1
INTRODUTION:
1. Urgency of theswas:
In our country, Chief Nurse System (CNS) is the first management level
of the hospital. Chief Nurse is responsible for implementing the medical
command of doctor, management of human resources and department
administration. Efficient quality of care, patient service, use of resources
depends significantly on CNS. According to survey in year 2007 of the Viet
Nam Nursing Association, Chief Nurse has had generally intermediate level
84.8%, College 7.2%, University 7.8% and postgraduate 0.2%. Have been
trained the nursing management with the rate of 37.8%, the effectiveness of
executive leadership, participation in the activities of training, guidance and
specialization guidance has been only done good 33.7% [42], [43].
In Nghe An (2008), Number of Chief Nurse has been more than 400
people, intermediate professional qualification has been 91.9%; college 8.1%;
Trained on nursing management 19.2% [71], [95]. In recent years, Nghe An has
gradually strengthened and perfected the nursing management system. However
in fact revealed a certain number of limitations, such as low-level professional
qualification, management capacity was not effective, management system was
insufficient, has been influenced on the quality of patient care.
With the challenges in health care, hospital overcrowding has increased
the shortage of nursing manpower, limitation of proficiency was barrier in
whole patient care. This was that the role and responsibility of the Chief Nurse
became very important in the planning, coordination of the work, the thesis was
the key to solve the above challenges, became more urgent and meaningful
practice.
Proceeding from the above requirements we have carried out
implementation of the project: Status and effect of Chief Nurse ability
intervention in Nghe An province with the goals:
1. Describe the situation and factors that has affected the ability of Chief

of knowledge, practices and attitudes: the nursing dean (ND) has had the
excellent technical expertwase, both have has good management skills and
seriousness and responsibility before actions. However, the application of the
preeminent quality management system, supporting Manager would increase
management efficiency [46], [47], [74], [91].
1.2. Nursing management capability:
1.2.1 Nursing management competency assessment skills:
Based on the knowledge and practice of the nursing management skills,
including 16 following skills [16], [14], [20], [30], [40], [95]: Organizing wholly
care for patients; Directing the hygiene work; Human resource management;
Asset - Materials Management; Participation in training, scientific research;
Planning; Plan performance organizations; Evaluation; Supportive supervision;
Application of information technology; Decwasion making; Problem solving;
Organization of meetings; Time management; Administrative documents and
drafting method of text and Records Management.
1.2.2 Nursing Management Capacity Method:
- Periodical, regular evaluation; - Extraordinary evaluation; - Periodical
evaluation interposed extraordinary [6], [10], [11], [39], [95].
1.2.3 Factors affecting the Nursing management capability:
Factors have affected nursing capacity, including:
- NURSE Qualifications was low [127], [129].
- The administration and documentation works of nurse occupy
percentage of time equivalent to the direct time for patient care (CP) (28%).
Meanwhile, each activity, work had not guidelines, procedures work to help
management methodically and unified [94].

3
- Awareness of staff, the low self-esteem, the complacent of the medical
staff for nursing person have affected to some extent the management operation
and covering and extending level of whole patient care (WPC) in the hospitals.

professional qualifications limited intermediate 90.6%, below the age of 35
accounted for 23, 9%. Rate of Chief Nurse not trained about management was
still high (62.2%) [42];
Pham Duc Muc’s research [59], to investigate systems and human
resource for Chief Nurse in central and provincial hospitals in 2007 shown:
Trained for Nursing management was 63.3%. Implementing authorities tasks:
Organizing and directing the implementation of whole patient care (WPC):
good 72.3%; medium 22.1%; poor 4.1%; no done 1.5%. Speech, check the
implementation in accordance technical procedures hospital regulations: Good

