Nghin cu khoa hc iu d- ng ton quc ln th II1HI IU DNG VIT NAMK YU TI NGHIN CU KHOA HC IU DNGK NIM20 NMNGY THNH LPHI IU DNG VIT NAM(26/10/1990 - 26/10/2010)Hi ngh khoa hc iu d- ng ton quc ln ivH NI, 10 - 2010Nghin cu khoa hc iu d- ng ton quc ln th IV2HI IU DNG VIT NAMCH BINB Vi Nguyt H Ch tch Hi iu dng Vit NamThS. Phm c Mc,Ph Ch tch thng trc ThS. Nguyn Bch Lu, Ph Ch tchBAN BIN TPTS. Trn Quang Huy,y vin Thng v, Trng ban nghin cu khoa hcThS. Trn Th Thun,y vin Thng v, Trng ban o to ThS. Phm Thu H, y vin Thng vThS. Thi Th Kim Nga,yvin ThngV,Phtrngbannghin cu khoa hcThS. Nguyn Th Thanh Thy,y vin Ban chp hnhThS. V Hng Ngc,y vin Ban chp hnhThS. Nguyn Th Nh T, y vin Ban chp hnhThS. o Thnh, y vin Ban chp hnhBAN TH KThS. Ng c Th,y vin Ban chp hnhCN. Nguyn Th Hng Anh,Vn Phng T Hi iu dng Vit NamCN. H Th Kim Phng ChuynvinPhng iudng-Tit ch, CcQun l Khm, cha bnh B Y tCN. Hong Xun Hng, Vn Phng T Hi iu dng Vit NamCN. inh Th Thy H, Nhn vin d n Phng iu dng-Tit ch, Cc Qun l Khm, cha bnh-B Y tNghin cu khoa hc iu d- ng ton quc ln th IV3LI NI UTrong nhng nm qua, cng tc nghin cu khoa hc trong lnh vc iu dng nc ta v ang pht trin mnh, ngy cng nhn c s hng ng nhit thnhcaiudng,Hsinhtrongton quc,trthnh yu cukhngththiutrong thchnh iudngv cBYtchnhthca vo l mttrong cc ni dung quan trng ca cng tc iu dng.HinghKhoahciudngtonquc ctchclnutinnm2002, lnthhainm 2005,lnth3nm 2007vi nhiuti nghin cuiu dng c gi tr, c p dng trong cng tc iu tr v chm sc ngi bnh ti cc c s y t, gp phn tng cng cht lng chm sc cng nh em li s hilng cho ngi bnh.Hi ngh Khoa hc iu dng ton quc ln th IV c t chc ti H Ni vongy 25 v 26 thng 10 nm 2010, Ban T chc nhn c hn 125 ti bo cokhoa hc ca iu dng, H sinh t mi min t quc gi v vi nhng ni dung rt phong ph, khng nh tim nng to ln ca iu dng trong nghin cu v p dng ktqunghin cuvothctin.l minh chngvs pht trinmnhmca ngnh iu dng Vit Nam.Ban Tchcxincmn ttccctcgi gibi tham gia bo co trongHi ngh Khoa hc iu dng ton quc ln IV. Vi thi lng t chc Hi ngh c hn nn Ban T chc xin c trn trng gii thiu cng bn c nhng tinghin cuiudngtiu biucbocotrongHinghccbnng nghip tham kho v p dng trong lnh vc chm sc ngi bnh.Rtmongsquantmv gp caQucgi cng tc nghin cuiu dng ngy cng pht trin.Trn trng cm n.BAN BIN TPNghin cu khoa hc iu d- ng ton quc ln th IV4In 700 cun kh 19 x 27cm ti Nh xut bn GTVT.ng k KHXB s: 148-2010/CXB/26-05/GTVTQuyt nh xut bn s: 163/Q-XBGT ngy 15/10/2010.TI LIU PHC V HI NGHNghin cu khoa hc iu d- ng ton quc ln th IV5THC TRNG NHN LC IU DNG TRNG TON QUC NM 2010Phng iu dng-Tit ch, Cc Qun l KCB1. T VN Chmsc iudngl hotng ngh nghip ca ngi iu dng, i hi ngi iu dng phi c kin thc chuynmn, knng thnh thov ocngh nghip,nnglccamiiudngth hinquabanidungtrn. iudng trng khng ch l ngi iu dng tho tay ngh,m cn cncnnglcqunl, v vy h l i tng cn u tin pht trin trong lc lng iu dng vin. C th v mtngiiudng trngl mtqun giatronggia nh ngngivila tui,thnhphn,trnh ,tnhcchkhc nhau. Sbnhyn, sungtcvthnh t camtgianh ln c phnnhti qun lcangiqungia.Dovy,ccnc trn th gii xy dng v thc hin mt chng trnh o tovQunliu dngtrongnhiunmnay vh u tinpht trin i ng ny. nc ta, chc danhY t trng (nay l iudngtrng)craitrong cc bnhvintnm 1965. Tuy nhin, 25nm sau, Phng Y t bnh vinmi c tntrong tchcbnhvinsaukhiBtrng BYtbanhnh Quytnhs570/Q-BYT ngy 14/7/1990. Tip , Phng Y ttrongVQunlsckhocaBYt cthnh lptiQuytnhs356/Q-BYT ngy 14/3/1992.Nm 1997, sau 7 nm Phng Y t ccbnhvinv5nmsaukhi PhngYtthucVQunlsckhorai,vi nhngng gp cacciudng trngBnhvin,Phng Y t -BYt xut vi B trngB Y t xem xt k Quytnhs1895/1997/Q-BYTngy19/9/1997 ban hnh Quy chbnhvin trong cquy nhPhngYt(iu dng)l mttrongnhngphng chc nng v nghip v ca bnh vin. Tnh n thng7/2010, sau13nmthchinQuy chbnhvin,CcQunlKhm,cha bnh tinhnh mtkhostnhanh, kt quchothy:100%bnhvintrcthuc BYt,72%bnhvintuyntnhv64,6% bnhvintuynhuyn thnh lp Phng hoc t iu dng trng theo quy chbnhvin.Tuynhin, vncn28%bnhvintuyntnhv35,4%bnhvin tuynqun,huynchathnhlpPhngiudngm bnhimiudng trng thuc Phng K hoch tng hp nncng tc iudngticcbnhvinnyhn ch hn so vi ccbnh vin thnhlp Phng iu dng.Xutphttyucuthctintrong cng tc qun l iudng,ngy2/7/1999, B trng B Y t ra Quyt nh s1936/1999/Q-BYT quy nhchc Nghin cu khoa hc iu d- ng ton quc ln th IV6nng, nhimvcaiudngtrng thuc S Y t cc tnh/thnh ph trc thuc Trung ng. Tnh n thng 7/2010, sau 11 nm thchinQuytnh1936/1999/Q-BYT c 74% (47/63) cc S Y t b nhimiudngtrngS;36,5% (23/63) SYtbnhimiudng trngSYtlmPh trngphngnghipVY,25,4%(16/63)SYtchabnhimiudngtrngSYt(kt qukhostcaphng iudng-Cc QLKCB).Ngy 03/8/2010, BYt ban hnhcng vn s 5134/BYT-KCB gi ti cc S Y tv cc BnhvintrcthucBYt yu cuccSYtv cc bnhvintip tc cng c h thng iu dng trng.C th ni, t khi c t chc theo h thngnghnghip,ingiudng trng khng nh c vai tr v v tr camnh trong ton ngnh y t,cnhng nggpquantrngvovictngcng chtlngkhm,chabnh,qunlcc ngunlccacc c sytv nng caotrnh cho iudng,hsinhvin. H thc s tr thnh nhng cn b ch cht trong cc n v. Mt s ngi c b nhimchcvcaottrungng na phng nh: Ph CctrngCcQunl Khm, cha bnh; Gim c, Ph gim c mtsbnhvin;PhGim cChicc dn stnh;Lnh omtstrng,khoa o to iu dng.Tuynhin, ngtrcyucukhm cha bnh ca nhn dn ngy cng cao, s pht trinkhoahcytngy cng nhanh,c ch t ch v x hi ha trong cc bnh vin ngy cng i hi trnh qun l ca cc bc s,iudngth ngiiu dngtrngcng ngtrcthchthc ln hn v nng lc qun l. Bn cnh , xuhngthiunhnlciudngtoncuv sdic nhn lciudnggia ccnc,ccvng, ccmintrongmt ncangl thch thcviccnh qun l y t,khngchVitNam.Thchthc lniviVitNaml thiuiudng c trnh chuyn mn cao v thiu ngiqun l iu dng gii. cbctranhtngthvngun nhn lc iu dng lm c s xy dng k hoch hnh ng quc gia tng cng cng tc iudng-hsinhgiaion2011-2015, Phng iudng-Titch,Cc QunlKhm,chabnhthchinmt kho st v thc trng nhn lc iu dng trng nm 2010 vi 3 mc tiu sau y:1. M tthctrngvslng,trnhchuynmn, trnh qunlcai ng iu dng trng S Y t.2. M tthctrngnhnlciu dng trng trong h thng bnh vin: s lng,trnh chuyn mn, trnh qun l v ph cp trch nhim c hng.3. xut gii php tng cng nng lccaingiudngtrngcc cp. 2. PHNG PHP NGHIN CUNghincumtctngangvii Nghin cu khoa hc iu d- ng ton quc ln th IV7tngkhostl iudngtrngSY tcaccSYttnh/thnh phtrc thuc trung ng, iu dng trng bnh vin,iudngtrngkhi,cnbca Phng iudngbnhvinv iu dngtrngkhoacaccbnhvintrc thuc B Y t, cc bnh vin trc thuc cc S Y t.Cng cthuthpsliugm2phiu khost:(1)danhsch trch ngang cn b phtrchcngtciudngtiSYt (iudngtrngSYT)v Trng phng iu dng bnh vin trc thuc B Yt(2)Boconhnlcqunliu dng ti cc bnh vin trc thuc B Y t vccbnhvinthucSYtcacctnh/thnh ph trc thuc Trung ng.Phiu kho st c thu thp trong thi gian t 15/8-5/10/2010 qua ng bu in hoc qua hp th in t. Tng s c 57 S Y t v 36 bnh vin trc thuc B Y t gibo co v, tuy nhin chng ti vnc thng tin c nhn cacciudng trngSYtv Trngphng iu dngbnhvintrc thuc BYt t nhng ln kho st trc. Trongqutrnhlmschsliu,mt s thng tin c kim nh m bo chnh xc. Sliucxlv phn tchbng phn mm SPSS 16.0.3. KT QUCc ktqudiythuthpct 57/63 SYtv 36 Bnhvintrcthuc B Y t.3.1. Trnh chuyn mn ca iu dng trng S Y t v bnh vin.Bng 1. Phn b trnh chuyn mn ca iu dng trng cc bnh vinS lng Trnh Chc danhS lng t l Tng > H i hc Cao ng Trung cpS lng 690 8 273 109 300Trng phngT l % 100.0 1,2 39,4 15,8 43,6S lng 342 2 98 63 179Ph phngT l % 100.0 0,6 28,7 18,4 52,3S lng 275 3 74 45 153DT khiT l % 100.0 1,1 26,9 16,4 55,6S lng 513 4 101 31 377 Cn b phngDTT l % 100.0 0,8 19,6 6,0 73,6DT khoa S lng 6758 1 1232 662 4863Nghin cu khoa hc iu d- ng ton quc ln th IV8T l % 100.0 0,0 18,1 9,8 71,9S lng 8578 18 1778 910 5872TngT l % 100 0,2 20,7 10,6 68,5Nhn xt: Tng s iu dng trng ccbnhvinckhostl8.572ngi,trong18ngi(0,2%)ctrnh trn i hc, 20,7% c trnh i hc v10,6% trnh caongv68,5%(5872) ctrnh trunghc.Sliu bng1cngchothytliudng trngctrnh cnhniudng gimdntcpphng nkhoa:t 39,4% cptrngphng;26,9% cp khiv18,1% cpkhoa.Trongkhi t l iu dng trng c trnh trung hciudngchimtlcaocp qunlkhoaphng(71,9% cpiu dngtrngkhoaxung43,6% cp Trng phng).3.2. Thc trng nhn lc iu dng trng S Y t v chuyn vin ph trchBng 2. Phn b theo ngh v trnh chuyn mn ca iu dng trngS Y t v chuyn vin ph trchTrnh chuyn mn (n = 47)Ngh nghip ca iu dng trng S Y tTng/t l (%)Saui hci hcCaongTrungcpT l % 85,3 7.3 87,8 4,9 0iu dngS lng 41 3 36* 2 0T l % 4,2 0 50,0 50,0 0H sinhS lng 2 0 1 1 0T l % 4,2 0 50,0 50,0 0K thut vinS lng 2 0 1 1 0T l % 6,3 0 100,0 0 0Bc sS lng 3 0 3** 0 0Tng s48 3 41 4 0Tng s/t l chungT l % 76,2 6,3 85,4 8,3 0Ghi ch: * 8 ngi ang lm nhim v nh iu dng trng nhng cha c b nhim chc danh.** Bc s c c kim nhim cng tc iu dng.Nhnxt:C48(76,2%)SYtb nhimchcdanhiudngtrngSYT vcchuynvinphtrchkimnhim cngtc iudngcaSYt.Ttc Nghin cu khoa hc iu d- ng ton quc ln th IV9trong s h c trnh chuyn mn t cao ngtrln. 85,4%ctrnh ihc, 6,3%ctrnh caohc.C3ngilbc s (Cn Th, An Giang, Thanh Ha) vscnlil iudng,hsinhvk thut vin Y.Bng 3. Phn b iu dng trng S Y t c b nhim lm Ph trng phngnghip v Y theo ngh v trnh Trnh chuyn mnNgh nghipiu dng trngS lng/t l (%)Sau i hci hcCaongTrungcpS lng 24 3 21 1 0iu dngT l % 92,0 12,5 83,3 4,2 0S lng 2 0 0 2 0H sinh -KTVT l % 8,0 0 0 100,0 0Tng 26 3 21 2 0Nhnxt:C26SYtbnhimiudngtrnglmPhtrngphngNghip V Y. Hu ht cc Ph trng phng nghip v ph trch iu dng c trnh i hc iu dng (92,0%) v ba ngi trong s h c trnh thc s, ch c mt ngi trnh cao ng.Bng 4. S lng v t l iu dng trng S Y t c chng ch qun l iu dngChng ch qun l iu dng S lng T l %C 32 66,7%Khng 16 33,3%Tng s 48 100%Nhn xt: C 66.7% iu dng trng S Y t v cn b chuyn trch cng tc iu dng ti S Y t c chng ch qun l iu dng. 3.3. Thc trng iu dng trng cc bnh vin trc thuc B Y tBng 5. Phn b theo trnh v ngh nghip ca Trng phng iu dng bnh vin trc thuc B Trnh Ngh nghipS.lng/t lTng s/t lSau i hci hcCaongTrung hcS lng 32 4 25 1 2iu dngT l % 91,9% 12,1% 78,8% 3,0% 6,1%S lng 2 0 2 0 0H Sinh T l % 5,4% 0 100,0 0 0Nghin cu khoa hc iu d- ng ton quc ln th IV10S lng 1 0 1 0 0Bc s T l % 2,7% 0100,0%0 0Cng 35 4 28 1 2Nhnxt: C35/36 Bnhvintrc thucBYt bnhimchcdanh trngphng iudngtrbnh vin Tm Thn T II (mi b nhim Ph trngphng). Hai trongs35trngphng iudngcn trnh trunghc iu dng (Bnh vin C Nng v PhongDa LiuQunhLp).C 4 trngphng trnh thc s (Ch Ry, Nhi TW, Tai Mi Hng TW v Phong Da Liu Quy Ha).Bng 6. Phn b theo trnh chuyn mn ca iu dng trng trong bnh vin trc thuc B Y tTrnh Chc vS lngT l %TngTrnThc si hc Cao ngTrungcpS lng 35 4 28 1 2T.phngT l % 100.0 12,3 80,0 2,9 5,8S lng 23 1 16 3 3Ph phngT l % 100,0 4,4 69,6 13,0 13,0S lng 45 3 21 8 13DT khiT l % 100.0 6,7 46,7 17,8 28,9S lng 39 0 20 5 14Cn b phng DT l % 100.0 0,0 51,3 12,8 35,9S lng 641 1 281 82 277DT khoaT l % 100.0 0,2 43,8 12,8 43,2S lng 783 9 366 99 309Tng sT l % 100.0 1,3 46,7 12,6 39,4Nhnxt:Tngsiudngtrng vcnbphng iudngca36bnh vintrcthucBYtl 783 ngi,gn na trong s h c trnh i hc (46,7%). Tliudngtrngctrnh trung hciudngchim39,4%tngsiu dngtrng, slngiudngtrng c trnh thc s cn rt thp (1,3%).Bng 7. Tnh hnh hng ph cp trch nhim ca cc chc danh iu dng trng, cn b qun l iu dng ti cc bnh vin trc thuc B Y tLoi Hng ph cp trch nhimS lng T l %Trng phng (n = 35) 35 100Nghin cu khoa hc iu d- ng ton quc ln th IV11Ph phng (n = 23) 23 100D trng khi (n = 45) 38 84,4Nhn vin phng D trng (n = 39) 4 10,3D trng khoa (n = 641) 634 98,9Nhnxt: 100%Trng,Phphngiudngv98,9% iudngtrng khoa chngphcptrchnhim.S iu dng trng khi l 84,4% v 10,3%cn bphng iudngchngph cp trch nhim.3.4. ThctrngiudngtrngtrongccbnhvintrcthucccSYt tnh/thnh ph trc thuc Trung ngBng 8. Trnh chuyn mn ca cc iu dng trng cng tc trong cc bnh vin thuc S y t cc tnh/thnh ph trc thuc trung ngS lng Trnh Chc danh S lngt lTng/ t l (%)Thc s i hc Cao ng TrungcpS lng 655 4 245 108 298Trng phngT