillating from
63.23 ± 15.6 to 69.14 ± 14.6). However, GPA of regional management
knowledge of our research in disadvantage regions was higher than the
advantage regions, this difference means the statistics.
Thus, generally our research data compared with some other researchs
was lower. Explanation for this problem was due to regional characteristics,
working conditions and improvement learning in Nghe An was still limited
compared to the country. On the other hand, maybe due to our research was the
direct interviews, other researchs were maieutic method so research result was
somewhat different. On the advantage regions GPA of general knowledge lower
than the disadvantage regions was due to partition plans. Thus, the general
knowledge results reflecting actual were appropriate.
Through the research results have suggested that Chief Nurse’s
management knowledge in Nghe An was lower than the national average level.
To improve the quality of management in particular, the quality of medical
services in general, the health branch should have a training plan, knowledge
improvement of nursing management. On the other hand the work of managing
staff planning, recruitment, appointment should be considered, based on
Nursing management training certificate.
4.1.2 Chief Nurse’s management practices:
Research results in Table 3.6 have stated that the rate of fair classification for
patient care practice was 40.3%; Hygiene work (35.7%); Asset management
(33.0%); Investigation - scientific research (2.9%); human resource management
(3.5%); rate of general practices grades average accounting for 36.7%, poor (63.3%).
In 412 Chief Nurse, rate of general management practices grades fair,
good (0%), average 36.7%. GPA of management practices (Figure 3.5) of
groups from colleges or more was 64.4; Intermediate group was 64.5. groups
from colleges or more and Intermediate group were approximately with
confidence interval 95% (-3.51 to 3.28). This difference did not mean the
statistics with p = 0.945. Thus, management practices assessment of Chief
Nurse has given also result as same as management knowledge. There was no
difference between the two groups according to professional qualifications.
For the classification of practice under provincial and district branches, the
research in Table 3.7 has indicated that the rate of general management practice
classified average in the provincial branch group was 19.7%, and in district branch
group 17.0%. GPA of management practices (Figure 3.6) in provincial branch was
69.78, district branch was 60.64. Provincial branch higher than district branch was
9.14 with confidence interval 95% (6.01 to 12.27). This difference has meant the
statistics with p = 0.0001. This difference could be explained that Chief Nurse in
the provincial branch although untrained nursing management as in district
branch, but in the provincial branch has had many conditions contacted
experiential management personnel, learned through a variety of information
channels. From real-life experience provided the more experience for Chief Nurse
in management, better thinking in management skills practice.
The rate of general management practices (Table 3.8) has classified
average in the public hospital group was 34.0%, and in the non-public group
2.7%. GPA of management practices of the public hospital group (Figure 3.7)
was 65.39; Non-public group was 58.77. Public group higher non-public group
was 6.62 with confidence interval 95% (2.66 to 10.58). This difference has meant
the statistics with p = 0.001. Interpretation of this result was similar to
knowledge assessment. Chief Nurse in non-public hospitals have had little
opportunity to exchange to learning, exchange of experiences, they have focused
on fulfilling their professional duties, the management work was little interest.
Research (Table 3.9) has shown that the rate of general management
practice has classified average in disadvantaged regions was 11.4%, in the
advantaged regions 25.2%. GPA of practice (Figure 3.8) of disadvantaged
regions was 63.21; advantaged regions 65.01. Disadvantaged regions lower
than advantaged regions was 1.80 with confidence interval 95% (- 5:49 to 1.89).
This difference did not mean the statistics with p = 0.337. For the practice, there
was no difference between the two ecoregions. In the same conditions of health
organization system, the same continuous training conditions, the same
implementation of the sector policy. So generally there was not a lot of different
on qualifications, policies for training and updating knowledge. They have
varied a little in economic - social conditions, traffic, etc. Thus, reinforces
recommendations to improve the knowledge and practice of Chief Nurse need
to implement continuous training organization for nursing management.
For the classification of Chief Nurse’s management capacity (Table 3.10),
the proportion of fair accounts for 19.8%, average (65.5%), still poor (14.6%)
with grade point average of capacity was x = 129.44 (Std: 23.2).
Compared to some researches, such as Pham Duc Muc (2007) , Do
Dinh Xuan (2007) ; Nguyen Thi Nhu Tu  and some other researhes,
we did not have a basis for comparison. Because nursing management capacity
researchs have based mainly on assessment of trained professional
qualifications, information technology, foreign languages and a number of
nursing technical processes, referring to knowledge, skills of management
process, but not sufficient compared with provisions of nursing management
training program  and the functions and duties of Chief Nurse . The
information collection method was also different, was based mainly on maietic
methods, depth interviews. Meanwhile our research uses a checklist and
evaluation of practice results through direct observation or indirect management
practices; combine information collection through documents, books, records of
storage management. We found that the Chief Nurse’s practice classification was
low-level, no kind of fair, good. This could be understood that as Chief Nurse was
trained the nursing management with low proportion (25.7%). The daily
management activities were carried out according to experience. So Chief Nurse
should be well schooled in the nursing management, prior to appointment should
have standard on basic of Nursing management Certificate. At the same
strengthening and developing the storage work of records and management forms.