4
90.0%; Average 3.2%; poor 5.2%; no done 1.5%. Organize training and rawasing
the level: good 62.4%; Average 22.5%; poor 9.2%; no done 5.9%. Join practice
guide for pupil - student: Good 35.8%; Average 31.4%; poor 26.6%; no done
6.3%. Procurement planning, test use and preservation: good 48.0%; Average
31.4%; poor 26.6%; no done 6.6%. Check the hygiene, infection protection: Good
88.2%; Average 5.5%; poor 5.2%; no done 1.1%. Join the organization,
recruitment work: Good 60.5%; Average 24.0%; poor 12.5%; no done 3.0%.
Participation in scientific research: Good 38.0%; Average 22.1%; poor 34.7%; no
done 5.2%. Participation in guidance of branch: Good 45.8%; Average 20.3%;
poor 22.8%; no done 5.2%. Sum up partially, generally: good 62.0%; Average
27.5%; poor 8.0%; no done 2.5%. Participation in propose ideas regarding the
nursing policies: good 77.9%; Average 17.0%; poor 4.1%; no done 1.1%.
According to Do Dinh Xuan’s research (2007) [107], has shown that
6,787 Chief Nurse were working in the public hospitals in the country,
including: Nurse 78.4%, Midwife 7.4%, Medical Engineering 8.2%, 6.0% Chief
Nurse with no professional qualification was nurse participating in nursing
management (doctors, pharmacists). Regarding the capacity status of Chief
Nurse Dean: 84% Chief Nurse Dean have assessed themself that they were able
to complete from more fairly in the contents: patient care organization;

management work at Saint Paul hospital in 2007, patient’s satisfaction results
have reached 55% [52].
Le Thi Binh’s research (2008), the Central Hospital was very satisfied by
people 42.1%; satisfied 48.2%; Provincial/ citify hospitals very satisfied 62%,
satisfied 36% [2]. Ha Thi Soan’s research (2007) has assessed the satisfaction
of patients and their family for the medical staff about attitude >90% satisfied,
specialization >90%, patients boards 94%. However, 10-12% non-satisfied
were mainly on administrative procedures, made the test but not explain, no
dietary guidelines, patients have had to buy more medicines outside [71].
Survey results of Nguyen Thi Ngoc (2005) at the General Hospital Thong Nhat,
Dong Nai, the average satisfaction rate was 45.3% primarily not satisfied with
guidance, explanation and health education yet thoughtful [64]. Hoang Thu
Nga’s research said: satisfaction rate for attitude of service 87.8%; guidance in
hospitalization 87.1%; mode of hygiene 84.8%; facilities, equipments 80.1%;
security 62.9% and expertwase 93.7% [63].
1.3.3 In Nghe An:
Research in 2009, Nursing staffs, midwives in Nghe An has had 1,735
workers, mostly women 84.5%. In which university degrees, college was
11.7%, foreign language level A was 12.3%, Office informatics were 24.8%,
trained nursing Management 38.5% [72].
According to the 2008 survey in Vinh City shown: Chief Nurse has had
intermediate level about 91.9%; Average age of 35-55 accounted for 78.8%; not
trained nursing management about 76.8%, capable of office computing and
foreign language level A accounted for 54.5 - 62.6% [96].
In recent years, although there have been many positive changes in the
domains of nursing, patient care in Nghe An. However, the nursing scientific
research has had still many limitation because the force of nurse, midwife and
technicians were mainly intermediate, an knowledge for research design and
methods of scientific research was weak. The major topics has used the
description method, bringing the summarization, report, very little research

Patients’ inpatient treatment:
Thus, the samples have selected to research of patient object were 400.
2.4.2.2 Qualitative Research:
- Depth interview: Director/Vice Director of the hospitals: 8 persons.
- Discussion under groups: 02 groups, each group was 8 head or deputy
department.
Stage 2: Evaluation of effectiveness of intervention "improvement of Chief
Nurse capacity".
2.4.2.3 Intervention research:
Total of Chief Nurse required to research 100 (Intervention group 100
and control group 100).
2.4.4 Research sample selection method:
2.4.4.1 Cross-sectional descriptive research:
- For the Chief Nurse:
Choose whole Chief Nurse working in 40 public hospitals, non-public in
Nghe An province.
- For inpatients: Select samples with 02 stages:

7
- Stage 1: Divise the provincial, district, citify hospitals into two
ecoregions (advantages and disavantages).
- Stage 2: Each ecoregion randomly has selected in proportion,
disavantage 3/12 hospital and advantage 7/28 hospital to conduct an
investigation, in each hospital investige 40 patients.
2.4.4.2 Qualitative Research:
Intentionally select 8 above research hospitals: Depth interviews with 8
Director/ Vice Director. Organize Discussion into 2 groups, each has been 8
head or deputy department[84].
2.4.4.3 Intervention research:
Step 1: Select the research locations: Select 21 hospitals/ 32 public hospitals

+ The result index of intervention group = (p
sct
- p
tct
)/p
tct
x 100%
+ The result index of control group = (p
sc
- p
tc
)/p
tc
x 100%
+ Effective intervention = The result index of intervention group - The
result index of control group
In which: The result index: Performance Index; p
tct
: The pre-intervention
research index of intervention group; p
sct
: The post-intervention research index
of intervention group; p
tc
: The pre-intervention research index of control group;
p
sc
: The post-intervention research index of control group.

8

the provincial and district branches: General management knowledge rate
grades fairly, good at provincial group was 29.4% (
x
= 65.43), the district
group was 43.2% (
x
= 64.32). According to public hospitals and private: rate of
general management knowledge grades fairly, good in public group was 65.1%
(
x
= 66.22), non-public group was 7.5% (
x
= 57.16). According to the
disadvantage and advantages regions: rate of general management knowledge
grades fairly, good in disadvantage regions was 23.5%, advantages was 49.0%.
Grade point average for general management knowledge according to
qualification: of 153 Chief Nurse having college degree or more was 65.36
(standard deviation = 15.2), of 259 Chief Nurse having intermediate degree
was 64.73 (standard deviation = 15.7). The results have shown that the college
degree or more higher than intermediate degree was 0.63 with confidence

9
intervals 95% (-2.49 to 3.74). This difference did not mean the statistics with p
= 0.693. According to the provincial and district branches: Grade point average
for general management knowledge of 173 Chief Nurse in provincial branches
was 64.32 (standard deviation = 15.2), the 239 Chief Nurse in district branches
was 65.43 (standard deviation = 15.8 ). The results shown that the provincial
branches were lower than district branches, was 1.10 with confidence intervals
95% (-4:16 to 1.94). This difference did not mean the statistics with p = 0.476.
According to public, non-public: Grade point average for general management

(standard deviation = 15.7). The results shown that the provincial branches
were higher than district branches, was 9.14 with confidence interval 95% (6.01
to 12.27). This difference has meant the statistics with p = 0.0001. According to
Public, non-public hospitals: Grade point average for management practices of

10

355 public Chief Nurse was 65.39 (standard deviation = 16.9), of 57 non-public
was 58.77 (standard deviation = 13.4). The results shown that the public group
higher non-public group was 6.62 with confidence interval 95% (2.66 to 10.58).
This difference had meant the statistics with p = 0.001. According to the
disadvantage and advantage regions: Grade point average for management
practices of 121 Chief Nurse in disadvantage regions was 63.21 (standard
deviation = 17.79), the 291 Chief Nurse in advantage region was 65.01
(standard deviation = 16.04). The results shown that disadvantage regions lower
than advantage region was 1.80 with confidence intervals 95% (- 5:49 to 1.89).
This difference did not mean the statistics with p = 0.337. Classification results
of Chief Nurse’s Management Capacity shown that the fair, good rate for
general management knowledge was 72.6%;
x
= 64.97 (Std: 15.5); Fair, good
rate for general management practices was 0%, average 36.6%;
x
= 64.48 (Std:
16.6); Fair management capacity was 13.8%, mainly average (67.7%);
x
=
129.44 (Std: 23.2).
3.1.2.4 Satisfaction assessment of patient for Chief Nurse:
Assessment of patients by satisfaction, very satisfaction with Chief Nurse capacity

Discussion

with c
olleagues

1.
65

0.
80

3.
42

p = 0.
177

Re-trained 1.32 0.67 2.62 p = 0.423

Comment: In a logistic multivariate regression model to control jamming
factors, the results shown that factors supporting profession has helped really
Chief Nurse, was factor of Workflows. The Chief Nurse had answered to be
supported for the Workflows have had capacity less greater than 0.29 times the
Chief Nurse being not supported this. That was more supported for workflows,
the Chief Nurse has had higher capacities.