l % 8,4 0,6 37,4 16,5 45,5S lng 319 1 82 60 176Ph phng T l % 3,6 0.3 25.7 18.8 55.2S lng 230 0 53 37 140DT khi T l % 3,0 0.0 23.0 16.1 60.9S lng 474 4 81 26 363 Cn b phng iu dngT l % 6,0 0.8 17.0 5.5 76.7S lng 6117 0 951 580 4586DT khoaT l % 78,5 0.0 15,5 9.5 75.0Cng S lng 7795 9 1412 811 5563T l % 100,0 0,1 18,2 10,3 71,4Nhnxt:Sliut57/63SYt chothytngsiudngtrngvcn bphng caccphng iudng thuc57 tnhl 7795 ngi,phnlnc trnh chuyn mn l trung cp (71,4%),tip l i hc (18,2%), cao ng 10,3% v t l thp nht l thc s (0,1%). Cnggingnhthctrngchungv Nghin cu khoa hc iu d- ng ton quc ln th IV12trnhchuyn mn caiudng trngctrnh by trong bng1.Bng ny cngchrarngtrnh chuyn mnca iu dng trng t l thun vi v tr cngtccah,cnghal vtriu dngtrngcpcaoth cng i hi ngi c trnh chuyn mn cao hn.Bng 9. Tnh hnh hng ph cp trch nhim ca cn b qun l iu dng ti cc bnh vin tuyn tnhHng ph cp trch nhimChc danhS lng T l %Trng phng (n=655) 622 94.9Ph phng (n=319) 295 92.5D trng khi (n=230) 105 45.7Nhn vin (n=474) 76 15.9D trng khoa (n=6117) 5637 92.2Nhnxt:Bng9chothy92.2%Trng,Phphng iudngv iudng trng khoa c hng ph cp chc v. Trn 50% iu dng trng khi v trn 80%cn b ca Phng iu dng cha c hng ph cp chc v.4. KT LUN V BN LUN4.1. Nhn lc iu dng Trng S Y tQuyt nh s 1936/1999/Q-BYT doBtrngBYtbanhnhtnm1999 yucuccSYtbnhimchcdanhiudngtrngSYtvchcdanh phphngnghipvyphtrchcngtc iu dng, nhng ti nay, sau 11 nm thc hin,mic48(76,2%)SYtbnhimiudngtrngSYthocccnb chuyn trch cng tc iu dng ca S. T lny cao hnktqukhostnm2007 caHiiudngVitNam(56,3%). Hinnay c 36 SYtbnhimchc danh iu dng trng v 26 ngi trong s h c b nhim lm Ph trng phngnghip v Y. T l ny tng ng vi kt qukhost nm2007. Mt trongnhng l do m t l ny khng thay i l do mt s ngi v tr ny ngh hu nhng cha cngi thay th.Trnh chuynmncaiudng trngSYtcstinbnhiu,91,7% iu dng trng SY t c trnh cao ng tr ln v 6,3% c trnh thc s. So vikhostnm2007,tliudng trngSYtctrnh chuyn mn t c nhn mi l 69,5% v khng ai trong s hctrnh thcs.66,7%iudng trng S Y t c o to v qun l iu dng. T l ny cao hn nhiu so vi kt qu kho st nm 2007 (25,5%).Nghin cu khoa hc iu d- ng ton quc ln th IV134.2. Nhn lc qun l iu dng ti cc bnh vin trc thuc B Y t35/36bnhvintrcthucBYt ckhostbnhimtrngphngiudng.Huhtcctrngphngliudng (92%) v 92,3% c trnh t i hc tr ln v 4 ngi trong s h tt nghipthcs,trongkhiktqukhost nm2007chactrngphngnoctrnh thcs.Tuynhin, cmtbnh vinbnhimTrngphnglbcs, 2Trngphngcn trnh trunghc iudng. 100%cc trngphng iu dngchngphcptrchnhim theo ch hin hnh.4.3. Nhn lc qun l iu dng ti ccbnhvintrcthucSYtcc tnh/thnh ph trc thuc Trung ngKt qu tng hp bo co nhn lc iu dng trng ca 57 S Y t cho thy tng s iu dng trng c 7791 ngi, trong tliudngtrngkhoachim t l cao nht 78,5% (6117 ngi) v Trng phng iudngchim8,4%(655 ngi),iudngtrngkhichchim 3%(230ngi)vtptrungccbnh vintnh/thnhph.iunychothyv tr iu dng trng khi cha c quan tm, bnhimccbnhvintuyn tnh/huyn. Trong khi mts bnh vin ccnbiudngcngtctiPhngiudngnhngkhngbnhimiu dng trng khi (6%).Phnlncciudngtrngcc bnhvinnyctrnh chuynmn bctrunghc(71,4%),tipl ihc (18,2%), cao ng10,3% v c 0,1% trnhthc s. Sliuny cho thycs tinbnhng khng nhiuvtrnh chuyn mn caiudngtrngsovi ktqukhostnm2007.Cctlv trnhchuyn mn caiudng trngnm2007theotuntTrunghc (73,7%), ihc15,6%v cao ngl10,7%. Tuy nhin, ktqukhostnm nay c 0,1%(9 ngi)iudng trngcctuynny c trnh thcs. Sthcscphnbccvtriu dngtrngtTrngphng (4 ngi), Phtrngphng(1ngi),cnbcng tc ti phng iu dng (4 ngi).Lin quan n ph cp chc v ca i ngny, ktqukhostchothytrn90%Trng,Phphng iudngviudngtrngkhoachngph cpchcv.Trn 50% iudngtrng khivtrn80%cnbcaPhng iu dngcha chngphcp chcv. Soviktqukhostnm2007,tl iudngtrngchngphcp chcvcccithinchtt(nm 2007, t l c hng ph cp l 86,6%).Vchngchqunliudng,do trong phiukhosti tng ny khnga ni dung thng tin ny v vy khng c s liu, tuy nhin theo s liu kho st nm 2009 ca phng iu dng,Cc QLKCB thtlny lsps50%soviktqu nm 2007 cho thy 54% iu dng trng cotovqunliudng.Bi trong 3 nm tr li y, mt s trng t chc o to qun l iu dng, nhng s lngny khng nhiu,nhnlciu dnglibinng,cnhngiudng Nghin cu khoa hc iu d- ng ton quc ln th IV14trngco toxonglichuyncng tc hoc ngh hu.5. NGH5.1. Cc SYtv cc bnhvincnthchinchocaBYttheotinh thncngvns5134/BYT-KCBngy3/8/2010 caBYtyu cuccSYt vccbnhvintiptcduytr vphttrin i ng iu dng trng.5.2. Cc SYtv bnhvincnu t nng lc chuyn mn v qun l cho cn b ch cht, c bit l iu dng trng bngtoiukinchoiudngtrng tham gia cc kha o to nng cao.5.3. B Y t, V khoa hc o to nnt chc cc kha o to Ging vin ging dychng trnh o toqunliu dng cho iu dng trng cp S Y t vcpbnhvin.VTchccnbvCc Qun l khm cha bnh nn xem xtchc danh iu dng trng khi nhng bnh vin hng c bit v hng I cphcpchnhthccho i tngnyngthi p ng ckhi lngcngtc qun l iu dng trong bnh vin.5.4. Cc trngihc,Caongvtrung hc y t nn nh gi nhu cu o to qunliudngcaccnvkhm chabnhtrn abn tchcnhiu kha otoqunlchoiudngcaa phng.5.5. Bnthnmiiudngtrng cnxcnhvaitrvtrchnhimca mnh vtrqunl,lnh oiu dngtrn luyn,nngcaotrnh chuynmncngnhtrnh qunl chuyn ngnh.6. TI LIU THAM KHO1. Hiiudng VitNam.Ktqu kho st v nhn lc iu dng ti cc cs khm cha bnh, 1999.2. HiiudngVitNam.Ktqu khostvnhnlciudngtrng nm 2007.3. Ktqukhost nhanh vnhn lc iu dng ca Cc QLKCB.Nghin cu khoa hc iu d- ng ton quc ln th IV15NH GI CC TI NGHIN CU KHOA HC IU DNG THC HIN TI VIT NAM, GIAI ON 2004-2009Nhm nghin cu: TS. Trn Quang Huy1, ThS. Phm cMc1,ThS.NguynBchLu1,ThS. VHng Ngc1,CN.inh Th Thy H1, CN. H Th Kim Phng1, CN. NguynThHng Anh2, ThS. PhmThu H3, CN. Phan CnhChng4, ThS. Thi Th Kim Nga5, CN. Nguyn Th Thy61. Cc Qun l Khm, cha bnh; 2. Vn phng Trung ng HiiudngVit Nam; 3. BnhvinNhi Trung ng; 4. Bnhvin Trung ng Hu; 5. Bnh vin ChRy; 6. Bnh vin VitNam-Thy in Ung BTM TT Nghincuhi cum tctin hnhnm2010 nhgi170 tinghin cu khoa hc iu dng thc hintronggiai on2004-2009. nhgida trn10tiuch vthang imdonhmnghin cu xy dngvisimtial68, im cc ti c phn 5 loi: Xut sc,gii,kh,tyucuv tyucu nhng cn hn ch. Kt qu: S im trung bnh caccti l 44,5 (t65% im tia).42,4%sti cxptloi khtrln, 34,7%sti tyucu nhng cn mt s mt hn ch. S ti ctnh cp thit v c ngha thc tin chim 52,9% v40%, tuynhinsticgitr khoa hc ch chim 14,7%. Khng c s khc bit c ngha thng k gia xp loi ti vi mt s bin s quan tm nh cp ca ti, phn tuyn ca c quan ch tr ti v hc v ca tc gi th nht. ti docquanchtr thuctuynTrung ng chim 48,8%, trong khi tuyn huyn ch chim 4,7%. ti cp c s chim 81,1%. ti thuc chuyn ngnh iu dng chim 78,8%. Lnh vc nghin cu ch yu l thchnh (51,2%), rt t cc tithuc lnhvc o to(2,9%). Thitk nghin cucacctichyulnghin cu m t (66,5%) vi phng phpthu thp s liu l phng vn cu trc hoc quan st dng bng kim (73,6%), cng c mt s t ti s dng phng php tho lun nhm hoc phngvn su.a s cc boco ti chanucchchnmu, phng php khngchsais,phngphpphntchsliuvkhacnho ctrongnghincu.Phnbnlunca ccbocothnglssi, cmts bocokhngcphnbnlun.Nhiu tiuchtrongtrnhbyktqu,bnlun vktluncaccti cha tyucu hoc cha c cp trong bo co. Ccbocochyullitkti liu thamkhochcha ctrchdntheo quy nh.Ktlun:(i)Nghincukhoa hctronglnhvciudng cnhiutinbcvlngvcht;(ii) Nghin cu khoa hc iu d- ng ton quc ln th IV16Mt sti cchtlngtt,ctnhkhoa hc v thc tin cao v c nghaivicngtcthchnh, pht trin ngh iu dng; (iii) Cn mt s hn ch nhtnhcaccti l: phnb lnhvcnghin cucha ngu;t ti cthchintuynhuyn;th sinh vin v k thut vin tham gia nghincu khoa hc; cc ti ch yu l nghincumt;mtsnidungcaboco ticha tyucutheocctiuchnhgi. ngh:(i) Trung ngHi iudngVitNamvccTnh/thnhhi nn t chc nhiu lp tp hun v hi nghkhoahctngcngnnglc nghincuiudngcbitltuyn huyn;(ii)Khuynkhchccgioviniudng,cchsinhvinvkthut vin thchinccti nghin cu;(iii)CcTnh/thnh, chi hivhivinnntham kho kt qu nghin cu ny lm bihckinhnghimcithinchtlng cc ti nghin cu trong thi gian ti.1. T VN iu dng l mt ngh, l mt ngnhkhoa hc ring bit (1). Theo nh gicaTchcYtthgiith dchviu dng l mt trong cc tr ct ca h thng dchvyt(2). Cngnhnhngngnhnghkhc, nng cao cht lng dch v iu dng, nghin cu khoa hc ng mtvai trquan trngvkhngththiu(3).Thngquanghincukhoa hc, chngtakhmphranhng iumi gipchothchnh da vo bng chng, pht hin v xc nhng vn , hiu r hn v vn quan tm;c bng chng v thc trng can thip v nh gi hiu quca nhng giiphp can thip t rt kinh nghimtrin khai trn mt phm vi rng hn gpphn ci tinnngcaocht lngcngtcchmscngi bnh(4,5). Hnth na Nghin cu khoa hc iu dngcngpphnthchhachuynngnhiu dng, khng nh tnh chuynnghip, tngcnghnh nhv vth ngi iudngtrongx hing thim rng phm vi hp tc vi iu dngQuc t (6).Ktkhi Hi iudngVit Namcthnhlp(26thng10nm1990)cho nnay, cngtc iudng cnhngtinbvt bctrong chotng Nghin cu khoa hc iu dng(7). Trc y hot ng nghin cu khoahc i vi ngi iu dng rt hn ch,nhng n nay chng ta c nhiu iudng trc tip tham gia nghin cu khoahc vi hng nghn ti cc cp khcnhau,trong c nhiuti c nhgi cao v ngha khoa hc v thc tinTrung ng Hi iu dng Vit Nam tchc nhiu lp tp hun vphngphpnghincukhoa hcv tchcba hi nghkhoa hc iu dng tonquc(8). Nhiu tnh/thnhhi vchi hiiudngbnh vin thng xuyn t chc hi nghkhoa hc nh hiiu dng H Ni, bnh vin Nhi Trung ng,bnhvin akhoaTrung ngHu, vmt s c s hi khc.Nghin cu khoa hc iu d- ng ton quc ln th IV17Tuy nhin, hot ng nghin cu khoahc iudngcntnti mtshnch: lc lng iu dng, hsinhv k thutvinthamgiaNCKHchanhiu;nng lc nghin cu ca iu dng cnyudothiullunvkinhnghimv nghin cu khoa hc. iu ny dn n s lng tiNCKHcnkhim tn,thiucht chvphng php nghin cu; Ni dung bo co cc ti nghin cu nhiukhi cnssi, chatun thnhngquynh trong trnh by mt bo co khoa hc;Phbinchia skt qunghincuving nghip cn nhiu hn ch do t c chi c trnh by ti cc hi tho, ng titrncc tpch, ccwebsite tipcnc gi.nhgithctrngtnhhnhccti nghincukhoahciudng chngthchinnghincu:nhgicc ti nghin cu iu dng cthc hin ti Vit Namgiai on 2004-2009 vi mc ch: nh gi thc trngcc ti nghin cu khoa hciudng ca Vit Nam c thc hin trong5nmt2004-2009 rt kinhnghimv aranhng xutnhmthc y,nng cao cht lng nghin cu khoa hciu dng.Mc tiu c th ca ti:1) M t s phn b cc ti NCKHv: c quan chtr, lnh vc nghin cu,tc gi nghin cu.2) nhgivchm imnidung boco ti nghincu khoa hc theocc tiu ch thng nht.3) nhgitngqut cc ti v:tnh cn thit, ngha thc tin v xp loi ti theo s im m ti t c.2. I TNG VPHNGPHPNghin cu c thc hin t thng 4 nthng9nm2010 bngphng phpnghin cu l m t hi cu vi i tngnghinculccboco ti nghincu khoa hc ca iu dng.Tiu chun la chn vo nghin cu:(i) ti cthchintronggiai on2004 n2009;(ii)c ngtrong k yucngtrnhNCKH cacchi ngh khoa hc iu dng ton quc, khu vc hoc hi ngh chuyn ngnh.Cmu: trong tng shn 300 tinghincu c ngtrong Kyuhinghkhoa hc iudngtonquclnth hai v ln th ba (2005, 2007), K yu hi nghkhoa hc iudngNhi khoatonquclnthnht nlnthsu(2005-2010) vhi nghkhoa hc iudngkhuvcminTrungmrnglnthnht nlnthba(2008-2010).pdng cng thc tnh cmu cho ccnghincu iutraqunthvi ccd kin: cqun th, tn xut kvng(p = 0,5), sai scao nht chp nhn c(d = 0,05) v mc tin cy l 95%. Theotnh ton cn cmul 168, trn thc t tinhnh nhgi170 ti nghincu khoa hc mbocctiu chun chn vo nh gi.Nghin cu khoa hc iu d- ng ton quc ln th IV18Phng php thu thpsliu: Cc ti NCKH m bo tiuchunchn vo nh gi c tp hp. Nhm nghincu thc hin nh gi theo cc tiu ch vcho imda trn bng im cnhm nghin cu xy dng v thng nht.Quy trnh nh gi: mi phn nhm gm 2thnh vin ca nhm nghin cu nh givcho im clpmtsti c phn cng, sau ghp im.Phntchsliu: Sliu cnhpv phntchbngphnmmthngkSPSS 13.0 v Epi-Info 6.02. Cc tiu ch(bins) nh giti ctnhtnxut, tl. Xp loi ti c phn tchtm mi lin quan vi mt s tnh cht cbn ca ti (c quan ch tr, cp ti, trnh ca tc gi th nht ca ti)v ckim nhbngtest vip 0,05 l c ngha thng k.Kthutkhngchsais: Cctiuch vthang im nhgi cnhmnghin cu xy dng v thng nht sau nh gi thv hon thin. Cn btham gia nh gi ctphuntrckhitin hnh nh gi.Kha cnh o ccati: tinghincunykhngthchintrn itng nghin cu l con ngi nn khngc nguy c gy tn thng, khng lm nh hngnlichcai tngnghincu. Ttcccsliuthuthp cchsdngvo mcchkhoahc,cc thng tin lin quan n c nhn cc tcgi ca ti nghin cu c bo mt.3. KT QU 3.1 c im chung ca cc ti3.1.1 Phn tuyn ca c quan ch tr v cp ca tiTrongtngs170 ti c chnvo nh gi, cc ti do cc c s thuc tuynTrung ngvtuyn tnh chtr chim t l l 48,8% v 38,8%, s cn lil cc ti ccquan chtrthuctuynhuynhoccccsytngnh(biu 1).48.838.84.77.70102030405060Trung ng Tnh Huyn Y t ngnhBiu 1. Phn b ti theo tuynca c quan ch trnh gi theo cp ti cho thyc 138 ti (81,1%) thuc cp c s, 32ti (18,9%) thuccpBhoc Tnh(biu 2).18.981.1Cp B/TnhCp c s Biu 2. Phn b theo cp ca tiNghin cu khoa hc iu d- ng ton quc ln th IV193.1.2 Mtscimcacctinghin cuS liu bng 1 cho thy phn ln ccti nghincu cthchinthucchuyn ngnh iu dng (78,7%), trongkhi cc ti thuc chuyn ngnh H sinhvCnlmsng chchimmttlrtnh(2,4% v 1,8%), scn li thuc ccchuyn ngnhkhc nh Phc hi chcnng, Gy m hi sc...