构建严重烧伤患者枸橼酸体外抗凝血液净化治疗的集束化护理指标体系

Construction of standardized nursing system for patients with severe burn treated with citrate as an in vitro anticoagulant for blood purification therapy

目的构建具有科学性、系统性、适用性的严重烧伤患者枸橼酸体外抗凝血液净化治疗的集束化护理体系,为开展枸橼酸体外抗凝血液净化治疗提供集束化护理依据。方法以变革理论为指导,建立多学科协作团队,查阅国内外相关文献、采用德尔菲法对16名专家进行两轮咨询,初步构建严重烧伤患者枸橼酸体外抗凝血液净化治疗的集束化护理体系。结果构建的的集束化护理体系包括护理评估、操作规范、并发症预防护理,集成化管理等4项一级指标,23项二级指标,43项三级指标。两轮专家咨询的问卷有效率均为100.00%,专家对一级、二级、三级指标的判断系数分别为0.956、0.943、0.931,熟悉系数分别是0.950、0.925、0.912,权威程度系数分别是0.953、0.934、0.922;专家协调系数为0.648~0.895,专家意见协调性较高(P<0.05)。第一轮专家咨询一级指标重要性赋值均数为4.42~4.80,标准差为0.51~1.25,变异系数为0.10~0.21;第二轮专家咨询一级指标重要性均数为4.76~4.98,标准差为0.47~1.23,变异系数为0.06~0.117。结论基于循证和德尔菲法构建的集束化枸橼酸体外抗凝血液净化治疗严重烧伤患者的集束化护理体系,具有系统性、科学性和实用性,值得临床推广应用。

Objective To construct a scientific,systematic and applicable standardized nursing system for patients with severe burn treated with citrate as an in vitro anticoagulant for blood purification therapy,in order to provide the basis for standardized nursing for blood purification therapy.Methods A multidisciplinary team was built.Relevant domestic and foreign documents were referred to and 16 experts were consulted for two rounds by Delphi method and a preliminary standardized nursing system for patients with severe burn treated with citrate as an in vitro anticoagulant for blood purification therapy was constructed.Results The constructed nursing system covered 4 first-level dimensions of nursing assessment,operation criteria,complication-preventing nursing and integrated management,23 second-level indexes and 43 third-level indexes.The response rate of two rounds of expert consultations was both 100.00%.The judgement coefficients for the three-level indexes by the experts were 0.956,0.943 and 0.931,respectively,and the authority coefficients were 0.953,0.934 and 0.922,respectively.The expert coordination coefficient was 0.648~0.895,with a higher coordination(P<0.05).For the first round consultation,the mean of importance assignment of the first-level indexes was 4.42-4.80,with a standard difference of 0.51-1.25 and a variation coefficient of 0.10-0.21.For the second one,the mean of importance assignment of the first-level indexes was 4.76-4.98,with a standard difference of 0.47-1.23 and a variation coefficient of 0.06-0.117.Conclusions The standardized nursing system for patients with severe burn treated with citrate as an in vitro anticoagulant for blood purification therapy based on evidences and Delphi technique are systematic,scientific and practical.Therefore,the system is worth clinical spreading.