Total Care Nursing Project in Taiwan: A Skill Mixed Model Development

Tuesday, 13 July 2010: 2:05 PM

Ming Yi Hsu, PhD, MSc, RPN, RN
School of Nursing, Chung Shan Medical University, Taichung, Taiwan
Jwo-Leun Lee, PhD
Department of Senior Citizen Service Management, National Taichung Nursing College, Taichung, Taiwan
Wen-Yi Chen, PhD
Department of Leisure Business Management, Nan Kai University, Nan Tou, Taiwan

Learning Objective 1: The learner will be able to know the policy content of total nursing care plan projects in Taiwan.

Learning Objective 2: The learner will be able to know the results of total nursing care plan effectiveness and efficiency analysis.

Purpose: To develop a skill mixed model in order to release inpatients families or relatives caring burden in terms of time and money and improve the quality of nursing care in acute hospital wards.

Methods: In this project, a total of 3 experimental wards and 5 control wards in 3 hospitals. Instead of taking care of 1 patient per nursing aid, one nursing aid took care of 4 to 6 patients in an 8 hours shift and charge one third of original service fees in experimental wards. Social benefit was measured by willingness to pay from a survey of 1,545 national population samples, and social cost was measured by salaries of nursing aids plus overhead (22% of salaries).Plan effectiveness indicators in this study are patient safety, nursing care quality, and family convenience. In those indicators, patient safety indicators include incidences of falling, pressure sore, infection, deliberate self-extubation and accidental extubation in the experimental wards. Nursing care indicators include satisfaction of patients to nursing care, nursing aids, and this project. Family convenience indicators include family accompanying rate, satisfaction to aids ability and to release of economic pressure and time pressure.

Results: The manpower of nursing aids would have statistically and clinically significant effects on family accompanying rate.The cost effectiveness analysis reveals that the average cost per person per day of this plan is 690 NT$ in 2007 and 584 NT$ in 2008. Cost benefit analysis shows that the total social benefit and cost are 29.7 billion and 19.7 billion NT$, respectively, Conclusion: The finding of positive net social benefit indicates that total nursing care plan in Taiwan is worth doing and that there would be a Pareto improvement or efficiency improvement among major policy stakeholders including government, constituencies, medical care professionals, and health insurers if this plan keep being implemented.