(chim 17,1%).Lnh vc nghin cu ca cc ti chyu thuc vthc hnh iudng, h sinh hoc xt nghim (51,2%),tip theo l truyn thng-gio dc sckhe (10,6%), qun l v kim sot nhimkhun (8,8% v 7,0%). C rt t cc tithuc lnh vc o to v nh gi shilng canhnvin(2,9%v1,8%).Ccti chyuthucnghin cunh lng(61,8%), 14,7% ti kthpc nhlngv nhtnh.Sti nghincu nh tnh chim 20,0%.Phng php nghin cuchyu csdngl phng php m t (66,5%). 12,9% sti sdng phng php can thip,scn lis dngccphngphpphntch, thmd hoc can thip.Bng 1. Cc c im chnh ca cc ti nghin cuTT Cc c imS lng(n=170)T l (%)iu dng 134 78,7H sinh 4 2,4Cn lm sng 3 1,81 Chuyn ngnhnghin cuKhc 29 17,1Thc hnh D/HS/XN 87 51,1Truyn thng, GDSK 18 10,6Qun l 15 8,8Kim sot nhim khun 12 7,0Hi lng ngi bnh 8 4,7o to 5 2,9Hi lng nhn vin 3 1,82 Lnh vc nghin cuKhc 22 12,9nh lng 105 61,8nh tnh 34 20,0Kt hp 25 14,73Loi nghin cuKhng c s liu* 6 3,5Nghin cu khoa hc iu d- ng ton quc ln th IV20M t 113 66,5Phn tch 4 2,3Can thip 22 12,9Khc 27 15,94Phng phpnghin cuKhng c s liu* 4 2,4Phng vn cu trc 36 21,2B cu hi t in 71 41,8Quan st 18 10,6Tho lun nhm 3 1,8Phng vn su 10 5,9Khc 22 12,85Phng php thuthp thng tinKhng xc nh 10 5,93.1.3c im c nhn ca tc gi th nht ca cc tiKt qu nh gi cho thy 71,2% tcgithnht l n. Nam gii chim tl 25,9%. Mt s t (2,9%) ti khng xcnh c gii tnh ca tc gi th nht.Sliubng2chothyiudng vin tham gia lm nghin cu l ch yu (58,2%).Tlhsinhvkthutvintham gia nghin cu l khng ng k. Cngcmtstbcsthamgialmnghincuviudng(1,2%).Tuy nhin c nhiutrnghpkhngxc nh c chc danh ca tc gi (36,5%) v khng c ghi trong bo co.Tc gicc ti c trnh ti hc/cao ng tr ln chim 32,3%, s tc gi c trnh trung cp rt t (2,4%), tuynhin c ti 58,8% cc trng hp khng xc nhctrnh catcgivkhng c ghi trong bo co ti.Bng 2. Mt s thng tin c nhn ca tc gi th nhtTT Tiu ch nh giS lng(n=170)T l (%)iu dng 99 58,2H sinh 2 1,2KTV Y 5 2,9Bc s 2 1,21 Chc danhKhng xc nh 62 36,5Sau i hc 11 6,5i hc/cao ng 55 32,3Trung hc 4 2,42 Hc v Khng xc nh 100 58,8Nghin cu khoa hc iu d- ng ton quc ln th IV213.2 Cu trc ni dung ca cc tiSliubng3chothy60%ccboco ti khngcphntmtt,mt s t cc bo co khng c phn bnlunhocktlun.Chc81,2%sbo coctiliuthamkho,trongch yu l c di 5 ti liu tham kho v ch c 32,4% s bo co c trch dn ti liu tham khotheoquynh,scn lich lit k danh sch cc ti liu tham kho.Tlccbocoti cnuvmtphngphpphntchsliu, binphpkhngchsaisl kh thp (28,2% v 8,8%). Chc16,5%sbo co c cp n vn o c trong nghin cu.Phnlnsbocoti trnhbyktqutheomctiunghincu, ktquctrnh by r rng v c kt hpbiu,bngv hnh nhtrnh by,minh ha kt qu.Phnbn lunktqutrongboco ti c nhnmnhktququantrng ca nghin cu v bn lun v nhng kt quchimtll51,2%. Ct bococsosnhktquviktquca ccnghincukhc(14,1%)vcbnlunvphng php nghin cu (22,4%).C 58,2 s bo co ti c kt lun ph hpviktqunghin cuv41,8% sbococnghhplda trn kt qu v mc tiu nghin cu.Bng 3. Kt qu cc tiu ch chnh nh gi tiTT Cc tiu ch nh giS lng(n=170)T l (%)Tm tt 68 40,0Gii thiu 170 100Phng php 170 100Kt qu 170 100Bn lun 159 93,5Kt lun 162 95,3 ngh 130 76,51 Cu trc bo coTi liu tham kho 138 81,2t yu cu 92 54,1t nhng cn hn ch72 42,4 2Mc ch/mc tiu(theo cc tiu chnh gi mc tiu)Khng t 5 2,9Nghin cu khoa hc iu d- ng ton quc ln th IV22TT Cc tiu ch nh giS lng(n=170)T l (%)t yu cu 55 32,4t nhng c hn ch 49 28,8 3Cmu vchnmuKhng t 66 38,8t yu cu 48 28,2t nhng cn hn ch 80 47,1 4Phng php phntch s liuKhng t 41 24,1t yu cu 15 8,8t nhng cn hn ch 37 21,8 5Bin php khngch sai sKhng t 118 69,4t yu cu 28 16,5t nhng cn hn ch 15 8,8 6Nu vn o ctrong nghin cuKhng nu 127 74,7Theo mc tiu 110 64,7Trnh by r rng 117 68,8 7 Trnh by kt quKt hp biu, bng 103 60,6Nhn mnh kt qu quan trng vphn tch nhng kt qu 87 51,2Sosnhvi kt qunghincukhc v phn tch24 14,1 8Bn lun kt quBn lun phng php 38 22,4Kt lun ph hp vi kt qu99 58,29Ktlunvkhuynconghphhpviktquvmc tiu71 41,83.3 nh gi chung v cht lng ca cc tiKtqunhgi(bng4)chothys ti c tnh cpthitv c nghathc tinchim52,9%v 40%, s ti c gitr khoa hc cn thp (14,7%).57,1% s bo co ti c mc rrng,thngnhtvgn70%sboco ti cvnphonglulot, ngngn, d hiu.Nghin cu khoa hc iu d- ng ton quc ln th IV23Bng 4. nh gi tng qut cht lng tiTT Cc tiu ch nh giS lng(n=170)T l (%)S cn thit ca nghin cu 90 52,9C ng gp cho cng tc chmsc iudngv pht trin ngnh iu dng68 40,01 ng gitng qutTnh khoa hc 25 14,7Cc mc r rng, thng nht 97 57,12Tng quanbo co Vn phong ca bo co lu lot,ng ngphp, ngngn, d hiu117 68,83.4 Xp loi tiVisimti a m mt bo co ti c tht c l 68 imv cchia thnh 5 loi: Xut sc ( 90% sim); Tt(t80-89% sim); Kh (t70-79% s im); t yucu(t60-69%sim); t yucunhngcn hnch( 0,05.Bng 5. Mi lin quan ca mt s yu t: c quan ch tr,cp ti v hc v ca tc gi th nht vi xp loi tiXp loi tiKh + t TT Bin s quan tmn % n %Gi tr pTrung ng 30 36,0 53 64,01 C quan ch tra phng + ngnh 34 39,1 53 60,9>0,05B/tnh 10 31,2 22 68,82 Cp tiC s 54 39,1 84 60,9>0,05Cao ng + 26 39,4 40 60,63Hc v tc gi th nhtTrung hcv khngxc nh38 36,5 66 63,5>0,054. BN LUN Ktqunghincuchothy:chac ti no cpNh nctrongs170 ti cchnvo nh gi nhngcng ctign20%sti thuc cp b v tnh, y l iu rt ng khch l.Tuynhinnghincucngchras phn bkhnguccti NCKHtheo tuyncacquan chtr ti.Phn ln cc ti c thc hin cc csthuctuynTrungngvtuyn tnh.Sovitngsccbnhvintrongc nc th cc bnh vin tuyn Trung ngch chim khong 5% (9), nhng cc tiNCKH cthchintuynny chim tign50%.Mcd trong cnccti hn 600 bnhvintuynhuyn(9) nhngsti cthchintuynhuynlrtt.cbitkhngcti no do cccsyttuynxthchin.iunycngphnnhmtthctrngchunglcnbyttuyndinichung,iu dng, h sinh v k thut vin ni ring ttham gia nghin cu khoa hc. Thc t nyc thdonhiunguyn nhn nh mitrnglmvicthiunglcphnutrongkhi nnglcthchinnghincu ca iu dng tuyn di cn hn ch.Nghin cu khoa hc iu d- ng ton quc ln th IV25nhginycngchothyphnln cc ti nghin cuthucchuyn ngnhiudng,trongkhiccti thuc chuyn ngnh hsinh,cnlmsng v dotcgithnhtlhsinhhockthut vin thc hin chim mt t l khng ng k, iu ny l khng tng xng vi phm vi, mc cng viccngnh tlphn bcaccitngnysovitngs nhn lc thuc khi iu dng, h sinh vk thut vin trong h thng y t (9).Cng nh btkmtngnh nghnokhc, o to ng mt vai tr quan trng, nng cao cht lng trong o to iu dng rt cn c nhng nghin cu v lnh vc ny. Qua nghin cu ca chng ti, s ti thuc lnh vc o to chim mt t lcnrtt(2,9%). iunychngt nghincuvototrongiudng cha cchtrng. tti NCKHthuc lnh vc o to chc chn s khng thcungcpcccsliuthcchng cntmhiunhvysnhhngn cng tc qunl, nng cao cht lngcngnhquyhochtronglnhvcny.Sliunycngthhinsbttngxngsovitimnngthchinnghincukhoahccainggiovin iu dng.Phichnghinnayhuhtcc gio vin dy iu dng cn l cc bc snn hcha thtsquan tm nnghincu iu dng?Ktqunhgichititni dung cc ti thhinnhngiu cn hn ch trong thc hnh nghin cu. Mctiucanhiuti cha cvit theo ngtiuch, nhiumctiunghincukhngcth.Phnlncctc gis dng thit k nghin cu m t vi phngphp thu thp s liu l phng vn trc tip hoc t in b cu hi cu trc hoc quanst datrn bngkim.yl phngphpthuthpthngtinctincyvchnhxckhngcao(10-12). Vinhngphng php ny nhiu khi s liu thu thp ckhngphnnhngthctrngtnhhnh nghin cuv khi c mtnghin cu vin quan st mt hnh vi hoc thao tc k thutth ngibquanstscgngth hinhnh vi hocthchinccbcthao tc k thut mt cch chun mc nht (13).Tuy nhin cng c mtsti s dngphngphptipcnnhtnhnhdngphngphptholunnhmhoc phngvnsu thuthpsliu.yliurtngkhchlnhtl trong nghincu iu dng v nhng phng php nycho php nghin cuvin tm hiuchi tit v giithchthuohnvnc nghincu. V vynhngphngphpny csdngnhiutrongnghincu iu dng (14).Nghin cuny cn bclmtsyu imkhccaccbocoNCKHiu dng trong phng php nghin cu: khng m t phng php chn mu, phng phpkhngchsaisvphntchsliu.c bitcrttti cpnkhacnho c trong nghin cu, tuy nghin cu khngNghin cu khoa hc iu d- ng ton quc ln th IV26phi l nhng nghin cu can thip hay th nghim lm sng nhng i tng tham gianghin cu c quyn c thng bo v t nguyn tham gia. Trnh by kt qu v bnluncngcn nhnghnch,mtsbo covadngbngvadngbiu trnh by cng mt s liu kt qu hoc s dngqunhiubngvbiu.Mts bo co khng c phn bn lun hoc phn bn lun c vit rt s si, cha tun th nhngkhunmuquynh.Chyuccbo co litk ti liuthamkhoch khngtrchdntheoquynh,thmch mtsbocokhngcti liutham kho. Bn cnhmt sbococ nhngktlunkhngbmstktquvnhiukinnghmangtnhchquanca ngi nghin cu.nhgichungchtlngtichothy sti tloikhtrln chimt lkhcao(42,4%)yl mtktqurt ng khch l.Tuynhin bn cnhmts ti t ktqu xutsc, hoc tt (t t 80% s im chun ti a tr ln) cng cnmtsti c simtcn thpcho thycht lng thc hin nghin cu changu.iuny cng ph hpvikt qunhgisti ctnhkhoahc cha cao trong nghin cu ny.y l mtnghin cuhicuvis tham gia nh gi ca11nghin cuvin.Bngnhgiti cccnghincuvin tholun,thngnht v c nh gi th trc khi hon thinvchnhthcsdng.Nhmnghincu cng c gng hn ch cc sai s nh tp hunnhgi,phncnghaingicngnhgimtsti tngtnhthng nht.Tuynhinnghincunycngcnmt s hn ch l: (i) S ngi tham gia nh gi nhiu d dn n sai s trong nh gi gia nhng ngi nh gi; (ii) Kt qu nh gi c th b tc ng bi mt s yu tchquannh: nginhgichcv caocththngkhtkhehnkhi nhn xt mt ti nghin cu khoa hc nn cthdnnnhgitithphn,choimthphn. (iii) V iukinthigian chnnnnhmnghincucha thc hin nh gi ngu nhin li mt t l nht nhccti cnhgixc nh tnh chnh xc ca kt qu nh gi.5. KT LUNViktquthuctnhgi170 ti NCKH iudngcthchin tronggiai on2004-2009trnphmvi ton quc,nhmnghin curtramts ktlunsau:(i)Nghin cukhoa hctronglnhvciudngc nhiutinbcvlngv cht;cc ti nghincuadng,phongph; Mtsti cchtlngtt,ctnh khoahcvcnghaivicngtc thchnh v pht trinnghiudng; (ii) Tuy nhin cc ti cng cn mts hn ch nht nh: t ti c thc hin tuyn huyn; phn b lnh vc nghinNghin cu khoa hc iu d- ng ton quc ln th IV27cucha ngu;shsinhvin v k thutvinthamgialmnghincukhoa hccha nhiu;cc ti chyulnghin cu m t; mt s ni dung ca bo co ti cha tyucutheocctiuch nhgi. ylnhngyuimcn khc phc thng qua tng cng o to v nghincukhoahcvtchchitho khoa hcchiaskinhnghimnngcao nnglcnghincuvknngvitbo co khoa hc cho iu dng vin, h sinh vin v k thut vin.6. NGHDa trn kt qu nghin cu ny, nhmnghincungh:(i)TrungngHi iudngVitNamvccTnh/thnhhicntchcnhiulptphunv hi nghkhoahctngcngnnglc nghincuiudngcbitltuyn huyn; (ii) Khuynkhchcc gio viniudng,cchsinhvinvkthut vinthchincctinghincu;(iii)CcTnh/thnh, chi hivhivinnntham khoktqunghin cuny lm bihckinhnghimcithinchtlng cc ti nghin cu trong thi gian ti.Licmn: Nhm nghin cuxinbytlng bitn chn thnh tiTrungngHi iu dng Vit Nam, Hi iu dng Canada nhittnhhtrthchin nghin cu ny.7. TI LIU THAM KHO1. Potter P.A&Perry A.G. 5thEd.(2005), Fundamentals of Nursing. MosbyPublisher.2. WHOannual report 2002. Geneva:World Health Organization.3. Phmc Mc (2005), Ph- ngphp nghin cu iu d- ng-Nh xut bnY hc, H Ni.4. Polit D.F&Hungler B.P. 5thEd.