脊柱侧凸围手术期护理质量敏感指标体系的构建

Construction of a sensitive index system for perioperative nursing quality of scoliosis

目的:构建基于循证的脊柱侧凸围手术期护理质量敏感指标体系,为医院脊柱侧凸患者围术期的护理质量管理与评价提供可靠依据。方法:根据循证法初步拟定护理质量敏感指标,检索中国知网、万方数据库、中国生物医学数据库、PubMed、Up To Date、Cochrane Library、RNAO、OVID、Medline、Web of Science文献数据库,检索时间均为建库至2019年12月,排除与本研究无相关、无法获得全文或会议摘要、信函和通知、数据不完整或不可用,研究内容及方法重复、研究方法有缺陷、数据统计存在问题的文献,采用约翰霍普斯金循证护理实践(JHNEBP)模型中的证据评估工具实施证据评价,形成评价指标体系初级条目池。以Donabedian模式为基本理论框架,初步拟定脊柱侧凸围手术期护理质量评价指标体系,运用德尔菲专家函询法进行两轮专家函询,并采用层次分析法(AHP)及百分权重法确立各指标权重。结果:构建了脊柱侧凸围术期护理质量敏感指标体系,包括3项一级评价指标(结构—过程—结果)、8项二级评价指标(护理措施、药物设备管理、手术室环境、护理评估、护理措施、患者结局)、14项三级评价指标。两轮专家函询的专家判断系数分别为0.78及0.90,熟悉系数为0.84及0.92,权威系数为0.81及0.91,协调系数为0.301~0.384,均有统计学差异(P<0.05)。结论:构建的脊柱侧凸患者围术期护理质量敏感指标体系形成单病种多部门联合质量监控的模式,基于数据化指导可更科学地进行质量持续改进。

Objectives:To establish an evidence-based sensitive index system for perioperative nursing quality of patients with scoliosis,so as to provide reliable basis for perioperative nursing quality management and evaluation of patients with scoliosis.Methods:According to the evidence-based method,the sensitive indicators of nursing quality were initially developed,and the literature databases of CNKI,Wanfang database,China biomedical database,PubMed,Up to Date,Cochrane Library,RNAO,OVID,Medline,and Web of Science were searched from their establishments to December 2019.Literature that is not related to this study,with incomplete or unusable data,with repetitive research contents and methods,defective research methods and data statistics problems were excluded.The evidence evaluation tool of Johns Hopkins evidence-based nursing practice(JHNEBP)model was used to evaluate the evidence and form the primary item pool of evalu-ation index system.With Donabedian model as the basic theoretical framework,the nursing quality evaluation index system was initially established.Delphi expert inquiry method was used for two rounds of expert in-quiry,and AHP and percentage weight method were used to determine the weight of each index.Results:The sensitive index system of perioperative nursing quality of scoliosis was established,including 3 first level evaluation indexes(structure process result),8 second level evaluation indexes(nursing measures,drug equip-ment management,operating room environment,nursing evaluation,nursing measures,patient outcomes),and14 third level evaluation indexes.The coefficient of expert judgment,familiarity,authority and coordination were 0.78 and 0.90,0.84 and 0.92,0.81 and 0.91,0.301-0.384 respectively,with statistical difference(P<0.05).Conclusions:A sensitive index system of perioperative nursing quality for patients with scoliosis was established,a joint quality monitoring mode of single disease and multiple departments was formed,so that continuous scientific quality improvement based on data guidance will be conducted.