11

3.2 Evaluate the effectiveness of interventions:
3.2.1 The assessment results before and after training:

(good, fair 4.8%), the difference has meant the statistics with p < 0.001. Result
index of intervention group = 630%; Result index of control group = - 40%;
Intervention result = 670%. So intervention was effective.
The opinion for depth interviews and group discussions also have turned
around comments on nursing management skills of Chief Nurse was clearly
improved. Thus, for the management skills of Chief Nurse has been highly
appreciated by the hospital managers/ departments, the significant improvement
for the quality and effectiveness of patient care.
3.2.4 Chief Nurse’s management capacity:
Table 3.16: Assessment for Chief Nurse’s management capacity: 12

Management
capacity

Pre-intervention After-intervention
Intervention
group
Control
group
p
Intervention
group
Control
group
p
n =
117

63

27.5

11

4.8

0.00
0

Fair 10

4.4

6

2.6

47

20.5

7

3.1

Average

49


Practice
Good 5

2.2

7

3.1

0.060

46

20.1

5

2.2

0.00
0

Fair 8

3.5

10

4.4

45

19.7

2

0.9

12

5.2

General
capacity
assessment

Good 6

2.6

1

0.4

0.005

63

27.5


16.2

8

3.5

84

36.7

Poor 61

26.6

61

26.6

1

0.4

10

4.4Comments: Before general management capacity intervention of intervention
group (good, fair 3.5%) lower than the control group (good, fair 6.1%), the
difference has meant the statistics with p < 0.005. After the general

document work and management forms.
3.2.7 Satisfaction of patient:
Before the intervention, the patient's satisfaction with Chief Nurse
between the two groups of intervention and control: difference (Regarding
gestures; Respond immediately; Visit, encourage; Professional knowledge,
Professional Engineering; examination procedures and hospitalization;
Implement the profession successfully and efficiently with p < 0.05); no
difference (For speech; Consulting, health education: care layout method,
treatment with p > 0.05). After the intervention, patients' satisfaction for Chief
Nurse in intervention group was higher than control group; This difference has
meant the statistics with p < 0.001.

Chapter 4. DISCUSSION
4.1 Status and factors affect Chief Nurse’s management capacity:
4.1.1 Chief Nurse’s management knowledge:
In accordance with research results showing that good classification rate
for patient care knowledge was 68%; hygiene work (54.6%); Asset
management (65.5%); Investigation - scientific research, directing the branch
(18.0%); human resource management (61.4%); rate of general management
knowledge grades fair, good accounting for 72.5%.
According to Pham Duc Muc’s research (2007) [59] patient care in good
(72.3%); hygiene work (88.2%); asset management (90.0%); Investigation -
scientific research, directing the branch (35.8 to 45.8%); human resource
management (60.5%). Do Dinh Xuan (2007) [107] research on 6787 Chief
Nurses for the public hospitals in the country (914 Nursing Deans) shown that
84% Nursing Deans were able to completion of works from fair level or more.
Pamela Duffy and colleagues’ research in the United States shown that there
was a difference in perception of the practice of provincial hospitals before and
after training. For pre-training skills rate of Nurse, Chief Nurse having
confidence in clinical practice was 46%, after training was 60% (p = 0.018), for