4.1.3 Factors affecting the management capability of Chief Nurse:
Research result has shown that there was especial relationship between
Chief Nurse’s management capabilities and instructions, scheme (2 = 1.98, p =
0.05); Workflows (2 = 0.28, p = 0.01); Discuss with colleagues (2 = 2.25, p =
0.05). In table 3.12 Hosmer and Lemeshow Test (Hosmer and Lemeshow 2 =
4.219, p = 0.75) shown that multivariant regression model was significant.
When logwastic regression analysis has analyzed that the relationship of these
factors with the Chief Nurse’s management capacity dependent variant and
independent variant were brought in binary form. Table 3.13 has indicated that:
The analysis results shown that this model was fully comfortable to multivariate
analysis between factors such as individuals, families and agencies with Chief
Nurse’s nursing management capacity. Workflows have associated closely with
the Chief Nurse’s management capacity, workflows of management capabilities
were better than 0.28 times (p <0.01) in comparison with workflow after
adjustment for other factors.
This result has eliminated some factor as compared with multivariate
analysis as the jamming factors were eliminated. Thus, for the management
work, Chief Nurse in the thinking were seriously to follow, less creative or
fearful. In fact, Chief Nurse forces were mainly intermediate level so following
the technical process more than the creation was easily understandable. On the
other hand due to limitation for funding conditions, time and sample size, the
results did not reflected clear relationship of some other factor. From the above
analysis, It was necessary to the next research to depth analysis of factors
affecting the nursing management capacity of Chief Nurse to propose appropriate
solutions contributing to improvement ofthe management capacity to meet
performance of function, protective duty, care and people's health growth.
According to Do Dinh Xuan’s research (2007) , the factors such as
age, sex, equipment and working conditions, the coordination of patient families
and doctors as well as the work overload, etc were considered as the relevant
factors and directly affecting the management capacity of Nursing Dean.
According to Nguyen Thi Nhu Tu (2007) , factors have affected the
management capacity of Chief Nurse that leaders have underestimated the
patient care work, imbalance in the number of patients and the nursing
manpower; weak, low qualification; not involved Council for reward,
dwascipline, recruitment, appointment, transfer.
In Ho Chi Minh City, Tran Thi Chau's research (2007) has suggested that
low qualifications (Intermediate level 78.3%); untrained nursing management
(59.4%) were also the factors contributing to affect the ability of Chief Nurse .
Our research results have shown that the factors affecting Chief Nurse’s
management capacity was somewhat different from previous researches. The
reason for this difference could be due to affect the customs, habits, different
conceptions between regions. Besides, due to the research design also has made
different results. Until now, very little topics study factors affecting the nursing
capacity or could re-statistize some related factors directly affecting the quality
of profession and management through the interviews. It needs the depth
analysis researches to assess the affected factors to provide effective
Thus, capacity management of Chief Nurse has affected a lot of factors,
depending on each local, the specific object of the influence of different factors.
4.1.4 Satisfaction of patients:
Research results (Figure 3.15) have shown that: Patients have satisfied,
very satisfied with speech 76.3%; Gesture 76.4%; Respond immediately upon
request accounted for 77.8%; Visit and encourage 79.1%; Consultant, health
education 86.1%; Professional knowledge 78.1%; Professional engineering
79.1%; Examination procedures and hospitalizations 76.8%; The layout of care
and treatment work 83.1%; Professional performance planed and efficiency
74.4%; However there were still dissatisfaction, very dissatisfaction for
professional performance planed and effective 25.6%; Speech 23.6%; Gesture
23.5% and examination procedures and hospitalizations by 23.1%.