(1995). Nursingresearch. Principles andmethods. Philadelphia: J.B. LipponcottCompany.5. Flemming, K. (1998). Askinganswerable questions. Evidence BasedNursing; 1: 36-37.6. Mulhall, A (1998). Nursing,research, and the evidence. Evidence BasedNursing; 1: 4-6.7. Bo co tng kt ca ban chp hnhTrung ng Hi iu dng Vit Nam tii hi i biu ton quc ln thV, nm2007.8. D tho chin lc quc gia cng tciu dng, h sinh 2011-2015 v tm nhn2020 (Hi iu dng Vit Nam).9. Nin gim thng k y t 2008, B Y t.10. Pope, C. (1995). QualitativeResearch: Reaching the parts othermethods cannot reach: anintroductiontoqualitative methods in health and healthservices research. BMJ; 311: 42-45.11. Berg B. (2001). "Qualitativeresearch methods for social sciences".Boston: Allyn & Bacon.Nghin cu khoa hc iu d- ng ton quc ln th IV2812. Patton, M. 2ndEd (1990).Qualitative evaluation and researchmethods. London: SAGE Publication.13. Dahlgren L. and A. Winkvist(2004). "Qualitative methodology forInternational Public Health" UmeaInternational School of Public Health,Epidemeology of Public Health Science,Department of PublicHealthandClinicalMedicine, Umea University.14. Morse J. and Field P. 2ndEd.(1984). "Nursing research: the applicationof qualitative approaches". London:Chapman and Hall.Nghin cu khoa hc iu d- ng ton quc ln th IV29IU TRA THC TRNG NGUN NHN LC IU DNG TRONG BNH VIN CNG LP NGNH Y T NGH AN NM 2009CN. L Th Hng SnS Y t Ngh An1. T VN Cng tc iudngl hotngquan trng trong cng tc chm sc sc kho cho ngibnhtibnhvinvchmscsc khotrongcngng.ingiudng a khoa (D)-iudngphsn(HS)c mtmilnhvccahthngchmsc sc kho v cn l tr ct chnh ca h thng cung cp dch vy t. T chcy t th gii khuynco:btkqucgiano,munnngcaochtlngchmscsc kho th phi ch cng tc iu dng vxem iu dng l mt ngh, mt mt xch quan trng v l phn na ca cng tc chm scsckho.MctiucaBYtn nm 2010 l mbochongibnhc chmsctondinticccsyt,m rngdchvchmscnccgianh vcngng,chtlngchmscphit ngangtmviccnctrongkhuvcvtngbchinhpviccnctrnth gii[1]. pngnhucu,cnch pht trinngunnhnlcD-HS vcs lng v cht lng.Trcskhnghongvthiungun nhn lc D-HS trn ton th gii, Hi ng Y t th gii ra ngh quyt s 54.12 ngy21/5/2001 vchinlc tng cng dch v TiVitNam ngy 3/5/2002 BytcQuytnhs1613/2002/Q-BYTphduyt K hoch hnh ng quc gia v tng cngcngtciudng- Hsinh[2].Trong c nh gi ngun nhn lc v ara cc ch tiu pht trin ngun nhn lc D-HS. HiiudngVitNam c nhiu nghin cuvngunnhnlciudng trong ton quc[4].Mtkhctngcngchtlng dchvchmscngibnh,qunl ngun nhn lc cabnh vin v nng caotrnh cho i ng iu dng vin, ngy14/7/1990BYtcquytnhs: 570/BYT-Q v vic thnh lp phng iu dngtrongccbnhvin [2], ngy19/9/1997bYt cquytnhs: 1895/1997/BYT-Q vbanhnh Quy ch Bnh vin. iu dng trng cc cp hin nay trthnhnguncnbchcht trong cc c s y t.TiNghAn, S Y t xy dng n pht trincngtciudnggiaion2001-2005. Hinghkhoahciu dngNghAnlnthnhtnm2006c 2 ti nghin cuvngunnhnlc iudngv Thctrngiudng trng[3]nhngcho nnay, sovik hochhnh ngqucgiavtngcng cng tc iu dng-Hsinhm BYt Nghin cu khoa hc iu d- ng ton quc ln th IV30D -HS ton cu[1]. ra cn mc khim tn.a s cc bnh vin c quyt nh thnhlpphng iu dngnhng sphngiudnghotngclpthchin ychcnngnhimvtheoquych bnhvinrtt,phnlnanghotng nh t iu dng.Mc d Ngnh iu dng Ngh An c nhngcgngngkhch l nhng thc tslngvcht lngngunnhnlc iu dng cha p ng c nhu cu, vai tr kh nng thc hinchc nng, nhim v ca mtsiudngtrngcn hnch cbitlnnglciuhnh, qunlvnghin cu khoa hc.Thchinchtrngcangnhyt tnh, chng ti tin hnh nghin cu: iu tra thc trng h thng v nng lc ngun nhn lciudngtrongbnhvincng lpngnh y tNghAn nm 2009 nhm mc tiu:1. M t t chc mng li phng iu dngticcbnhvincnglp ngnh yt tnh.2.Mtthctrngvngunnhnlc iudng-Hsinh-K thutvin trong ccbnh vin cng lp ngnh y t tnh.3. xut cc gii php nhm cng c h thng v nng cao nng lc cho i ng iu dng.2. ITNGV PHNGPHP NGHIN CU2.1. i tng nghin cu- iu dng, h sinh ti 26 bnh vin cng lp ca tnh Ngh An.- Phng iudng,iudng trng bnh vin, iu dng trng khoa 26 Bnh vin cng lp ca tnh Ngh An.2.2. Phng php nghin cu: M t ct ngang.2.3. Phngphpthuthpsliu:Phiu iu tra gi v cc Bnh vin cng lp trc thuc S Y t qua ng bu in.2.4. Cng cthuthpsliu:02b phiu iu tra:- Ngun nhn lc iu dng- H sinh trong cc bnh vin.- Phng, tiudng,iudng trng cc bnh vin. 2.5. Thi gian: T thng 17/20092.6. X l s liu: Bng bng tnh Exel.3. KT QU 3.1.T chc mng li phng iu dngBng 1: H thng t chc Phng iu dng/DT bnh vinT chcS lng (n =26)T l (%)C phng iu dng18 69,2Ch c 1 DT trong phng KHTH 7 27Cha c quyt nh DT1 3,8Nghin cu khoa hc iu d- ng ton quc ln th IV31Tng 26 100Nhn xt: S bnh vin c phng iu dng chim t l cao (69,2%), cn 27% bnh vinchciudngtrngbnhvin,vncn 1bnhvincha c hthngiudng trng (3,8%).Bng 2: Hot ng ca phng iu dng.Ni dung S lng T l %Phng D hot ng theo Quy ch BV 6 33,3Phng D hot ng nh t D 12 66,7Tng 18 100Nhn xt: Ch c 33,3% s phng iu dng hot ng c lp theo ng chc nng nhim v, s cn li hot ng nh t iu dng (66,7%).Bng 3. Bnh vin c ph cp trch nhim cho phng/DTHng ph cp chc v S lng T l (%)- C 39 57,3- khng 29 42,7Tng 68 100Nhnxt:Michc53,7%cnbphng chngphcpchcv,vncn42,7% cn b phng cha c hng ph cp chc v.Bng 4. Trnh qun l ca iu dng trngC Khngi tngSL % SL %TP iu dng hoc DT BV10 38,5 16 61,5iu dng trng khi 7 19,4 29 80,6iu dng trng khoa 70 43,7 90 56,3Nhn xt: S cn b cha hc qun l iu dng chim t l cao, nhiu nht l iu dng trng khi (80,6%), DT bnh vin cn 61,5% cha hc qun l.Bng 5. Trnh chuyn mn ca cn b phng iu dng /DT BVTrnh chuyn mn S lng T l (%)i hc 2 2,9Cao ng 12 17,6Trung hc54 79,5Nghin cu khoa hc iu d- ng ton quc ln th IV32Tng 68 100Nhn xt: Ch yu l trnh trung hc 79,5%, trnh i hc thp 2,9%. Cn li ltrnh cao ng 17,6%.3.2. Ngun nhn lc iu dng, h sinh cc bnh vin cng lp trong ngnhBng 6. Phn loi D-HS theo gii tnh, nhm tui.S lng (n=1735) T l (%)Gii tnhNamN268146715,584,5Nhm tui50 tui43433048248925,01927,728.3Nhn xt: i ng D-HS a s l n (84,5%), Nhm tui >50 tui chim t lcao hn trong cc tui (28,3%). Bng 7. Phn loi D-HS theo trnh chuyn mnTrnh chuyn mnChuynngnhTng sT l %HT l %CT l %THT l %SHT l %D 1486 85,65 13 0,8 130 8,7 1265 88,9 25 1,6HS 249 14,35 3 1,2 32 12,8 199 86 0 0Tng 1735 100 16 2,0 162 21.5 1464 87 25 1.6Nhn xt:- iudngchimtlcaohn trong tngs(85,65%),chyul trnh trung hc (88,9%). Trnh i hc 0,8%, cao ng 8,7%.Vn cn D s hc lm vic bnh vin (1,6%).- H sinh chim 14,35% trong tng s, trnh i hc 1,2%; cao ng 12,8%, trunghc 86%.Bng 8. Trnh ngoi ngTrnh ngoi ng S lng (n=1735) T l (%)Anh A 121 6,97Nghin cu khoa hc iu d- ng ton quc ln th IV33Anh B 83 4,78Trnh ngoi ng S lng (n=1735) T l (%)Anh C 7 0,4Php B 2 0,1Tng s 212 12,25Nhnxt: Trnh ngoingcht12,25%trn tngs,chyul bngAting anh, bng B ting php c 2 ngi t 0,1%.Bng 9. Trnh tin hcTrnh tin hc S lng (n=1735) T l (%)Tin A 210 12,1Tin B 221 12,7Tng 431 24,8Nhn xt: Trnh tin hc t 24,8% trong tng s, bng A v B gn tng ng nhau.3.3. Phn b t l iu dng-H sinh so vi Bc s v ging bnh.Bng 10. Phn b t l iu dng-H sinh/Bc siu dng-H sinh Bc s T l D-HS/BSTng s 1735 774 2,2Nhn xt: T l D-HS/ BS: 2,2/1.Bng 11. Phn b iu dng-H sinh theo ging bnhiu dng-H sinh Ging bnh KH T l D -HS/GBTng s 1735 3795 0,45Nhn xt: T l D-HS/GBKH: 1/0,45.4. BN LUN4.1. Tchcmngliphng iu dng- Trong tngs26bnhvinhng III trln, michc18bnhvin c quytnhthnh lpphngVncn 8 BVcha thnh lpphngiudngtheoquynhcaQuych bnh vin[5].-Mcd cquytnhthnhlp Phng iudngnhng 66,7% s phng ang hotngnh tiu dng,trngphng lmvicv sinhNghin cu khoa hc iu d- ng ton quc ln th IV34iudng(tl69,2%).Trung bnh s cn b ca phng l 3 1 ngi.hot vi phng KHTH hoc phng khc,cc thnh vin cn li lm vic v sinh hot tikhoalmsng, cha thchinng chcnngnhimvcaphngtheoquych Bnh vin.- Cn bphng iudngchachngphcpchcvvncn42,7%, nhiunhtl iudngtrng khi.Mttrnghpiudngtrng bnhvintuyntnh mnhncng vic3nmnhngvncha chng ph cp chc v.- Vncn 61,5% cn btrng phng/DTBV, 80,6% DTkhi,56,3%DTkhoa cha chcqunliu dng theo chng trnh ca B Y t.- C 79,5% cn bphng iudng trnh trung hc, i hc v cao ng ch chim20,5%. Victhchinnhimv thamgianghincukhoahccha c ch trng.4.2. Ngun nhn lc D-HS cc bnh vin cng lp trong ngnh- ingiudng,hsinhtrongton ngnh l: 1735 ch yu l n (84,5%), y cng l c th ca ngh nghip vi a s l cn b n.-Tlihc,caongl 11,7%sovi nghin cu ca Nguyn Th XungiovintrngcaongYtNghannm 2006 l 1,5%[5], y l kt qu ca s quan tm gip ca lnh o cccp v sc gngvn ln caingiudng nhng so vi k hoch hnh ng ca B Y tnnm2010l: 40%[1]th khng t c. Trong khi mtsncnh ThiLan ang ph cp iu dng trnh i -Trnh ngoingt12,25%trntngs,sovinm2006(5,83%)th i ngiudngcscgngnhngcnphiphnunhiuhnnakhit nc ang trong thi k hi nhp.- Trnh tin hc t 24,83% trn tng s(nm2006:10,5%)[3], chyulbnh vintuyntnh,ccbnhvinminnit l ny thp.4.3. Phn b t l iu dng-h sinh so vi bc s v ging bnh- T l D-HS/BS thp 2,2/1 so vi k hochhnh ngcaBYtnnm 2010l3/1thcnthiu587iudng na.Trongkhimtsncnm2007 nh: Thi lan l: 8/1, Nht bn: 4/1 [4]-T l D-HS/GBKH cn cao (1/0,45),sovikhochhnh ngcaBYt nnm2010:0,5 [1]th cnthiu162 iu dng.5. KT LUN 1. TchcmngliPhng iu dngcha ngb/cnbphng iu dng cn hn ch v trnh , a s chac o to v qun l iu dng.- S bnh vin hng III tr ln cha cquyt nh thnh lp Phng iu dng cn8/26 Bnh vin (30,7%)- Cn12/18bnhvincquytnh Phng iu dng (66%) nhng hot ng nh t iu dng. Nghin cu khoa hc iu d- ng ton quc ln th IV35hc.Vncn trnh s hclm victi bnh vin (1,6%).-C 42,7%cn bPhng iudng cha c hng ph cp chc v.- Trnh chuyn mn caPhng iu dng: Trnh i hc v cao ng mi t 20,5%. So vi k hoch hnh ng ca B Y t n nm 2010 l: 100% c nhn, 15% cao hc [1]l qu thp.- Scn bphng qua lpqunl cn thp: ch c 38,5% trng phng/DT,trong khi chtiu khochhnh ngca B Y t n nm 2010 l 90%[1].-Mtsphng iudngthchin chcnngnhimvcha ytheoquy chbnhvincbitthchinnhimv tham gia NCKH cha c ch trng.2. Nhn lcD-HS-KTVcha cni v c cu, thiu v s lng v yu v cht lng. - T l D-HS/BS: 2,2/1 l qu thp.-TlD-HS/GB:1/0,45lcha t theo yu cu.- Trnh chuynmn: Chyultrnh trung hc (88,9%), trnh i hc v cao ng ang mc thp: iu dng (0,8%); Hsinh:(1,2%).Vncnshc (1,6%).- Trnh ngoi ng v tin hc cn thp: Ngoingmit12,25%trongtngs (ting Anh, ting Php, bng A,B,C). Tin hc t 14,83% (Chng ch A, B).3. Cc gii php- Tngcngkimtragimstvic - o to qun l iu dng cho iu dngtrngkhoatrln ticcbnh vin. Mc tiu n ht nm 2010 tt c cc cn b lm qun l c o to.-CnbtcingD-HSshc, mboD-HSctrnh ttrunghc tr ln.- CkhochnhnD-HSvoccbnh vin c nhn lc phc v chm sc ngibnhton din(u tin ihc, cao ng).-Tngcngotohtichccho cn b c bin ch.- C k hoch o to nng cao trnh tin hc, ngoi ng.6. KIN NGH1. i vi U ban nhn dn tnh- a chtiu nhn lcD-HS/ging bnhtheoKhochhnh ngqucgiav tng cng cng tc D-HS giai on 2002-2010caBYtvochtiunhnlc ngnh Y ttnhphcvchmscngi bnh ton din.- C ch,chnhschh trcnb iu dng i hc i hc v sau i hc.2. i vi S Y t- Ckhochtuyndngnhnlc D-HS c trnh trung hc, cao ng, i hc sau khi tt nghip (u tin i hc, cao ng),cnivitlgingbnhvnhn lc bc s.- Khuynkhchototichc(i hc,caong),nngcaotrnh chuynNghin cu khoa hc iu d- ng ton quc ln th IV36thchinccquytnhcaBYtvquy ch bnh vin ti cc n v.mncho D-HS cbinchticc Bnh vin.3. i vi trng Cao ng Y t- Tng cngo toCaong,ck hoch lin kt o to i hc iu dng h ti chc ti Ngh An.- Mlpo to Qunliudng theochngtrnhcaBYtmiban hnh.4. i vi cc bnh vin - Phithnh lpPhng iudng theo quyt nh ca B Y t (cc bnh vin t hng III tr ln).- Phng iudngccBnhvin hot ng theo ng chc nng nhim v.- p dng hng ph cp trch nhim theo ng quy nhchoiudng trng cc cp.