good in group of provincial branches 29.4%, in group of district branches
43.2%. Grade point average (GPA) of management knowledge (Figure 3.2) of
173 Chief Nurse in provincial branches was 65.43; of 239 Chief Nurse in
district branches was 64.32. The results have shown that GPA of management
knowledge of Chief Nurse in provincial branches higher than district branches
was 1.10 with confidence intervals 95% (-4:16 to 1.94). This difference did not
mean the statistics with p = 0.476. Comparison of knowledge between provincial
and district branch, at first sight could show that provincial branches would have
higher knowledge than district branch but in our research there was no difference
between the two groups under branches. The reason to explain about this
problem not to training for nursing management training remains highly (74.3%).
In Table 3.4 the results have shown the percentage of general management
knowledge grades fair, good in public group was 65.1%, and non-public group
7.5%. GPA of general management knowledge (Figure 3.3) of 355 public Chief
Nurse was 66.22; of 57 non-public Chief Nurse was 57.16. The results shown
that GPA of general management knowledge of public Chief Nurse higher than
non-public was 9.06 with confidence interval 95% (3.99 to 14.14). This
difference has meant the statistics with p = 0.001. In fact, the amount of Chief
Nurse working in the area of non-public hospitals were recruited from two new
sources of and recruitment of retirees. This force was not trained on nursing

15

management; on the other hand they were interested mainly in profession and in
management under boss model.
The research results in Table 3.5 has shown that the proportion of general
management knowledge grades fair, good in disadvantage regions was 23.5%, in
advantage regions 49.0%. GPA of management knowledge (Figure 3.4) of 121
Chief Nurse in disadvantage regions higher than in advantage regions was 69.14;
of 291 Chief Nurse in advantage regions was 63.23. GPA of general management

4.1.2 Chief Nurse’s management practices:
Research results in Table 3.6 have stated that the rate of fair classification for
patient care practice was 40.3%; Hygiene work (35.7%); Asset management
(33.0%); Investigation - scientific research (2.9%); human resource management
(3.5%); rate of general practices grades average accounting for 36.7%, poor (63.3%).

16

In 412 Chief Nurse, rate of general management practices grades fair,
good (0%), average 36.7%. GPA of management practices (Figure 3.5) of
groups from colleges or more was 64.4; Intermediate group was 64.5. groups
from colleges or more and Intermediate group were approximately with
confidence interval 95% (-3.51 to 3.28). This difference did not mean the
statistics with p = 0.945. Thus, management practices assessment of Chief
Nurse has given also result as same as management knowledge. There was no
difference between the two groups according to professional qualifications.
For the classification of practice under provincial and district branches, the
research in Table 3.7 has indicated that the rate of general management practice
classified average in the provincial branch group was 19.7%, and in district branch
group 17.0%. GPA of management practices (Figure 3.6) in provincial branch was
69.78, district branch was 60.64. Provincial branch higher than district branch was
9.14 with confidence interval 95% (6.01 to 12.27). This difference has meant the
statistics with p = 0.0001. This difference could be explained that Chief Nurse in
the provincial branch although untrained nursing management as in district
branch, but in the provincial branch has had many conditions contacted
experiential management personnel, learned through a variety of information
channels. From real-life experience provided the more experience for Chief Nurse
in management, better thinking in management skills practice.
The rate of general management practices (Table 3.8) has classified
average in the public hospital group was 34.0%, and in the non-public group

we did not have a basis for comparison. Because nursing management capacity
researchs have based mainly on assessment of trained professional
qualifications, information technology, foreign languages and a number of
nursing technical processes, referring to knowledge, skills of management
process, but not sufficient compared with provisions of nursing management
training program [16] and the functions and duties of Chief Nurse [23]. The
information collection method was also different, was based mainly on maietic
methods, depth interviews. Meanwhile our research uses a checklist and
evaluation of practice results through direct observation or indirect management
practices; combine information collection through documents, books, records of
storage management. We found that the Chief Nurse’s practice classification was
low-level, no kind of fair, good. This could be understood that as Chief Nurse was
trained the nursing management with low proportion (25.7%). The daily
management activities were carried out according to experience. So Chief Nurse
should be well schooled in the nursing management, prior to appointment should
have standard on basic of Nursing management Certificate. At the same
strengthening and developing the storage work of records and management forms.
4.1.3 Factors affecting the management capability of Chief Nurse:
Research result has shown that there was especial relationship between
Chief Nurse’s management capabilities and instructions, scheme (
2
= 1.98, p =
0.05); Workflows (
2
= 0.28, p = 0.01); Discuss with colleagues (
2
= 2.25, p =
0.05). In table 3.12 Hosmer and Lemeshow Test (Hosmer and Lemeshow 
2
=

