Establishing Standardized Nursing Quality Sensitive Indicators

This is a pilot research project was prepared to assess the impact of implementing essential standardized nursing quality sensitive indicators in monitoring, evaluating, and controlling the nursing services and activities which implemented in daily nursing care works with the patients in a health institute, aiming for emphasizing the concept of “nursing quality sensitive indicators” which is valuable to elaborate nursing care performance, and for continuous upgrading of daily nursing care, which hopefully will result in more beneficial outcomes, and lesser negative or undesirable outcomes in all aspects of nursing care, and consequently the health care process, particularly regarding patient safety, patient satisfaction and nursing performance improvement. This pilot research project for the essential standardized nursing quality sensitive indicators was applied in intensive care unit (ICU) department in Qurayyat general hospital, and resulted in excellent improvement of all outcomes correlated with the essential standardized nursing quality sensitive indicators. These essential standardized nursing quality sensitive indicators are hopefully be accepted and accredited by the higher health authorities as standardized nursing quality sensitive indicators in health institutes.

Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia

BACKGROUND Severe pneumonia is a common severe respiratory infection worldwide,and its treatment is challenging,especially for patients in the intensive care unit(ICU).AIM To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.METHODS We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1,2021 and December 31,2023.We compared and analyzed the respiratory mechanical indexes[airway resistance(Raw),mean airway pressure(mPaw),peak pressure(PIP)],blood gas analysis indexes(arterial oxygen saturation,arterial oxygen partial pressure,and oxygenation index),and serum inflammatory factor levels[C-reactive protein(CRP),procalcitonin(PCT),cortisol(COR),and high mobility group protein B1(HMGB1)]of all patients before and after treatment.RESULTS Before treatment,there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups(P>0.05).However,after treatment,the respiratory mechanical indexes of patients in both groups were significantly improved,and the improvement of Raw,mPaw,plateau pressure,PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group(P<0.05).The serum CRP and PCT levels of patients were significantly decreased,and the difference was statistically significant compared with that of nursing group alone(P<0.05).The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.CONCLUSION The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators,blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

Application of nursing sensitive indicators in improving the quality of hemodialysis

To explore the application value of hemodialysis-related nursing sensitive indicators in improving the quality of hemodialysis.Methods Totally 40 outpatients undergoing dialysis treatment from January 2016 to December 2016 served as observation group.Another 40 outpatients who received dialysis from January 2015 to December 2015were selected as control group.Patients in control group received routine nursing and health education on hemodialysis,and those in observation group were given interventions based on nursing sensitive indicators.The hemodialysisrelated nursing sensitive indicators and satisfactory degree of patients on nursing service were compared between two groups.Results Observation group had a better outcome of hemodialysis nursing sensitive indicators compared with control group(observation group:Kt/V[1.30±0.06],Hb[115.0±4.8]g/L,serum Ca[2.31±0.06]mmoL/L,serum P[1.75±0.18]mmoL/L,product of Ca and P[30.95±0.58]mg2/dl,PTH[305±65]pg/mL.control group:Kt/V[1.18±0.07],Hb[99.0±5.2]g/L,serum Ca[2.52±0.07]mmoL/L,serum P[2.07±0.21]mmoL/L,product of Ca and P[39.75±0.74]mg2/dl,PTH[420±84]pg/mL.P<0.05 respectively.)The satisfactory degree of patients on nursing service was97.5%(39/40)in observation group and 80.0%(32/40)in the control group,with a significant difference(P<0.05).Conclusion Hemodialysis-related nursing sensitive indicators provide a scientific basis for nursing quality improvement in patients with hemodialysis,and also play a certain role in promoting high quality nursing service.

Consistency of Nursing Directors, Nursing Supervisors, and Nursing Quality Specialists’ Perception about Nursing-Sensitive Indicators in Acute Care Settings

Introduction: Nursing-Sensitive Indicators (NSIs) is a critical concept for the advancement of the nursing profession. However, different managerial positions may have a different perspective on the appropriate NSIs that should be used in hospitals for the monitoring of nursing care quality. This study aims to find if there is a difference between three groups of nursing managerial positions on the appropriateness of NSIs for the monitoring of nursing care quality. Methods: Descriptive cross-sectional approach was employed to evaluate if there is a difference among the three managerial groups in their evaluation for the appropriateness of using a cluster of NSIs in acute care settings. The study was conducted in Jordan between February and March 2020. Result: The study participants were 60 nurses from different managerial positions. The mean scores of the participants were: directors of nursing (200.6), nursing supervisors (199.1), and nursing quality specialists (198.62). The findings revealed no statistical difference between the three groups of their evaluation of the appropriateness of the NSIs. Conclusion: Standardizing the nursing mangers perspectives of NSIs may advance utilization of the NSIs for the monitoring and reporting of nursing care quality. Implications for Nursing Management: Consistent understanding of the measures that can be used to monitor quality of nursing care can establish the foundation for quality measurement and quality improvement in acute care settings.

