结核性脓胸行胸腔镜清除术患者中西医结合肺康复护理方案构建

Construction of pulmonary rehabilitation nursing program of integrated traditional Chinese and Western medicine for patients with tuberculous empyema under thoracoscopic clearance

目的:构建结核性脓胸行胸腔镜清除术患者中西医结合肺康复护理方案。方法:通过文献研究、患者访谈、病例回顾和小组讨论后初步拟订结核性脓胸行胸腔镜清除术患者中西医结合肺康复护理方案。通过德尔菲法对15名专家进行函询,对方案条目进行修改、增减,确定最终护理方案。结果:两轮专家函询问卷应答率分别为100.0%(15/15)和93.9%(14/15),提出建议者分别占60.0%(9/15)和14.3%(2/14)。经两轮专家函询后,专家的权威系数为0.96,其中,专家的判断依据系数为0.95,对函询内容的熟悉程度系数为0.96。两轮专家函询的变异系数分别为0.00~0.45和0.00~0.14,肯德尔和谐系数分别为0.336和0.119(χ^(2)值分别为176.340和99.910,P值均<0.001)。最终方案包括术前、术后、出院3个一级指标,14个二级指标,47个三级指标。结论:构建结核性脓胸行胸腔镜清除术患者中西医结合肺康复护理方案的专家积极性和权威程度较高,专家意见协调程度一致性好,构建的护理方案具有可靠性和科学性。

Objective:To construct a pulmonary rehabilitation nursing program of integrated Traditional Chinese Medicine(TCM)and Western medicine for patients with tuberculous empyema undergoing thoracoscopic clearance.Methods:Based on literature research,patient interview,case review and group discussion,the pulmonary rehabilitation nursing program of integrated TCM and Western medicine for patients undergoing thoracoscopic tuberculous empyema removal was established.Using the Delphi method,15 experts were consulted,and the items of the program were modified to determine the final nursing program.Results:The recovery rates of the two rounds of expert consultation questionnaires were 100.0%(15/15)and 93.9%(14/15),respectively,and those who making recommendations were 60.0%(9/15)and 14.3%(2/14),respectively.After two rounds of expert consultation,the experts’authority coefficient was 0.96,among which the experts’judgment basis coefficient was 0.95,and the familiarity coefficient of the consultation content was 0.96.Of the two rounds of expert consultation,the coefficients of variations were 0.00-0.45 and 0.00-0.14,respectively;and the Kendall’s coefficients of concordance were 0.336 and 0.119,respectively(χ^(2)=176.340 and 99.910,P<0.001).The final plan includes 3 primary indicators(preoperative,postoperative,and discharge),14 secondary indicators and 47 tertiary indicators for preoperative,postoperative and discharge stage.Conclusion:The construction of pulmonary rehabilitation nursing program of integrated TCM and Western medicine for patients with tuberculous empyema undergoing thoracoscopic clearance has high enthusiasm and authority of experts,and the coordination of expert opinions is satisfactory.The constructed nursing program is reliable and feasible.