血液透析血管通路护理质量评价指标体系的构建

Construction of nursing quality evaluation index system for hemodialysis vascular access

目的构建血液透析血管通路护理质量评价指标体系,为血管通路质量评价和改进提供参考依据。方法借助Donabedian三维结构质量评价工具,结合文献检索法、半结构式访谈和德尔菲法,以电子邮件、微信等方式发送专家咨询表,对来自全国9个省、直辖市的血液透析血管通路领域的临床护理、护理管理、医疗工作的15名专家进行2轮函询,确定评价指标体系。专家积极程度采用问卷有效回收率表示,专家意见协调程度采用协调系数和变异系数表示,专家权威程度采用专家权威系数表示。结果2轮专家函询的问卷有效回收率均为100.00%(15/15);专家咨询的判断依据系数为0.900,熟悉程度系数为0.827,权威系数为0.864,一、二、三级指标的协调系数分别为0.280、0.267、0.206、(P<0.05)。最终构建的血液透析血管通路护理质量评价指标体系包括3个一级指标、11个二级指标、39个三级指标。结论血液透析血管通路护理质量评价指标体系设置合理,构建过程严谨,具有较高的科学性和可靠性,可为血液透析血管通路护理质量评价提供客观、可量化的参考依据。

Objective To construct the nursing quality evaluation index system of hemodialysis vascular access,so as to provide reference for the evaluation and improvement of vascular access quality.Methods Using the Donabedian three-dimensional structural quality evaluation tool,combined with literature search,semi-structured interviews,and Delphi method,expert consultation forms were sent via email,WeChat,and other means.Two rounds of consultation were conducted with 15 experts in clinical nursing,nursing management and medical work in the field of hemodialysis vascular access from 9 provinces and municipalities in China to determine the evaluation index system.The enthusiasm of experts was expressed by the effective response rate of the questionnaire,the degree of coordination of expert opinions was expressed by the coordination coefficient and coefficient of variation,and the degree of expert authority was expressed by the expert authority coefficient.Results The effective response rates of the two rounds of expert inquiry questionnaires were both 100.00%(15/15).The judgment coefficient of expert consultation was 0.900,familiarity coefficient was 0.827,the authority coefficient was 0.864,and the coordination coefficients of the first,second,and third level indicators were 0.280,0.267,and 0.206,respectively(P<0.05).The final quality evaluation index system for hemodialysis vascular access nursing includes 3 primary indicators,11 secondary indicators,and 39 tertiary indicators.Conclusions The nursing quality evaluation index system for hemodialysis vascular access is reasonably set,the construction process is rigorous,and it has high scientificity and reliability.It can provide objective and quantifiable reference basis for the nursing quality evaluation of hemodialysis vascular access.