patient care work, imbalance in the number of patients and the nursing
manpower; weak, low qualification; not involved Council for reward,
dwascipline, recruitment, appointment, transfer.
In Ho Chi Minh City, Tran Thi Chau's research (2007) has suggested that
low qualifications (Intermediate level 78.3%); untrained nursing management
(59.4%) were also the factors contributing to affect the ability of Chief Nurse [26].
Our research results have shown that the factors affecting Chief Nurse’s
management capacity was somewhat different from previous researches. The
reason for this difference could be due to affect the customs, habits, different
conceptions between regions. Besides, due to the research design also has made
different results. Until now, very little topics study factors affecting the nursing
capacity or could re-statistize some related factors directly affecting the quality
of profession and management through the interviews. It needs the depth
analysis researches to assess the affected factors to provide effective
intervention methods.
Thus, capacity management of Chief Nurse has affected a lot of factors,
depending on each local, the specific object of the influence of different factors.
4.1.4 Satisfaction of patients:
Research results (Figure 3.15) have shown that: Patients have satisfied,
very satisfied with speech 76.3%; Gesture 76.4%; Respond immediately upon
request accounted for 77.8%; Visit and encourage 79.1%; Consultant, health
education 86.1%; Professional knowledge 78.1%; Professional engineering
79.1%; Examination procedures and hospitalizations 76.8%; The layout of care
and treatment work 83.1%; Professional performance planed and efficiency
74.4%; However there were still dissatisfaction, very dissatisfaction for
professional performance planed and effective 25.6%; Speech 23.6%; Gesture
23.5% and examination procedures and hospitalizations by 23.1%.
Roderick research in the United States for improving the quality of
patient care [147] has stated that the satisfaction rate of the patients for the
doctor was higher than Chief Nurse in intensive clinical department, whereas in

(11/16 skills did not meet). After training, knowledge of 100% Chief Nurse met
requirement. GPA before training was 36.7; after training was 77.9. Training
effect = 42.1. Thus, training interventions were effective. Through these results,
we known that the role of training work has had an important position, but in
order this result were sustainable development, shall plan to strengthen
supportive supervision for the knowledge became really skill, competence.
Table 3.14, before intervention the management knowledge of Chief
Nurse of intervention group (good, fair 7.5%) and control groups (good, fair
5.2%), the two groups did not differed with p > 0.05. After the intervention the
management knowledge of Chief Nurse of intervention group (good, fair
occupies 48.0%) higher than the control group (good, fair 7.9%), the difference
between the two groups have meant the statistics with p < 0.01. Intervention
result = 490%. Before intervention the assessment was the same between the
two groups, after intervention the intervention group has had higher knowledge
than the control group, so the intervention was effective. This issue was as to

20

compliance as explanation the nursing management so initial assessment in
GPA of knowledge before training was low (
x
= 36.7), after training
knowledge was significantly improved (
x
= 77.9). The results shown that
interventions were effective (interventions result = 490%); simultaneously
during task execution, the Chief Nurse has applied the learned nursing
management skills in specific conditions, within learning and working,
combines the supportive supervision so awareness was much improved.
Whereby this has indicated the nursing management training organization for

to further study and improve the knowledge and management skills. On the other
hand it was necessary to strengthen the supportive supervision and exchange of
experience through meetings, cross-check between departments, learn from
experienced, overcome and repair to meet well the requirement of task execution.