- B tr D-HS lm vic theo ng vn bng, chc danh. - Hngnmckhochotov chuyn mn, qunl, ngoing,...cho i ng D-HS.7. TI LIU KHAM KHO.1. BYt,Khochhnh ngquc gia v tng cng cng tc iu dng-H sinh giai on 2002-2010, thng 5/2002.2. Bo co ti nghin cukhoahc iudngtnhNghAnlnthnht thng 11/2006.3. K yu ti Nghin cu khoa hc iudng,tiHiNghkhoahciu dngton quclnthIII,thng10 nm 2007.4.PhmcMc,NguynHiNinh, oThnh: Mtsnhnxtvspht trintnhincangunnhnlcYt-iudngv Hsinhtrongbicnh ngunnhnlcVit Nam giai 1986-2000.Kyuccti nghincukhoahciu dng, thng 5/2002.5. Quy ch bnh vin.6. Thngtin iudngs32thng 10 nm 2007.Nghin cu khoa hc iu d- ng ton quc ln th IV37HIU BIT NGH NGHIP V LNG YU NGH CA SINH VIN IU DNGTS. Trn Quang Huy, CN. Nguyn Th ThyPhngiu dng, bnh vin Vit Nam-Thy in Ung B.TM TTMc ch: Mtshiubit, lngyu nghv nhngyutclin quan sinh vin iu dng. Phng php:Nghin cu m tsdng bcu hi t in ctinhnhtthng3-thng6nm 2009 trn 536 sinh vin cao ng vi hc iu dng thc tp lm sng tibnhvinVitNam-Thy inUngB.Kt qu: ngkdthi iudnglnguyn vngthnht ca58%ssinhvin c kho st v ch c 11% s sinhvin chn nghiu dng l do yuthch, s cn li l do tnh c hoc do tcng ca gia nh hay bn b. Tlsinhvinhiubit y vvai tr, chcnng v nhng lnh vc nhim vcbn ca ngh ang theo hc khng cao.45,3%ssinhvinchorngnghiudng cvththphnsovinhngngh khc v c ti 25,4 % s sinh vinc nhchuyn hcnghkhc. Sinhvin nam t hi lng v gn b vi ngh thp hn so vi n. Sinh vin h i hchiubitnghnghiptthnsinhvinhcao ng, nhngsinhvinhcao nglihi lng v nh gi vth nghiudngcaohnsovi sinhvin hihc. Khnng chuynngh nhm sinh vin khng hi lng v nh githp v th ca ngh cao hn nhiu so vinhm sinh vin hi lng vi ngh v nhgicao vthcanghiudng. Ktlun vngh:Nghiudngchaphilmtnghhpdn, mtskhngnhsinhvinchorngnghiudngc v th thp hn so vi nhng ngh khcv c t tng chuyn i hc ngh khc.V vy cn tng cng tuyn truyn qungb, m rng t vn, hng nghip ti sinhvin trc khi thi vo trng; Bi dng,nng cao nhn thc ngh nghip cho sinhvinsaukhi nhp hccnghaquantrng nng cao s hiu bit ngh angtheo hcchosinhvintc ngchc tp ng n hn v gn b vi ngh;Cnthchinmt nghincukhctrnmt quy m rng hn v kt hp c phng php nh lng v nh tnh.Tkha: o to iudng, hiubit nghnghip, hi lngnghnghip,Vit Nam.1. T VN iu dng l mt ngh, l mtngnh khoa hc ring bit (1).iudng ltrct ca hthng Chm scsc khe (2). nhiu nc trn th gii,ngh iu dng c tn trng v c v th cao trong x hi. Ngi iu dngNghin cu khoa hc iu d- ng ton quc ln th IV38yu nghca mnh v tho vngh nghip ca mnh nh ngi ta thng ni: iudnglnhngngipnht.Trn lnhvcphttrin ngh c nhiuiu dng t hc vcao v c phonghm gio s ca cc trng i hc danhting. Vit Namtrongnhngnmgnyngnh iudng cnhngbctinnhy vt trong clnh vc thchnh,qun l v o to. Hnh nh v v th cangi iudng c thay i rtnhiu v c x hi tha nhn (3). Tronglnh vc o to iu dng c nhngthay i quan trng. Theo bo co ca V Khoa hc o to, BY t, hin nay tonquc 15cs o to i hc iudng v hn 30 trng trung cp Y cnng cp thnh trng Cao ng Y oto iudng trnh cao ng(4).Mt sc so to nh trng i hcYH Ni, Y-Dc thnh phHCh Minh, i hc iu dng Nam nh, ihc Y Hu thc hin cc chng trnho to Thcs iudng, iudungchuynkhoaIChnhvi spht trinnhvynnhngnm chngnghnsinh vin iu dng cao ng v i hciu dng chnh quy v ti chc c oto vs c nhiu iu dng c trnh sau i hc c tt nghip ti cc trngtrong cnc. iu ny v sgp phnthay i dn c cu trnh trong lc lngiu dng (2). Tuy nhin trn thc tchothy c nhiu sinh vin iu dng khngkhi chn thi hoc chn ngnh iu dnglmngnh hc camnh. Cnhngemchn thi v vo hc ch l do tc ng cabnbhocldogia nhvi suyngh:cngvo hcchovui hoccncngilmngnhy chmscsc khegianh hoc n gin l c b m lm nghnhy ri nu hc nghny sdxin vicvvVi nhng l do nhvy dn ntrong qu trnh hc mt s em ny khng cng c hc tp ng n, ny sinh tm lchn nn, mun bhc v cng c mtsem bhc thi li votrngkhc,chnnghkhc(5). Tuychacsliuchnh xc nhng trn thc t c mt s iu dng tt nghip, c cng vic n nhri nhngvn bnghvchorngngh iu dng va vt v, va thu nhp thpv khng cvthxng ngtrongxhitm hiur hn phn no vvnnu trn chng ti tin hnh nghin cunynhm mc ch: mtshiubit,lng yu ngh v nhng yu t c lin quan sinh vin iu dng.2. I TNG VPHNGPHP-Thigiannghin cu:T thng 3-6nm 2009- a im: TibnhvinVitNam-Thy in Ung B.- Phng php: M t - i tng: sinh vin iu dng thctp lm sng ti bnh vin.Nghin cu khoa hc iu d- ng ton quc ln th IV39xc nh r rng nguyn vng ca mnh- Tiu chun la chn vo nghin cu:cc sinh vin iu dng hcao ng hoci hc chnh quy, t nguyn tham gia.- Cmu: p dng cng thc tnh c mu cho cc nghin cu iu tra qun thtrong chng trnh Epi-Info vi cc d kin: cqunth(N=2800), tnxut k vng(p=0,5), sai scaonht chpnhnc(d=0,05)vmc tincy(99%).Theotnhtoncncmul 536sinhvin. Phngphp chnmungunhinn c thc hin trong scc sinh vin tiu chun tham gia nghin cu.- Phngphpthuthpsliu: T in b cu hi cu trc vi nhng cu hi ng v mt s cu hi m (6).- Phn tch sliu: Sliu c nhpvphntchbngphnmmthngkyhc EPI Info phin bn 6.02. Cc ni dungkho st (bin s) c tnh tn xut, t l,tsut chnh (OR) v c kim nhbngtestvip50 tuilkhng nhhctiptc(83%).Tnhtrng hn nhn: D c thn d nh tip tcshcnngcaotrnh (85%)vD lpgianhc nhhctip (55%). Tngscon:Dlpgianhnhng cha c con c d nh tip tc hc (82%) v khng c d nh hc tip tc khi c 1 con (14%), 2 con (37%) v 3 con(100%). Ktlun:DTCcquytnh tiptchcnngcaotrnh l Dcthnhoccgianh nhng cha ccon, tui 50 tui l khng nh hctiptc.Ktquph hpvinghincu ca D.Colleen Delaney c s khc bit giaDdnhtiptchcnngcao trnh chuyn mn v tui nh D d nhtiptchctui35.7v Dkhng c nh hc tip tui 46.3 (10).TibnhvinNhndn115nhm tui trng tuyn cao nht l t 25-29 tui chim t l 100% ( nm 2008) v tui 30-34chimtl50%(nm2005),cn tui trn 45 tui th khng c D nongkdthi (12).Nhvy, Dvi tuicngcaoth cngkhngc nh hctipdotuicnglncngkhtip thu. Ngoi ra, theoqui chtuynsinh D > 45 tui khi i hc phi t tc honton kinh ph hc tp.Tnh trng hn nhn lin quan n t l quyt nh tip tc hcC85% D cthndnhtip tc s hc nng cao trnh trong khi ch c 55% D lp gia nh c nh hc tip. iu ny chng t rng D c thn c nhiu c hi thun li hn so vi D lpgianh trong vichcnngcao trnh .Ktqunykhc vinghins khc bit gia D d nh tip tc hc nngcaotrnh vtnhtrnghnnhn (10). S khc bit ny do nghin cu ca tc giD.ColleenDelaneycthchinti M l quc gia pht trin vi li sng hin i,quyntdo,tlpcao,con>18tui hontontlp,chamcngtbrngbuc.Trongkhi,tiVitNamth conci ph thuc rt nhiu vo cha m. Do , nhngDlpgianhrtkhkhn trong vic hc nng cao trnh tip tc.Tng s con lin quan n t l quyt nh tip tc hcC 82% D lpgianh nhng chaccondnhtiptchcnngcao trnh .TrongkhinhngDcconth tlkhngdnhhctiptc cngtngtheosconnhc1conl14%, 2conl37%vnuc3conthhon ton khng c nhhctip (100%). Ktqukhcvinghin cuca D.ColleenDelaneylkhngcskhc bit gia D d nh tip tc hc nng cao trnh vtngscon(10). Skhcbit nydonghincucatcgiD.Colleen Delaney c thc hin ti M l quc gia pht trin cha m v con ci t b rng buc v x hi c y cc chnh sch chm lo chotrem.Trongkhi,tiVitNam chnh sch x hi cho tr em cha y , nnchamlngichmlochnhyu cho con ci. Do , vi gia nh cng ngconth nhucuchmsccngtng. VthiviDcngcon rtkh Nghin cu khoa hc iu d- ng ton quc ln th IV54cu ca D.Colleen Delaney l khng c khn trong vic hc nng cao trnh .6. KT LUNT l DTC c d nh tip tc hc tctrnh CNDt 72%, khngd nh l 10% v cn lng l cha quyt nh l 18%.Nhnglichcavichcnngcao trnh gm: mang nlichchobn thn (99%), lichchonghnghip (98,5%), m rng kin thc (99%) v nngcao k nng tay ngh (73%). Mt s cc yu t tr ngi khi DTC hc nng cao trnh nh: vn ti chnh (59%)vi hc ph cao (47%) v chi ph nhiu khon cho vic hc tp nh mua sch, ti liu (50%). Ngoi ra, vnthigianlochogianh b hnch(47%)vkhongcchtnh n trng xa (36%). Thi gian hc b nh hng v tnh chtcngvicva hc,valm, va tham gia trc (83%), mi trng lm vic bn rn (22%) v lmca-kp (14%).Nhngyu t thun ligipDTChc nngcaotrnh cnhnbaogm:tuyn sinh uvo dhn (67%), htrhcph(52%), cng vic nn c sp xp linh ng (54%) lnh o BV cn khen thng D hc t kt qu tt (50%).Cc yu t nh hng n t l DTC quytnhhcnngcaotrnh :tui t21-30dnhtiptcshcnng caotrnh (80%)vphnngD>50 tuilkhng nhhctiptc(83%). Tnhtrnghnnhn:phnlnDc thndnhtiptcshcnngcao trnh (85%) v ch mt s D lp gia nhc nhhctip(55%). Tngs con: a s D lp gia nh nhng cha ccon c dnhtiptchc(82%)vkhng c dnhhctiptckhi c 1Tnh trngcngvicv mcthunhp khng nh hng n t l quyt nh tip tc hc.7. NGHLnh o bnh vinHtrhcphcho D hcnngcao trnh , to mi trng lm vic thoi mi Dantmcngtcv hctp.Ch tui thun li xt duyt cho i hc l t 21 n 30 tui.H tr D trong thi gian hc khng tham gia lm vic v cng vic nn c spxpmtcchlinhngnhbtr trc,lm ca- kp thch hp. Cncphn thng khuyn khch khi D hc t kt qu tt.Nh trng:Qui chtuynsinhu vo nn d hn.Gia nh:Htrtchccvmtvt chtlntinhthnchoDhcnngcao trnh , nht l nhng D lp gia nh.Cththunhgntrnghchn i vitrnghpnhxa thunlicho vic D hc tp.8. TI LIU THAM KHO1. Qui chtuynsinhcnhniu dng tichc hvahcva lm nm2009. iHcYDcthnhphH Ch Minh.2. National Council on Nurse EducationandPractice(2001). Nursing:Astrategicasset for the health of the nation policy onthe nursing workforce shortage, 102 ndNghin cu khoa hc iu d- ng ton quc ln th IV55con (14%), 2 con (37%) v 3 con (100%). meeting. Silver Spring, MD: Author.3. TrnThChu(2007).PhnghnghotngcaHiD thnh ph HCM- 2007-2012. i hi i biu Hi D thnh ph HCM, tr. 1-3.4. NguynThXuyn (2009). Tiuchunkimtrabnhvinnm2009 .Quyt nh ban hnh bng kim tra bnh vinnm2009. S2866/Q-BYTbanhnh ngy 10/8/2009.5. National Council on NurseEducationandPractice(2001). Nursing:Astrategic asset for the health of thenationpolicyonthenursingworkforceshortage, 102 nd meeting. Silver Spring,MD: Author.6. NguynVnThanh(2009). otolinktiudngvinvivaitrthay i hin nay cc nc ng Nam . Website http://www.ykhoa.net.7. SpratleyE., JohnsonA.,SochalskiJ., FritzM.,et al(2000).Theregisterednurse population: Findings from thenational sample survey of registerednurses. Rockville, MD: U.S. Departmentof HealthandHumanServices, HealthResources and Service AdministrationBureauof HealthProfessions, Divisionof Nursing.8. Zuzelo R.P. (2001). Describing theRN-BSNlearner perspective: Concerns,priorities, and practice influences.JournalofProfessionalNursing,17 (1),pp. 55-64.9. CallinM. (1996). The RNtoBSN: Seeing familiar situations indifferent ways. The journal ofContinuing Education in Nursing, 27 (1),p. 28-33.10. Coleen D.,& Barbara P. (2004). RN-BSNprograms. Journal fornursesin staff development, 20 (4), pp. 157-161.11. Trainor M.J.(2000). Astudyofthe work environment as a factor inpersistence or non-persistence of RNstudents in a baccalaureate nursingprogram. Published doctoral dissertation,Pennsylvania State University.Nghin cu khoa hc iu d- ng ton quc ln th IV56NGHIN CU NNG LC THC HNH CA SINH VIN TT NGHIP LMVIC TI CC C S Y T V XUT GII PHP NNG CAO CHT LNG O TO TI TRNG CAO NG Y T NGH AN1. ThS. PhanQucHi; 2. CN. NguynThXunvCS.Trng Cao ng Y t Ngh An1. T VN Thc trng gio dc hin nay l mt t lkhngnhccsinhvin ttnghip khng kinthc,knngcnthit hnhngh.Khoch otohngnmcxydngdatrn nng lcnhtrng,vicnhginhucucax hi cha cquantm ngmc.Vncht lng o to khng p ng nhu cu x hi ang l mtthchthc. Mtkhc, xuthhinhpkhuvcvthgiiihingilaongphic kinthc,k nng thc hnh ngh nghip p ng c nhucusdngnhnlc.Thchinch trng ca Nh nc, cc trng cn phi chngnhginhucusdnglao ngvslngv chtlngnhmci tinmctiu, nidung,chng trnh oto,ngthibomtchunvcsvtcht,trangthitb,giotrnh mnhcnngcaochtlngoto,p ng nhu cu th trng lao ng. Theo kt qukhostnhgisauoto,cht lng nng lc thc hnh ngh nghip hc sinh, sinh vin tt nghip ra trng ch p ngc50%slngththutc phncngtheotuynvimcthnhem khi thc hnh ngh nghip cn hn ch knnggiaotip,t vnv gio dcsc kho[2].Vntral phichngc s cha ph hp gia chng trnh o to titrngv nhu cusdngcacccsyt?.Docnthitphitinhnhnh gi vnhucusdng,nhngthiu htkinthc,knngcangihcsau ttnghipiuchnhchng trnh otoph hpvinhucux hi.Vildo trn, chng ti tin hnh nh gi nng lc thc hnh ca sinh vin trng Cao ng Y t Ngh An tt nghip v ang lm vic ticccsyttrongtnhNghAn trncsxutgiiphpnngcao cht lng o to ca nh trng. Nghincu c nhng mc tiu c th sau:1. nhginnglcthchnhca hcsinh,sinh vin sau khi ttnghip trng Cao ng Y t Ngh An lm vic ti cc c s y t trn a bn tnh.2. Tm hiunnglcthcticanhtrng theo cc tiu chun v i ng gio vin, chngtrnh, giotrnh, csvt cht, trang thit b dy hc, cng tc qun l hc sinh, sinh vin3. ra gii php nhm nng cao chtNghin cu khoa hc iu d- ng ton quc ln th IV57tho 76,6%, rt thnh tho 4,5%, hu ht cc lng o to.Nghin cu khoa hc iu d- ng ton quc ln th IV582. I TNG VPHNGPHPNGHIN CU2.1. Thitknghin cu: M tct ngang.2.2. i tng nghin cu:-Hcsinh, sinhvinttnghipca trngCaongYtNghAnlm vic cc c s y t ti thi im iu tra. - Cn bchchtcaccc syt ni tipnhnhcsinh,sinhvin tt nghip ca nh trng v lm vic.