Roderick research in the United States for improving the quality of
patient care  has stated that the satisfaction rate of the patients for the
doctor was higher than Chief Nurse in intensive clinical department, whereas in
obstetrics satisfaction for Chief Nurse was 73 %, for doctors 71%. According to
Vuong Kim Loc (2007), studying the situation of nursing management at SaintPaul hospital, patient’s satisfaction results have reached 55% . Le Thi
Binh’s research (2008), the Central Hospital was very pleased by people 42.1%;
satisfied 48.2%; Provincial/ citify hospital were very satisfied 62%, satisfied
36% . According to a Nguyen Thi Ngoc’s research result (2005) at General
Hospital Thong Nhat, Dong Nai, satisfaction rate of average level for Chief
Nurse’s capacity accounted for 45.3% mostly not satisfied with instructions,
explanations, health education not yet thoughtful . Ha Thi Soan’s research
(2007)  has assessed the satisfaction of patients and families for the medical
staff about altitude > 90%, patients boards 94%. However, 10-12% were
dissatisfied mainly on administrative procedures, the test not explain, no dietary
guidelines, patients should buy medicines outside. According to Hoang Thu
Nga said: satisfaction rate for mental attitude of service 87.8%; guidance for
hospitalization 87.1%; hygiene mode 84.8%; facilities, equipments 80.1%;
security 62.9% and specialization 93.7% .
Comparing these results with previous researchs, our research has given the
same result, although in different conditions in the socio-economic, customs and
traditions, but the general doctors, Chief Nurse in particular were devotion to the
patient, sacrifice, dedication to the job, devoted care, service to the patient. On the
other hand patients often have complained about spirit, service attitude, behavior.
Through the research results, the managers were helped to know the requirements,
the desire, the factors have related to patient satisfaction.
4.2 Evaluate the effectiveness of interventions to improve management of Chief Nurse:
4.2.1 Chief Nurse’ Management Knowledg:
Research results at Figures 3.16 and 3.17 have indicated that Chief Nurse
before training cognite about 16 skills of nursing management were still limited
(11/16 skills did not meet). After training, knowledge of 100% Chief Nurse met
requirement. GPA before training was 36.7; after training was 77.9. Training
effect = 42.1. Thus, training interventions were effective. Through these results,
we known that the role of training work has had an important position, but in
order this result were sustainable development, shall plan to strengthen
supportive supervision for the knowledge became really skill, competence.
Table 3.14, before intervention the management knowledge of Chief
Nurse of intervention group (good, fair 7.5%) and control groups (good, fair
5.2%), the two groups did not differed with p > 0.05. After the intervention the
management knowledge of Chief Nurse of intervention group (good, fair
occupies 48.0%) higher than the control group (good, fair 7.9%), the difference
between the two groups have meant the statistics with p < 0.01. Intervention
result = 490%. Before intervention the assessment was the same between the
two groups, after intervention the intervention group has had higher knowledge
than the control group, so the intervention was effective. This issue was as to
compliance as explanation the nursing management so initial assessment in
GPA of knowledge before training was low ( x = 36.7), after training
knowledge was significantly improved ( x = 77.9). The results shown that
interventions were effective (interventions result = 490%); simultaneously
during task execution, the Chief Nurse has applied the learned nursing
management skills in specific conditions, within learning and working,
combines the supportive supervision so awareness was much improved.
Whereby this has indicated the nursing management training organization for
Chief Nurse force or person in planning was a very important contributing to
improving management capacity. Strengthen supportive supervision was also very
important to contribute improvement of capacity.
The depth interviews for management staffs and group discussions given
also similar opinion, knowledge for nursing management of Nursing dean was
limited, usually done under medical command and mainly done the
administrative responsibility of department, the tasks were implemented
through meetings content. After intervention training solutions for nursing
management, still has confused at first, later to be monitored so Chief Nurse
understook the concepts, processes, content of management operation process
now. The opinions of hospital managers were more positive comments.
4.2.2 Practice of Chief Nurse’s management skills:
Before the intervention (Table 3.15) have evaluated the management
practices of Chief Nurse in the intervention group (good, fair 5.7%) and control
groups (good, fair 7.5%), the two groups did not differed with statistically
significant with p > 0.05. Research results after intervention Chief Nurse’s
management practice of intervention group (good, fair occupies 41.5%) higher than
the control group (good, fair 4.8%), this difference was statistically significant with
p < 0.001. Intervention result = 670%; results reflect effective intervention.
Before the intervention, Chief Nurse’s management practice in the intervention
group and control group were differences, after the intervention Chief Nurse’s
management practice of the intervention group was higher than the control group.
The reason for this difference was due to the intervention group was applied the
direct work instruction measures, construction and application of management skills
process, strengthen inspection and supervision in place for Chief Nurse. After 24
months of intervention, assessment for Chief Nurse’s management practices of
intervention group was higher than the previous 35.8%. This result was evidence to
mark the interest in leadership of department/hospital for nursing management forces,
the efforts of the Chief Nurse, the support and assistance of supervision staffs. So, to
maintain the intervention results in a sustainable way, the Chief Nurse was required
to further study and improve the knowledge and management skills. On the other
hand it was necessary to strengthen the supportive supervision and exchange of
experience through meetings, cross-check between departments, learn from
experienced, overcome and repair to meet well the requirement of task execution.