21

For group discussions, the management staffs level department has had
the same opinion as the management staffs level hospital: "The current
management staffs generally for the specialization were doing well, while the
management operations were done on emotions, experience and imitation so do
not well". Management knowledge of the Chief Nurse was insufficient,
equivocal as they were not trained so the management skills reveal weakness
"These management skills done do not comply with any process, how to
understand how to do it".
Nursing management skills were identified by the management staffs
level hospital and department to only be completed tasks, not satisfied with the
respon of functionality and mission requirements, so it was necessary to have
management capability improvement solutions so that contribute to improving
the quality of health services.
After intervention implementing the management activities carried out by
Chief Nurse to ensure the built process. Content, the process steps for each
management activity were very scientific, real comfortablet, easy to apply. The
opinions of depth interviews and group discussions also turn around the comments
on nursing management skills of Chief Nurse were markedly improved.
4.2.3 Chief Nurse’s management capacity:
Through the survey, 229 Chief Nurse in Nghe An province, we found
that: Before intervention (Table 3.16) general capacity of the intervention group
(good, fair occupies 3.5%) lower than the control group (good, fair was 6.1%),
this difference was statistically significant with p < 0.005.

This has demonstrated that the intervention was effective. There was a change in
the results was due to research using the measures for training, strengthening the
inspection and control, feedback of results, remind the person in charge of this task
to help them improve cognitive, management skills for records and forms. Thus
the management works have brought efficiency contributing to improving the
quality of health services.
Through depth interviews, group Discussions, most hospital/ department
managers found that their storage status of record, medical file were much
limited, not scientific. To meet the demand for improving the quality of health
care, should have the right solution, scientific, safety, quality and efficiency in
the record works and management forms.
4.2.5 Satisfaction of patients:
Research results on 403 patients, before intervention (Table 3:18),
patient’s satisfaction for Chief Nurse in the intervention group and control
group was differences in gesture; Respond immediately; Visit, encourage;
Professional knowledge; Professional engineering; Examination procedures and
hospitalization; Professional performance and planed and efficiency (the
difference was statistically significant with p < 0.05); no differences in speech;
Consultant, health education; The layout of the care and treatment (p > 0.05).
After implementing a number of intervention methods, patient’s satisfaction for
Chief Nurse in intervention group was higher than in control group; This
difference was statistically significant with p <0.001. Improvement of patient’s
satisfaction in the intervention group was higher than in the control group was
by improving knowledge and practice of the management of Chief Nurse
forces, Chief Nurse’s attitude, behavior with patients were improved; know
implementation of all nursing activities of science methodically, scientifically
and bring good results. Patients recognize the effect of management activities
through daily communication and nursing care outcomes. Patients feel
comfortable for spirit, physical growth, disease remission, shorten of
hospitalized days. So, should organize training nursing management for

Disadvantage regions (63.21) < advantage regions (65.01) with p = 0.337.
- Management capacity: Assessment Fair for management capacity accounted
for 19.8%, Average (65.5%), still poor (14.6%) with grade point average of
management capacity was
x
= 129.44 (Std: 23.2).
1.1.2 Factors affecting the management capacity of Chief Nurse:
Univariate analysis of factors affecting the management capacity of Chief
Nurse shown Guidelines, schemes; Workflows; Discussion with colleagues;
Re-training (p <0.05). Analysis of multivariate regression logistic the Chief
Nurse respond to be supported the workflows with capacity greater than 0.29
times the Chief Nurse that did not have the support.
1.2 Assess the intervention effectively of management capacity improvement
of Chief Nurse:
1.2.1 Knowledge, practice, management capacity of Chief Nurse:
- Knowledge of management: Before intervention the intervention group
was evaluated good, fair 7.5%, control group 5.2% (p > 0.05). After the
intervention the intervention group was evaluated good, fair 48.0%, control
group 7.9% (p<0.001). Intervention result = 490%, intervention was effective.
- Practice of management: Before intervention the intervention group was
evaluated good, fair 5.7%, control group 7.5% (p> 0.05). After the intervention

24

the intervention group was evaluated good, fair 41.5%, control group 4.8% (p
<0.001). Intervention result = 670%, intervention was effective.
- Capacity of management: Before intervention the intervention group
was evaluated good, fair (3.5%), control group 6.1% (p <0.05). After the
intervention the intervention group was evaluated good, fair 47.2%, control
group 7.9% (p <0.001). Intervention result = 1220%, intervention was effective.

contributing to improve the quality of health services.