- S liu sn c v i ng gio vin,csvtcht,trangthitbdyhc, chng trnh, gio trnh mn hc.2.3. Cmu v chnmu: p dng cngthcchnmuchonghincum t ct ngang:- Sinh vin ttnghiptrngCao ng Y t Ngh An ang lm vic ti cc c s y t.n = Z2(1-a/2) x p x (1-p)/d2 n = 400itngnghincucchn 10 bnh vin ca tnh Ngh An. Mi bnhvinchn40iudng,hsinhnguynl hc sinh, sinh vin ca trng Cao ng Y t Ngh An bng phng php chn mu ngu nhin n.- nh gi k nng thc hnh sinh vinttnghip:100iudng,hsinhc chnngunhin ntrongs40HS-SVcphngvntimic s(5D v 5HS).-Cnbchchtcccssdng cn b y t: 100 ngi, mi c s 10 ngi gm:1idinbanGimc,4Trng khoa v 5 D trng khoa.2.4. Phng php thu thp s liu- Kho st iu dng, h sinh bng b cu hi t in.- nh gi k nng bng bng kim.-Phngvncnbchchtbngb cu hi cu trc.- Ly s liu sn c t kt qu nh gikimnhchtlngotocctrng Cao ng,TrungcpYtkhuvcBc Min Trung nm 2008.2.5. X l s liuSdngphnmmthngk Epi-Info6.043. KT QU 3.1. Thc trng v nng lc thc hnh3.1.1. Kt qu nh gi kin thc, thc hnh ca iu dng vin, h sinhBiu 1: p dng c kin thc hc cho cng vicNhnxt: iudng,hsinhtnh gi mcttv kh l 90,3% v 92.7%;Cn b qun l nh gi mc tt, kh l 81,1%.Nghin cu khoa hc iu d- ng ton quc ln th IV59Biu 2: Lm c s lng cc quy trnh k thut hc trngNhn xt: s lng iu dng, h sinh lm c quy trnh k thut l 65,1% v 69,4%; Cn b qun l nh gi t l thp hn (37,2 %).Biu 3: Cc th thut c tin hnh ng quy trnhNhnxt: Ktqukhostchothy iudngctlbbccaohn Hsinh (24,4% so vi 14,8%); Cn b qun l nh gi b bc 26,1 %.Biu 4: Thc hin t vn, gio dc sc khoNhn xt: S iu dng, h sinh thc hin t vn, gio dc sc khe thng xuynchimtlthp(18.3% v 25.3 %). 45,7% scnbqunlchorngiudng,h sinh cha thc hin cng vic ny hoc c lm nhng c nhiu hn ch.3.1.2. Thc trng thc hin quy trnh k thut ca iu dng, h sinhBng 1: Thc hin 10 quy trnh ti 10 Bnh vinThnh tho Cha chun B bc Quy trnhK thutn=120Tn s % Tn s % Tn s %Tim bp tht 13 8 61,5 4 30,8 1 7,7Truyn dch 13 9 69,2 2 15,4 2 15,4Tim tnh mch 13 8 61,5 4 30,8 1 7,7o nhit 15 11 73,3 3 20,0 1 6,7Theo di mch 14 10 71,4 3 21,4 1 7,2Theo di nhp th 12 9 75,0 2 16,7 1 4,8o Huyt p 14 10 71,4 3 21,4 1 7,2Th xi 9 6 66,7 1 11,1 2 14,3Cho n = sonde 7 4 57,1 2 28,6 1 14,3Thay bng 10 7 70,0 1 10,0 2 20,0Nghin cu khoa hc iu d- ng ton quc ln th IV60Nhn xt: mc thnh tho (57,1-75,0 %), mt s cn b bc (4,8-20,0 %)3.1.3. Cc yu t nh hng n nng lc thc hnh ca iu dng vinBng 2: Mi lin quan gia tui, trnh , tuyn cng tc v nng lc thc hnhNng lcNhm tuiThnh tho (n) Cha chun (n)Tng< 30 tui 14 12 26T 30-39 tui 9 6 15Nhm tui Nng lc Tng 79Thnh tho (n) Cha chun (n);2= 4.7; p < 0.01Cao ng tr ln 28 3 31Trung cp 54 35 89Tng 82 38 120;2= 9.3; p < 0.01Min ni 17 20 37ng bng, ven bin 46 15 61Tp Vinh 19 3 22Tng 82 38 120;2= 13.4; p < 0.01Nhnxt: Cskhcbitcngha thng k v nng lc thc hnh gia cc nhm tui, trnh chuyn mn v tuyn cng tc.3.2 Thctrngvinggiovin,c svtcht v trang thitbdyhc, chng trnh, gio trnh mn hc Kt qu nh gi kim nh cht lng giodccakhuvcBcTrungBnm2008 cthhinbiu5.Theokt qunhgicaon kimnh,nhtrng t92.9%sovichunKim nh cht lng o toNghin cu khoa hc iu d- ng ton quc ln th IV61Biu 5: T l t ca cc tiu ch c kim nh3.3 Gii php nng cao cht lng o to3.3.1. Gii php v qun l v phi hp nh trng-bnh vinBng 3: Cc gii php phi hp c cc nh qun l cp (n = 105)Gii php kin xut T l %Phi hp qun l lm sng cht ch 100 95,2Tp hun pp dy hc lm sng cho Bs, D bnh vin 100 95,2D bo hng nm nhu cu ngun nhn lc ngnh y t 97 92,4T chc hi ngh cc c s bnh vin thc hnh u nm 85 81,0Xy dngchng trnh, gio trnh c sthamgiagp kin ca n v s dng nhn lc y t83 79,1iu tra nh k 5 nm nhu cu XH, m hnh bnh tt 81 77,1Nhnxt:Cc kinphnlncp nqunllmsngchtch,tphun nngcaonnglcchocnbbnhvin tham gia ging dy lm sng, d bo ngun nhn lc.Cgn80%skinchorng khi xy dng chng trnh phi c s tham gia ca c s thc hnh.3.3.2 Gii php v tng cng ngun lc Sliubng4chothy:Giiphp kthpVin-Trngc100%cccn bcphngvnxut.T91-96%scnbchichorngcntng cngo tochuyn khoa cho iu dng,tngcngnghin cukhoahc. Cc kin v tng cng u t hn na cho c s o to v c chnh sch thu ht inggiovin giicngc nhiu kin cp. Nghin cu khoa hc iu d- ng ton quc ln th IV62Bng 4: Cc gii php tng cng c cc nh qun l cp (n = 105):Gii php kin xut T l %Kt hp Trng-Vin 105 100,0o to nng cao, chuyn su 101 96,2Sng kin, ci tin k thut 96 91,4Khai thc hiu qu TTB, tit kim trong s dng vt t 96 91,4Thu ht cn b c trnh cao 89 84,8Tng u t cho gio dc 75 71,43.3.3 Mt s gii php khc (n = 105)a) Trang b kin thcBng 5: Nhu cu o to v kin thcNi dung kin thc kin xut T l %Phng chng nhim khun 102 97,1Hi sc cp cu 99 94,3S dng, bo qun, vn hnh trang thit b, my mc y t 97 92,4Ni dung kin thc kin xut T l %Chuyn khoa Nhi 86 81,9V sinh an ton thc phm 85 81,0Chn on iu dng 84 80,0Chuyn khoa h ngoi 82 78,1Chuyn khoa h ni 75 71,4V sinh phng dch 71 67,6Nhn xt: Hn 90% s kin cho rng hcsinh,sinhvin iudng,hsinh phictrangbkinthckimsot nhimkhun,chmsccpcu;sdng, boqun,vnhnh sdngtrangthitb. Nhiukinmongmunsinhvinphi c o to chuyn khoa.Nghin cu khoa hc iu d- ng ton quc ln th IV63b) Rn luyn k nngBng 6: Nhu cu o to v k nng (n = 105)K nng kin xut T l %K nng truyn thng-Gio dc sc kho 105 100,0K nng t vn 105 100,0K nng qun l iu dng 103 98,1Knngthchinccquytrnhkthutiudng chuyn khoa, hi sc cp cu99 94,3K nng tin hc, ngoi ng 89 84,8K nng nhn nh, chn on iu dng. 76 72,4K nng lp k hoch chm sc iu dng 76 72,4Nhn xt: Nhu cu knng c cp chyu l T vn, Truyn thng-Gio dc sc khe, Qun l iu dng v quy trnh k thut iu dng chuyn khoa.4. BN LUNQua iutra420HS-SVttnghip ra trngv 105 cn bqunl,chng ti thy rng:askinchorng hc sinh, sinh vin sau tt nghip p dng kinthchcvocngvic(90,3-92,7 %skin),ktqunycngtng tnghin cucaCaoThcSinh [2]. Vsquytrnhkthuthc trng v lm c sau khi ra trng t tlkhcao(65,1%choiudngv69,4%chohsinh),tuynhincnb qun l nh gi t l ny thp hn (37,2%). Nghin cu ca H Th Son ti Ph Thnm 2004 cho thyt lny chl50,9 % [3]; Ktqukhostcachng ti (biu 3) cho thy khi thc hin cc th thut t l b bc cn kh cao (14,8chohsinhv24,4%cho iudng),cnbqunlnhgi iudng,h sinh lm tt, b bc cn cao hn (26,1%).Theo nghin cucaNguynCnhPh tlny l 11%[1]. Trong nghin cu cachngtitliudng,hsinh thng xuyn thc hin t vn, gio dc sc kho chim t thp (18.3% cho iu dng v 25.3% cho h sinh). Nhiu cn b qun l cho rng iu dng, h sinh cha lm, hoclm khng ttnhimv ny (45,7% s kin). Kt qu ny thp hnktqutrongnghincucaCao ThcSinhnm2005[2]. iunychothycntngcngototrongnhtrngvt vngiodcsckhecho hcsinh, sinhvin ccemcnhn thc tt hn v tm quan trng ca cng vicny v c nnglcthchin t vn, gio dc sc khe.nh gi thchin10quytrnh k thutiudngdoiudng,h sinh thchintrongnghin cuca chng ti cho thy mc thnh tho chim t l 57.1-75.0%, b bc (4.8-20.0 %).Nghin cu khoa hc iu d- ng ton quc ln th IV64Ktqunycngtngtnhktqu nghincucaNguynCnhPh( bcv thnh tho: 68,3%; bbc: 11%) [1] v ca nh Xun ( bc v thnhtho73,8%,bbc20,9%)[4]. Nhvycththytnhtrngct xn ng tc khi thao tc ca iu dng, h sinh l kh ph bin v cn c tng cng qun l.Theo kt qu nh gi kim nh cht lng o to ca khu vc Bc Trung B nm2008, trngCaongYtNgh An c cc tiu chun quan trng theo yucu kim nh t im tng i cao so viimchun,tuynhincnmts tiu chun m nh trng cn phi n lc nhiu hn l: nh gi hc sinh trng v v c sthchnh, trang thitb, dngdyhcvhinnayimcacctiu ch ny cn thp.Nghin cu ca chng ti tm hiu kinvnhnggiiphpnhmnng cao cht lng o to ca nh trng trong cnhnggiiphpcnkhn trng trinkhail: Tphun phng php dyhclmsng chobcs,iudngcabnhvinnichcsinh,sinhvin nthctp; xydngchngtrnh, giotrnhcsthamgiagpkincanvs dngnhnlcyt.Ccgiiphpnhdbohng nm nhu cungunnhn lcngnh y tv nhkiutrakhostnhucuxhi, m hnh bnh tt l nhng xut cn xem xt p dng.Ngoi ra cc kin v tng cng cs vt cht, trang thitb, nngcao trnhchuyn mn cho ingcnbgio vinnhtrngcnglnhngxut hplnumunnngcaochtlng o to ca nh trng.5. KT LUN V NGHTktqunghincu,chngtirtra mtsktlunsau:(i)Phnlnhc sinh, sinh vin sau tt nghip p dng ttkinthcvothctcngvic,tuy nhincmtsththuttcchi cthchintrongthctcngvic; (ii)Tuycsnhgikhcnhaugia itnghcsinh,sinhvin tt nghip v cn b chcht ca cc c s y tni tipnhnhcsinh,sinhvin tt nghipvlvic,nhngnhnchungkin u thng nht vshnch v k nng tay nghcasinhvin sau tt nghip,trongtnh trngctxnng tc, chathchinnghimtcccquytrnhkthutcngcnkhphbin; (iii)Nghincutmhiuvtphp cnhiukinxut giiphphu chnhmnngcaochtlngoto ca nh trng.Da trn nhng kt qu v kt lun trn y, nhm nghin cu ngh1. i vi B Y t v B Gio dc vo to:Xydng cc chng trnhkhungmangtnhphhp,khthi,linthng, hinhpv p ngnhucus dng ngun nhn lc y t.Nghin cu khoa hc iu d- ng ton quc ln th IV652. ivi tnh:ut xy dngcsvtcht,muasmtrangthitb, phngtindyhcchoTrng;Tngbin chtipnhn,thuhtcnbc trnh cao v trng cng tc lu di.3. iviSNiv:xydngcchchnhsch,ccquynhcth thuht v iuchuyncnbctrnhcaovTrngcngnh c ch khuyn khch cn b i hc tp nng cao trnh .4. ivilnh onh trng:Ci tinchngtrnhgiodctheohng p ngyucungisdng,ngi hc; Xydngkhochotokhoahc, kh thi, hiu qu; Tng cng cng tc kimtra,gimstqutrnh o to; p dngccbinphpnngcaocht lng o to bt u nm hc 2009 -2010nh kthpVin-Trng; C chnh schthu ht cn b trnh cao; Tng cng csvtcht,trangthitbdyhc; nng cao cht lng qun l o to.v.v.6. TI LIU THAM KHO1. NguynCnhPhv cngs. Nghin cugiiphpkthpgia Trng Cao ng Y t vi cc bnh vin nng cao cht lng dy/hc lm sngvchmscngibnhtiNghAn, (2007), Kyuti nghincukhoa hciudng,Nh xutbnGiao thng Vn ti-H Ni.2. Cao Thc Sinh, Mtsgiiphp chyunngcaocht lngo totitrng Cao ng Y t Ngh An giai on 2004 -2010, Lunvn Thcskhoahc gio dc, i hc Vinh.3. HThSon(2004),Hintrng ngunnhnlciudng,hsinh,k thut vin ti cc c s y t nh nc vt nhn tnhPhThnm 2004, kyunghincukhoahciudngtonquc ln th II.4. nhXunvcngs,nhgi thctrngngunnhnlcgiovincacctrng,cckhoaotoiu dng v cng tc o to iu dng nc ta. Trnh by ti Hi ngh pht trin ngunnhnlciudngVitNam (2005), Nam nh.Nghin cu khoa hc iu d- ng ton quc ln th IV66PHN TCH TC NG CA VIC THC HIN NGH NH S 43/2006/N-CP N NGUN NHN LC IU DNG TI 7 KHOA LM SNG CA BNH VIN BCH MAI NM 2010ThS. Bi Vn Thng - Phng D Bnh vin Bch MaiTM TTMtnghincumtctngangkt hpnhlngv nhtnh ctin hnhti7khoalmsngcabnhvin BchMaitthng1nthng6nm 2010nhmmctiu:(1)Phntchthc trngngunnhnlciudngti7 khoalmsngcabnhvinBchMainm2010; (2) Tmhiutcngca victhchinNghnh43nngun nhn lc iu dng ti 7 khoa lm sngcabnhvinBchMai; (3) xut nhnggiiphpnngcaonnglc caiudngcvslng,cht lng v kh nng hon thnh cng vic. Sliunhlngcthuthpthng qua 30 phiu quan st trc tip cng vic hngngycaiudngv145phiu khostiudngvin; sliunh tnh cthuthpbngphng phptholunnhmivi07iudng trngkhoav07 iudngvin. Kt qunghin cuchothy:Vtrnh chuyn mn: 84,1% iudngti7 khoa vn c trnh trung cp; 15,9% c trnh caongv ihc;Hinnay angxyratnhtrngqutichoiu dngti7khoadothiunhnlc,s qutinylcaohnsovitrckhi khon; Cng tc o to cho iu dng ti mt s khoa t c quan tm hn sovitrckhikhon;Khithchinkhon qun th thc trch nhim ca iu dng c nng ln, cn thn hn trong cng vic trnhsai st, iudngtnghhn;Lnh okhoaquantmhn ncngtc chuyn mn caiudng;Sphihp, gip nhau gia cc NVYT trong khoa tt hn v straoithngtinvngibnh cngnhiuhn; Thu nhpcaiudng cao hn so vi trc khi khon, i sng n nh hn gip cho iu dng yn tm cngtc. Nghincucng aramts khuynngh:cnnhnthm nhn lciu dngvkhoa,utintuyndngiu dng c trnh cao ng v i hc; Ban lnh occkhoaphithc squantm, ng h v bo v quyn li cho iu dng; Trinkhaimhnh:bcschothuctrc tip vo my vi tnh; T chco tonng caotrnh chuynmncho iudng bngnhiuhnh thc;Ccphng chc nng, khihucncngphivo cuc triudngvlm victheongchc trch nhim v ca mnh; Xy dng v thc hintheophciutrchunhoc protocol hng dn iu tr.1. T VN S ra i ca h thng dch v hnhngh y t nhn gp phn to ra mtNghin cu khoa hc iu d- ng ton quc ln th IV67bctinquan trngtrongvichuyng cc ngun ti chnh, nhn lc v cung cp cc dch v khm cha bnh cho nhn dn. Ko theo l vic thu ht ngun nhn lc t c sy t cng sang c s y t t nhnthngqua victrlngcaocngnhiukinlm victt,schnh lchnyngy cng ln.gipccn vs nghipcnglpchngtrongcngtc qun l, Chnh ph ban hnh Ngh nh s10/2002/N-CP vchti chnh pdngchonvsnghipcthu,tuy nhin khi a vo thc hin thy cn nhiu btcpnncnphibsung,iuchnh v Nghnhs43/2006/N-CP ngy25/04/2006 quy nh quyn t ch, t chu trch nhimvthchinnhimv,t chc b my, bin ch v ti chnh i vi nvsnghipcnglp cban hnh[9].Ngy28/12/2006BtrngBYt k Quytnhs5550/Q-BYTv vicgiaoquyntch,tchutrch nhimvti chnh ivin vs nghipcnglpvcthlbnhvin Bch Mai. Theo quyt nh ny, bnh vin BchMaicphnloinvtbom mt phn chi ph hot ng[7].Ngy 22/5/2007, Gim cbnhvin BchMaikQuytnhs252/Q-BMvvicbanhnhquychquynh quyn t ch, t chu trch nhim v thc hinnhimv,tchcbmy,bin ch v ti chnhchocc nvtrcthuc bnhvinBchMai,tutingm 20 n v t thng 6 nm 2007, trong c 12 nvlmsng, quyntchc giao cho lnh o cc n v di s qun l ca Ban Gim c bnh vin[6]. T khi trinkhaithchinNghnhny, s lngbnhnhnnitrlintctng mnhquaccnm,nnaytngln23.876 bnhnhnso vi thi imbt u thc hin khon qun. Ch tiu ging bnh khochchobnhvint1.080ging nm 2007 n1.500gingnm2008vcuinm2009l 1.800 ging.Tuynhinvicbsungnhnlclikhngtheokp vitngtrngdnntnhtrng thiu nhn lc y t ti bnh vin[1], [3], [4]. Vy vic trin khai thc hin Ngh nh 43 c tc ng nh th no n ngun nhn lc iu dng ti cc khoa khon qun? TibnhvinBchMaichacnghincu khoa hc chnh thc no v vn ny.Chnh v vy, vi kh nng v ngun lc vphm vi ca ti ny, chng ti tin hnhnghincuPhntchtc ngcavic thc hin Ngh nh s 43/2006/N-CP n ngun nhn lc iu dng ti 7 khoa lm sng cabnhvinBchMai,nm2010 nhm 3 mc tiu:1. Mtthctrngngunnhnlc iudngti7khoalmsng cabnh vin Bch Mai nm 2010.2. Phntchtc ngcavicthc hinNghnh43nngunnhnlc iudngti7khoalmsng cabnh vin Bch Mai.3. xutnhnggiiphpnng caongunnhnlc iudngcvs lng, cht lngv kh nng hon thnhcng vic.Nghin cu khoa hc iu d- ng ton quc ln th IV682. PHNG PHP NGHIN CU2.1. Thit k nghin cuy l nghin cu m t ct ngang, kt hp nghin cu nh lng v nh tnh.2.2. i tng nghin cuTtciudngvin c thm nincng tc ti 7 khoa t trc nm 2007.2.3 Thi gian nghin cuThigiannghin cu:ctinhnht thng 12/2009 n ht thng 06/2010.2.4. a im nghin cuTi7khoalmsngcabnhvin BchMai:khoaThnkinh,khoaHuyt hctruynmu,khoaHisctchcc, khoa Thntitniu,khoaC xngkhp,khoaNitit&ithong, khoa H hp.2.5. Cmuvphngphpthuthp s liu-Sliunhtnh:pdngphngphp tholunnhm ring ivi 7 iu dngtrngv 7 iudngvin ca7 khoa lm sng trong bnh vin. - S liu nh lng: -150phiukhostkincaiu dng cthuthptheophngphppht vn:trongbuigiaobancaccnv,iutravinthngbomcchca nghin cuv cch trliphiukhost theo quy nh trong phiu hng dn, pht phiu iu dng t in v kim tra s y ca thng tin khi thu phiu.iu dng c th in phiu v np ngay hocinvo thigianthchhpv np livosnghmsaucho iutravin.iu tra vin sau khi pht vn v thu phiu kimtrav lm schsliutrckhi np phiu cho gim st vin.- 30 phiu quan st trc tip cng vic caiudngcthchintheo phngphpm n. Quanst vinsncckhoav ghi littcnhngcng viccangiiudngtrong1ngylm vic (bt u t lc 7 gi 30 pht cho nkhihtca), miphiuchdng quanst cho1 iudngtrong1nhmchm sc.2.6. Phn tch s liu-Sliunhlngsaukhithuthp c nhp bng phn mm Epi Data 3.1 v cxlbngphnmmSPSS15.0 cho cc thng tin m t v phn tch thngk. Mchi lng so vitrckhi khon cchiathnh3nhm: nhmthilnghn, shilngkhngthay i v nhm hi lng hn tnh t l hi lngvi vic thchin Ngh nh 43 theo tng tiu mc. -Thngtintccphiuquanstc m ha v phn tch theo s liu nh lng,clin hvichcnngnhimv ca ngi iu dng.- Cc s liu nh tnh c x l theo phng php thng thng.Nghin cu khoa hc iu d- ng ton quc ln th IV693. KT QU V BN LUN3.1. Thc trng ngun nhn lc iu dng ti 7 khoa lm sngBng 1: Thng tin v tui v thm nin ca i tng nghin cuThng tin chung N T l (%)Tui (mean = 36,7; min = 25; max = 59) 145 100 29 tui 24 16,630-39 tui 77 53,140-49 tui 25 17,2 50 tui 19 13,1Thm nin cng tc (mean = 13,9) 145 100s 9 nm 58 40,010-19 nm 50 34,520-29 nm 25 17,2 30 nm 12 8,3iu dng trong nghin cu ny c tuitrungbnh l 36,7; thpnhtl 25 tui v cao nht l 59 tui; cao nht l nhm tui 30-39chim53,1%;nhmtui50ch chim13,1%;iudngcthmnincng tc 9 nm chimas(40%).iu ny cho thy nhn lc iu dng ti 7 khoa lm sng a sl tr,bn cnhcngc 13,1% iudngctui50,yli ngspsa vngh hu theo quy nh, do vynhngnhqunlcngcnck hoch b sung nhn lc trong thi gian ti.Bng 2: Thng tin v gii, trnh lao ng ca i tng nghin cuThng tin chung N T l (%)Gii tnh: 145 100- Nam 9 6,2- N 136 93,8Trnh chuyn mn 145 100- Trung cp 122 84,1- Cao ng 5 3,5- i hc 18 12,4Nghin cu khoa hc iu d- ng ton quc ln th IV70Giitnhcaiudngtrongnghincuny asln(chim93,8%);nam giichchim6,2%. TlnythphntrongnghincutibnhvinBchMaicaXunQuang nm 2005(12,9%)[12] v nghin cu ca Nguyn Th Minh Tm trn abnH Ninm2004 (14,3%)[13]. Phnlniudngctrnhtrungcp(84,1%); trnh caong hocihcchchim15,9%. iunycngchngttnh trngthiuhtiu dngctrnh cao nghocihc. Tlny theo quy nhivibnhvin Bch Mai phi t 30%.Bng 3: T l v nhn lc ti 7 khoa tnh trung bnh nm 2009T l BS/DStt Tn n vTheo quy nh Thc t1 H hp 1/3-3,5 1/2,32 Ni tit & i tho ng 1/3-3,5 1/1,73 Thn tit niu 1/3-3,5 1/2,14 Hi sc tch cc 1/4,8 1/3,85 C xng khp 1/3-3,5 1/1,76 Huyt hc truyn mu 1/3-3,5 1/2,67 Thn kinh 1/3-3,5 1/3,0Bng 3 cho thy s lng iu dng ti 7 khoa lm sng trong bnh vin hin nay so vi quy nh u thiu c bit lti khoa C xng khp v khoa Ni tit (mittl1bcs/1,7iudng). Tlny thphn tltrungbnhchungcatonbnhvintheothngkcaphng TCCB (1 bc s/2,3iu dng)[5].Theonghincucatcgi Khng Anh Tun v cng s ti 5 bnh vinTrungngtrong cBVBch Mai chothytlcnbyttrn1gingbnhdaongt0,57-1,09 lqu thp so vi quy nh[14].Bng 4: S lng bnh nhn trung bnh m 1 iu dng phi chm scTrong gi hnh chnhTrong ca trcS lng bnh nhn phi chm scN % N %< 10 bnh nhn 60 41,4 27 18,610 s 20 bnh nhn 36 24,8 20 13,820 s 30 bnh nhn20 13,8 0 0 30 bnh nhn29 20,0 98 67,6Tng cng 145 100 145 100Nghin cu khoa hc iu d- ng ton quc ln th IV71Bng4chothyslngbnhnhn m 1 iu dng phi chm sc hin nay lkh nhiu,cbittrongcccatrc.Tnhtrung bnh trong gihnh chnh 1 iu dng phi chm sc cho 19 bnh nhn cntrong m trchocvo ngy ngh,1iu dngphichmsccho53bnhnhn.ycngl plciviiudng Hin nay 1 iu dng phi chm sc cho qunhiubnhnhn,khngthpng c yu cu v chm sc ngi bnh tondin ( kin ca DT).1.515.516.49.856.9Giao ban TH thuc CS khc Ghi chp Vic ringBiu 1: T l v thi gian tin hnh cc cng vic ca iu dngKtqutnghptphiuquanst trctipcngviccaiudngti biu1chothytrongtngthigian lmvichngngytibnhvin,thi giandnhchovicthchinccylnh v thuc cho bnh nhn chim n 56,9% (gmphtthuc,tim, truyn);nhng chm sc khc nh hng dn, thay bng, lyxtnghimchchim15,5%thi gian. Giithchvvnnyckin chorng: Slngbnhnhnm1iudngphichmscl qu ln nhtltrongcatrc,slngylnh phithchincho1bnhnhnhinnay cngnhiucbitlnhiuloithuc phidng ngtimhoctruyntnh mchnnchimrtnhiuthigianca iu dng ( kin ca DV).3.2. Tc ng ca vic thc hin Ngh nh 43 n ngun nhn lc iu dng3.2.1. Tc ng n cng vic ca ngi iu dngBng 5: T l iu dng/ging bnh ti cc n v trc v sau khonT l D/GBStt Tn n vNm 2007 Nm 20091 H hp 1/2,8 1/3,22 Ni tit & i tho ng 1/3,1 1/3,53 Thn tit niu 1/4,2 1/4,04 Hi sc tch cc 1/0,9 1/0,9Nghin cu khoa hc iu d- ng ton quc ln th IV72T l D/GBStt Tn n vNm 2007 Nm 20095 C xng khp 1/3,1 1/3,76 Huyt hc truyn mu 1/2,1 1/6,57 Thn kinh 1/1,5 1/3,48 Trung bnh 1/2,5 1/3,6Bng 5 cho thy tnh trung bnh s ging bnh k hoch do 1 iu dng ph trch ti cc khoa tng ln 1,1 ging so vi trc khi khon, c bit l ti khoa Huyt hc truyn mu (t 2,1 ln 6,5) v khoa Thn kinh (t 1,5 ln 3,4).Bng 6: kin ca iu dng v nhng cng vic hin nayC KhngNi dungN % N %iu dng phi lm nhng cng vic khc so vi trc khi khon86 59,3 59 40,7Khoa trin khai thm cc k thut mi trong chnon,iutrv chmsc saukhikhon qun 119 82,1 26 17,9Thngk cho thy40,7%iu dngchornghangphilmthmnhngvicmtrckhikhonh khng philm. iudngangphi lm nhngvicm ng ra ngi khcphilmnh:thcchithanhton chobnhnhn,qunlthbohimy t,nhpylnhcabcsvomytnh,i lnhthuc,... ( kincaDT). 82,1% iudngtrlil sau khi thc hinkhonqun,khoactrinkhai thmcckthutmitrongchnon v iutr,trongchc42,9%iu dng khng tham gia trong cc k thut ny; 50,4%kimnhimcn 6,7%lchuyn trch.Nghin cu khoa hc iu d- ng ton quc ln th IV73011.788.357.226.915.9020406080100%Khi lng cng vic Sai st trong cng vict hn Vn nh vy Nhiu hnBiu 2: So snh ca D v khi lng v sai st trong cng vic,gia trc v sau khi thc hin khon qunHuhtiudngvin v iu dngtrngthamgiatholunnhm u cho rng S qu ti ca iu dng hinnaythhin:slngbnhnhn phi chm sc hng ngy, s lng y lnh phithchincho1bnhnhn,cqu nhiuthucphithchinbngng timhoctruyntnhmch,nhngvic ngoi cng tc chuyn mn nh: thc chi thanh ton, qunlthBHYT,ilnh thuc... ( kin ca DT). Kt qu thng k cho thymcd khilngcngvic nhiunhng sai st trong cng vict,l do c a ra l Khi trong khoa c saist g th u tin mi ngi thng ngh ldo iudng,khngcainglnbov,cngvilvictrtin thngivingixyrasaist nn mi ngi u cn thn hn ( kin ca DV).3.2.2. Tc ng n s lng v cht lng nhn lc iu dng54,5% iu dng khi c hi u tr li l s iu dng hin nay ti cc khoa sovi trc khi thc hin khon l thiu hn, l do c thng k theo bng sau:Bng 7: L do thiu iu dng ti cc khoaL do N T l %iu dng khng mun v khoa 10 12,7Bnh vin khng cung cp 12 15,1Khoa khng mun nhn thm 30 38,0Qu ti bnh nhn v cng vic 20 25,3Thiu iu dng i hc 1 1,3D khng mun v v BV khng cung cp 1 1,3BV khng cung cp v khoa khng nhn 3 3,8Khng bit l do 2 2,5Tng cng 79 100Nghin cu khoa hc iu d- ng ton quc ln th IV74Phnlnkinkhostcaiu dng vin cho thy l do thiu iu dng ticckhoal do khoa khng mun nhn thmngi.TcgimVitCngvcng s tin hnh nh gi tc ng banu ca vic thc hin t ch ti chnh i vicungngvchi trdchvyt,kt qu cho thy mt xu hng ph bin v gia tng v s hp ng ngoi bin ch ti cc bnh vin sau khi thc hin t ch[11]. Tuynhin, mt s kin ca iu dng trng chatnthnhviquan imnyKhoavn u tin nhn thm nhn lc v c ngith micthtrinkhaiccng vic,giiquyttnhtrngthiunhn lc,cckhoaphikhpngthmiu dng lm vic ti khoa.64,1% iudngkhichiu cho rngslnthamdcckhao to vchuynmnhinnaysovitrckhi khon l khng thay ihocthn, l doca ra chyul thiunhnlcnnkhoakhngspxpc.Ktqunh tnh cng ph hpvinhnnhtrnTrcycckhoathngtphunv chuyn mn theo chuyn khoa cho iu dng 1 hc 2 tun/ln, nay th 1 thng/ln hoc c khoa th khng thc hin c mt cch thngxuyn. Mtsiudng Trung cpcnguynvngihcln Caong hoc i hc nhng cng khng thc hin c do khoa khng c ngi thay th nn cha sp xp c ( kin ca DT). Khi thamgia cc lptphun,iu dngphicamktkhngnhhngn cng vic ti khoa, nu i hc th phi lmb, v vynn Dcngkhngmuni hoc nu i th cng n mun v sm (kin ca DV).3.2.3. Tc ng n quan im ca lnh o khoa v phi hp ca ng nghip i vi iu dng0.71188.38.332.459.33.411.784.9050100%Kim tra o to To p lct hn Vn nh vy Nhiu hnBiu 3: S quan tm, tc ng ca lnh o khoai vi cng tc iu dngTheo kt qukhost88,3%iu dngchobitsaukhithchinkhon qun,lnh okhoakimtracngtc chuyn mn caiudngnhiuhntrc v p lc to ra cho iu dng cng nhiuhntrc. iunygipchohiu qu cng vic trong khoa tt hn Khi thc hinkhonqun,thctrchnhimca Nghin cu khoa hc iu d- ng ton quc ln th IV75cnbnhnvincaohn, thchnhtit kimhn, cnglaongv hiuqu cngvictthn, nhnvinyttngh hnkckhivncnnhiungyphp,mingichncngvichnv s gpphisaist,isngcanhnvin ytcaohn v minh bchhn so vitrc khi khon ( kin ca DT).4.122.873.13.427.6695.535.259.3020406080%PH hon thnhCVTrao i thng tin Gip t hn Vn nh vy Nhiu hnBiu 4: S phi hp ca ng nghip vi D gia trc v sau khi khonMttrongnhngtcngtchcc khccavicthchinNghnh43ltng cng s phi hp v trao i thng tin giaccnhnvin y tvinhau. 73,1% iudngchorngngnghip phihptthn; 69% trao ithngtin nhiuhn;59,3%nhncsgip nhiu hn.3.2.4. Tc ng n thu nhp ca iu dngBng 8: Nhn xt v thu nhp ca bn thn hin nay so vi trc khi khonNhn xt N T l (%)Thp hn 16 11,0Khng thay i 19 13,1Cao hn 110 75,9Tng cng 145 100Ktqu cho thymcthunhp trung bnh hng thng ca iu dng ti 7 khoa lmsng trong nghin cuny l4.347.587 ng/thng;trong75,9%i tngnghincukhichiucho rngthunhphinnaycabnthncao hnsovitrckhikhonqun;ktqu nhtnhcngtrngkhpvikinnyTkhithchinkhon,isngca CBVCticckhoanichungv iu dngniring cnngln, thunhphngthngtnggngpisovi trckhikhon,ckhoacncaohn( kin DV).Nghin cu khoa hc iu d- ng ton quc ln th IV763.2.5. Mc hi lng ca iu dngBng 9: Mc hi lng ca iu dng gia trc v sau khi khont HL hn Vn nh vy HL hn Hi lngca iu dngN=145 % N=145 % N=145 %Tng cng (%)HL vi cng vic 47 32,4 74 51,0 24 16,6 100HL vi lnh o 8 5,5 59 40,7 78 53,8 100HL vi ng nghip 7 4,8 53 36,6 85 58,6 100HL vi thu nhp 26 17,9 86 59,3 33 22,8 100Thngk vshi lng caiu dng gia trc v sau khi khon ti bng 9 cho thy cng vic hin nay lm cho iu dng t hi lng nht (32,4%); tip sau l thu nhp 17,9%; t hi lng hn vi lnhov ngnghipchimtlthp.iu lm cho iu dng cm thy hi lng hnso vi trc khi khon chnh l s phi hp cangnghipvsquantmcalnho khoa.3.3. Gii php nng cao hiu qu ngun nhn lc iu dng ti 7 khoaBng 10: Kt qu nh tnh v gii php nng cao hiu qu ngun nhn lc DGii php kin ca DT kin ca DVThng nht mt phn mm trong bnh vin 7/7 7/7Tr iu dng v ng chc nng nhim v ca mnh 7/7 7/7Tuyn dng thm nhn lc, u tin D c trnh cao ng hoc i hc6/7 5/7o to nng cao trnh cho D 7/7 6/7Bc s cho thuc vo my vi tnh 7/7 7/7Xy dng cc phc iu tr chun 4/7 5/7Tng cng kim tra vic ra y lnh 7/7 7/7Hn ch dng thuc theo ng tim 7/7 7/74. KT LUN4.1. Thc trng ngun nhn lc iu dng-Vslng:tnhtheoThngts 08/2007/TTLT/BYT-BNVngy5thng6nm 2007 vi t l BS/D quy nh l 1/3-1/3,5 th hin nay 7 khoa lm sng ny cnthiu t 46 n 90 iu dng.Nghin cu khoa hc iu d- ng ton quc ln th IV77- Vtrnh chuyn mn: 84,1% iu dng ti 7 khoa vn c trnh trung cp; theo quy nh ca B Y t th i vi bnh vinhngcbitnh BV BchMaiphi t t l 30% iu dng c trnh cao ng v i hc.-Vcngvic:tnhtrngquticho iu dng do: s lng bnh nhn ng, ylnh thuc nhiu, iu dng phi thc chi thanh ton, qunlthBHYTcaBN,gylnhcabcsvomytnh... dnn thigianthchinccchmsckhc ivibnhnhncn t v cng vicghi chp iu dng thc hin cha tt.4.2. Tc ng ca vic thc hin Ngh nh 43 n ngun nhn lc iu dng4.2.1. Tc ng tt-Khi thchinkhonqunth thc trch nhim ca iu dng c nng ln,cnthnhntrongcngvictrnhsai st, iu dng t ngh hn.- Lnh okhoaquantmhn n cng tc chuyn mn ca iu dng.-Sphihp,gipnhaugiacc NVYTtrongkhoatthnvstraoi thng tin v ngi bnh cng nhiu hn.- Thu nhpcaiudngcaohn sovitrckhikhon,isngnnhhngip cho iu dng yn tm cng tc.4.2.1. Tc ng cha tt- Squticaiudngnhiuhnso vi trc khi khon:- Vico tochoiudngtimt s khoa t c quan tm hn: do cng vic nhiu; thiunhnlcthaythnnkhngsp xp c cho iu dng i hc.4.3. Cc gii php nng cao hiu qu ngun nhn lc iu dng-Cnthngnhtmtphnmmqun l thng tin ca bnh nhn trong ton BV.- Cc n v cn m nhn trch nhim camnh triudngvlmvic theo ngchcnngnhimvchnhcamnh l chm sc bnh nhn.- Tng cngthmnhn lciu dng cho cc khoa.- Xy dngccphciutrchun hocprotocolhngdnticckhoa thng nht v y lnh.5. NGH5.1. i vi cc khoa lm sng-Cnnhnthm nhnlciudng vkhoa,cgngtchtiuvslng iu dng theo quy nh ti Thng t lintchs08/2007/TTLT/BYT-BNVcaB Y t v B Ni v.-Banlnh occkhoaphithcs quan tm, nghv bovquynlicho iudng.Tchcototich nng cao chuyn mn cho iu dng.- Trinkhaimhnh: bc schothuc trc tip vo my vi tnh trnh nhm ln v gim gnh nng cho D.5.2. i vi bnh vin-Cnxcnhnhucubsungnhn lc iu dng ca cc n v v tin hnhtuyndngpngcngtcchuynmn cng nh quy nhcaB.Trong u tin tuyndngiudngctrnh cao ngv ihctrnhtnhtrngthiu nhn lc do iu dng i hc.Nghin cu khoa hc iu d- ng ton quc ln th IV78- Tchcotonngcaotrnh chuynmncho iudngbngnhiu hnh thc: chnh quy, ti chc, cm tay ch vic, t chc cc bui sinh hot ngoi kha hoctheochuyn iudngcc khoa trao i kinh nghim ln nhau.-Ccphngchcnng,khihucn cngphivocuctriudngv lmvictheongchctrchnhimv ca mnh, iu dng c nhiu thi gian dnh cho vic chm sc bnh nhn hn.-Bnhvincnchocckhoaxy dngv thchintheophciutr chunhocprotocolhngdniutr thun li hn cho cng vic ca iu dng.6. TI LIU THAM KHO1. Bnh vin Bch Mai (2007), Bo cothng k bnh vin, H Ni.2. BnhvinBchMai(2007),K hochtrinkhai thchinNghnh43 CP, H Ni.3. Bnh vin Bch Mai (2008), Bo cothng k bnh vin, H Ni.4. Bnh vin Bch Mai (2009), Bo cothng k bnh vin, H Ni.5. Bnh vin Bch Mai (2009), Bo co thngk ngunnhnlccabnhvin Bch Mai, H Ni.6. Bnh vin Bch Mai (2007), V vic ban hnh Quy chquynhquyntch, t chu trch nhim v thc hin nhim v, tchcbmy,bin chv ti chnh chocc n v trc thuc Bnh vin Bch Mai, Quytnhs252/Q-BM, ngy 21 thng5 nm 2007.7. B Y t (2006), V vic giao quyn t ch,tchutrchnhimvti chnh ivi nvsnghipcnglp,Quytnhs 5550/Q-BYT, ngy 28 thng 12 nm 2006.8. BYt-BNiv(2007),Hng dn nh mc bin ch s nghip trong cc c sytnh nc, Thng t lin tchs 08/2007/TTLT/BYT-BNV, ngy05thng06 nm 2007.9. Chnhph(2006),Quynhquyn tch,tchutrchnhimvthchin nhimv,tchcbmy,bin chv tichnh ivisnghipcnglp,Ngh nhs43/2006/N-CP, ngy25thng4nm 2006.11.mVitCng &cs (2008),nhgitc ngbanucavicthc hintchti chnh ivicungngvchi trdchvyt,Vinchinlcvchnh sch Y t, H Ni.12. Xun Quang & cs (2005), nh gi ngun nhn lc iu dng, h sinh, k thutvin tibnhvinBchMainm 2005, Bnh vin Bch Mai, H Ni.13. NguynThMinhTm&cs (2005), "Khost nhnlc iu dng, h sinh, kthutvinticccsytkhu vcnhncvtnhntrn abnHNi",Kyuti nghincukhoahc iudngton quclnthII,Nh xut bn GTVT, H Ni, tr. 7-16.14. KhngAnhTunvcs (2007),nh gi tnh hnh qu ti ca mt s bnh vin ti H Ni v Thnh ph H Ch Minh v xut gii php khc phc, Vin Chin lc v Chnh sch Y t, H Ni.Nghin cu khoa hc iu d- ng ton quc ln th IV79KHO ST NHU CU S DNG DCH V CHM SC Y T TI NH CA NHN DN TRN A BN THNH PH HI DNG NM 2009CND. Nguyn Th LyS Y t Hi Dng1. T VN Sauhn20nm tncimi,kinhtnctalintctngtrngtrn7%nm, isngcanhndnc nngcaorrt,cbitkhuvcthnhth, nhu cu sng cng ngy cng i hi cao hn ph hp vi s pht trin chung, mttrongnhngnhuculchmlosc kho ca chnh mnh cng nh ngi thn trong gia nh.Trongkhi , bcs,iudnggia nhlmttrongnhnghnhthcchm scsckhonhndnticngngdn c, lmgimtichohthngccbnh vin v ang cnhiunctrn th gii hin nay p dng.Hinti,thnhphHNivthnhphHChMinhpht trincchnhthc dch v chm sc y t ti nh.Tuy nhin titnhHiDng cha cnghin cucthno minhchngcho vnny. V vy,chngtitinhnhnghin cu ny vi cc mc tiu:1. Khostnhucusdngdchv chm sc y t ti nh ca nhn dn trn a bn thnh ph Hi Dng.2. xutgiiphppngnhucu chm scy ttigianh, nhmgimti cho cc c s y t trn a bn.2. I TNG V PHNG PHPNGHIN CU2.1. i tng nghin cuH gia nh trn a bn Thnh ph HiDng thuc n v hnh chnh c, chn 6 phng theo phng php ngu nhin.2.2. Phng php nghin cu- Nghincumtctngangthng qua hnh thc phng vn trc tip- Cng c nghin cu: B cu hi thit k sn c 8 cu hi.2.3. Thi gian nghin cu- T thng 4/2009-thng 12/2009.2.4. Mu nghin cup dng cng thc:p.(1-p)n = Z2( 1 -/2)d2Trong :n: C mu nghin cup: T l ngi tr li c nhu cu s dngdch v y t ti nh (gi thit p = 50%)q: T l ngi tr li khng c nhu cu s dng dch v y t ti nh q = 1-pd: Sai s mong mun (5%)Z = 1,96 (khong tin cy 95%)Qua cng thc,tnhccmu nghin cu: n = 384 lm trn 400Nghin cu khoa hc iu d- ng ton quc ln th IV80C mu n = 400 d phng cho mt s trng hp t chibcuchocphiuphngvnhng chng ti c tnh thm 50% c mu. Nhvy tng s phiu cn iu tra l 400 + 200= 600 phiu.2.5. Cc bc chn mu- Lpdanhschccphngcca Thnh phHiDng nh s t1n13 (PhmNgLo, NguynTri, Thanh Bnh,QuangTrung, TrnHng o,BnhHn,NgcChu,HiTn,TrnPh,LThanhNgh, Cm Thng, Vit Ho, T Minh).- Bcthmngunhinchnc6 phng:QuangTrung,NgcChu,Trn Hng o,PhmNgLo, TrnPh,LThanh Ngh.- Lp danh sch cc h gia nh thuc 6 phng theo s trong s h khu.- Chn ngu nhin 600 h (mi phng 100) theo khong cch mu.- Mi gia nh tin hnh phng vn mt ngitronghgianh(davoccyu t: tui, gii, ngh nghip, vai tr trong gianh, thu nhp c nhn).2.7. a im nghin cuTi600hgianh 6phngthuc thnh ph Hi Dng chn.2.8. Phn tch, x l s liu- Sliuclm schv xlbng phn mm SPSS 12.03. KT QU NGHIN CUBng 1: Phn b gii ca i tng nghin cuGii S lng T l %Nam 325 54,2 %N 275 45,8 %Tng 600 100,0 %Nhnxt:Tngsitngthamgianghincul600 t100%trongnam chim 54,2%, n chim 45,8%, t l gn tng ng nhau.Bng 2: Ngh nghip ca cc i tng tham gia nghin cuNgh nghip S lng T l %Cn b, cng chc 89 14,8 %Cng nhn 129 21,5 %Bun bn 118 19,7 %Ch doanh nghip 20 3,3 %Ni tr 57 9,5 %Nghin cu khoa hc iu d- ng ton quc ln th IV81Gi/ Hu 63 10,5 %Ngh khc 124 20,7 %Tng600 100,0 %Nhn xt: Nhn vo biu cho thy i tng tham gia nghin cu y cc thnhphnx hi, chyul Cng nhn (chim21,5%)v Bun bn (chim19,7%)ngoi racn cc ngnh ngh khc, cn b cng chc cng chim t l kh cao (14,8%).Bng 3: Gia nh c ngi gi, ngi mc cc bnh mn tnhKt qu S lng T l %C 267 44,5%Khng 333 55,5%Tng 600 100,0%Nhnxt:Trongtngs600hgianh cphngvncti267gianhcngi gi mc cc bnh mn tnh chim t l kh cao 44,5%.Bng 4: Gia nh c tr nhKt qu S lng T l %C 334 55,7%Khng 266 44,3%Tng 600 100,0 %Nhn xt: Tng s c 334 gia nh c chu nh tham gia nghin cu chim t l cao 55,7%.Bng 5: Gia nh s dng dch v y t ti nhKt qu S lng T l %C 242 40,3%Cha 358 59,6%Tng 600 100,0%Nhn xt: C 242/600 i tng tham gia nghin cu tr li tng s dng dch vytgianh dinhiuhnh thc:Tim thuc,truyndch,khmt vntinhchim 40,3%.Nghin cu khoa hc iu d- ng ton quc ln th IV82Bng 6: Thun li v bt tin khi s dng dch v y t gia nhKt lun C s dng T l%Thun li 242 100%Bt tin 0 0%Tng 242 100%Nhn xt: Trong s 242 i tng tr li s dng cc dch v y t ti nh c hi v nhng thun li v bt tin khi s dng cc loi hnh dch v ny th 100% i tng u tr li l thun li.Bng 7: Gia nh c nhu cu s dng dch v y t ti nhKt qu tr li S lng T l %C 551 91,8%Khng 49 8,2%Tng 600 100,0%Nhn xt: Theo kt qu iu tra cho thy c 551 trong tng s 600 i tng tham gia nghin cu chim 91,8% tr li c nhu cu s dng dch v y t ti nh.Bng 8: Mc mong mun s dng dch v y t ti nhKt qu tr li S lng T l %Thng xuyn 398 66,3%Thnh thong 169 28,2%Khng s dng 1 0,2%Khng tr li 32 5,3%Tng 600 100,0%Nhnxt: Tlitngthamgia nghin cutrlimongmunthng xuyn sdngccloihnh chm sc sc khotinhl66,3%, cn169 itng tr li ch cn thnh thong c s dng dch vyttinh chim28,2%,scn litr likhngmunsdnghockhngt quan im chim 5,5%.Nghin cu khoa hc iu d- ng ton quc ln th IV83Bng 9: Cc hnh thc dch v y t mong mun s dngLoi hnh dch v S lng T l %Chm sc ngigi, ngitn tt,bdichngsaucc bnh255 95,5%Chm sc tr nh 324 97,0%Chm sc, theo di thai ph nh k 295 49,2%o huyt p ti nh 407 67,8%Tim thuc, truyn dch theo n 567 94,5%Thay bng, xoa bp, chm cu, bm huyt ti nh 525 87,5%Khm v t vn sc kho nh k ti nh 420 70,0%Nhnxt: Trong600gia nhthamgia nghin cuth c 255/267(95,5%)gia nhcngigi, ngimcbnh mntnhv 324/334(97,0%)gia nh ctrnhmongmunsdnghnhthc chm sc ngigi, ngi tn tt, ngi bnhdichngvchmsctrnhti nh. Ngoi ra, cc loihnh dchvyt khcctrn50%ngidnmongmun s dng.Bng 10: Gia nh c nhu cu s dng dch v cp cuKt qu S lng T l %C 563 93,8%Khng 31 5,2%Khng tr li 6 1,0%Tng 600 100,0%Nhn xt: 93, 8% ngi c hi u tr li mun s dng dch v cp cu ti nh.Bng 11: Gia nh sn sng chi tr chi ph c s dng dch v y tKt qu S lng T l %C 559 93,2%Khng 33 5,5%Khng tr li 8 1,3%Tng 600 100,0%Nhn xt: 93,2% i tng tham gia nghin cu tr li sn sng tr chi ph khi s dng cc dch v y t.Nghin cu khoa hc iu d- ng ton quc ln th IV84Bng 12: Mi lin quan gia ngh nghip v nhu cu s dng DVYT ti nhC NHU CU SD DVYT TI NHNGH NGHIP C KHNGTNGCn b cng chc 78 11 89Cng nhn 117 12 129Bun bn 112 6 118Ch doanh nghip 17 3 20Ni tr 52 5 57Gi/ngh hu 58 5 63Ngh khc 115 9 124Nhnxt:Tngsc89ngilcnbcngchcthc78ngi(87,6%)tr li c nhu cu s dngcc dch v y t ti nh. Tng t nh vy, cc i tng khc: Cngnhn90,7%, Bunbn94,9%, Ch doanh nghip85,0%,Nitr91,2%, Gi/Nghhu 92,1%, Nghkhc92,7% u tr li c nhu cu s dng cc dch v y t ti nh.Nhnchungkhngcskhcbitv nhu cusdngdchvytgiacci tng, c