Training indicators and quantitative criteria for emergency nurse specialists

Objective： By constructing a training system of quality evaluation standards for emergency nurse specialist（ENS）, we can ensure smooth operations and quality training for ENS.Methods： First, the frame structure of indicators was designed on the basis of system theory and the balanced scorecard method. Meanwhile, corresponding quantitative standard indicators were compiled through literature analysis and a review of training characteristics. Next, screening indicators were collected through consultation with experts and statistical calculations. The indicators weight coefficient was calculated using the analytic hierarchy process（AHP）. Finally, indicators were validated in two groups of nurses in two different training courses.Results：（1） We created a three-level indicator system： level-Ⅰ dimensions have 4 indicators, while level-Ⅱ dimensions and level-Ⅲ dimensions have 13 and 34 indicators, respectively;（2） The coefficient of expert＇s judgment is 0.840, familiarity is 0.914 and authority is 0.877, and the three rounds of coordination coefficient are 0.456, 0.553 and 0.715, respectively;（3） There are at least 56 indicators in alternative quantitative standards; and（4） The alpha reliability value of the indicator system in the two training course had no significant difference（P 〉 0.05）. The same result was observed when examining two groups of nurses in one training course（P 〉 0.05）.Conclusions： This study established a training system of quality evaluation standards for emergency nurse specialists that is objective, reliable, easy to operate and representative according to scientific selection and verification. This system can therefore provide a basis for quality evaluation and targeted improvement for ENS training in addition to promoting health.

Empirical Verification of Swanson’s Caring Processes Found in Nursing Actions: Systematic Review

Caring has long been recognized as central to nursing and is increasingly posited as a core concept although developing a theoretical description of caring which is adequate in the 21st. century continues to be a difficult task for nursing scholars. Consequently, verifying existing theoretical structures of caring remains an ongoing challenge. The aim of this article is to provide empirical verification of the caring processes of “knowing,” “being with,” “doing for,” “enabling” and “maintaining belief” from Swanson’s Middle Range Caring Theory based on the categorization of nursing actions from a systematic literature review on care. Methods: A systematic literature review was conducted in the fields of nursing sciences, medicine and psychology. Purposeful sampling was carried out covering a period from 2003-2013. The final sample included 25 articles. Results: Major themes of nursing actions included “knowing” which consisted of centering, nurturing, informed understanding, assessment skills, communication and respect for individual differences. “Being with” was characterized by intimate relationship, connecting, presencing, emotional adaptability awareness of self/other and decentering. “Doing for” included competence, knowledge, professional/technical skills, helping actions, anticipatory, multidisciplinary and preserving dignity. “Enabling” was characterized by self care, commitment, complexity of care, appropriate communication, information/education, sharing power, enabling choice and ongoing validation. Finally, “maintaining belief” was characterized by spiritual being, humanistic view, harmonious balance, hope, love, and compassion, meaning, and religious and spiritual orientation. Conclusion: Empirical verification was shown for the caring processes described in Swanson’s Caring Theory grounded in concrete nursing actions.

Quality indicators for the care of older adults with disabilities in longterm care facilities based on Maslow’s hierarchy of needs

Purpose:This study aimed to develop quality indicators for the care of older adults with disabilities in long-term care facilities(LTCFs)based on Maslow’s hierarchy of needs.Methods:The draft of the quality indicators was drawn up based on a literature review and research group discussion.The quality indicators were finalized by two rounds of expert consultation(involving 15 experts)using the Delphi method.The Analytic Hierarchy Process was applied to calculate the indicators’weight.Results:The response rates of the two rounds of consultation were 100%and 93%,and the expert authority coefficients were 0.86 and 0.87.After two rounds of consultation,the expert opinion coordination coefficients of the first-,second-and third-level indicators were 0.42,0.25,and 0.96,respectively(P<0.05),and the variation coefficient was0.25.The final quality indicators for the care of older adults with disabilities in LTCFs included 7 first-level,19 second-level,and 107 third-level indicators.Conclusion:The quality indicators for the care of older adults with disabilities in LTCFs are reliable,scientific,comprehensive,and practical and specify the content of person-centered care needs.This can provide a reference for evaluating and improving care quality in LTCFs.

Challenges using electronic nursing routine data for outcome analyses:A mixed methods study

Objectives To explore the challenges of secondary use of routinely collected data for analyzing nursing-sensitive outcomes in Austrian acute care hospitals.Method A convergent parallel mixed methods design was performed.We conducted a quantitative representative survey with nursing managers from 32 Austrian general acute care hospitals and 11 qualitative semi-structured interviews with nursing quality management experts.Both results were first analyzed independently and afterward merged in the discussion.Results On average,76%of nursing documentation is already electronically supported in the surveyed Austrian hospitals.However,existing nursing data is seldom used for secondary purposes such as nursing-sensitive outcome analyses.This is due to four major reasons:First,hospitals often do not have a data strategy for the secondary use of routine data.Second,hospitals partly lack the use of standardized and uniform nursing terminologies,especially for nursing evaluation.Third,routine nursing data is often not documented correctly and completely.Fourth,data on nursing-sensitive outcomes is usually collected in specific documentation forms not integrated into routine documentation.Conclusion The awareness of the possibilities for secondary use of nursing data for nursing-sensitive outcome analyses in Austrian hospitals is still in its infancy.Therefore,nursing staff and nursing management must be trained to understand how to collect and process nursing data for nursing-sensitive outcome analyses.Further studies would be interesting in order to determine the factors that influence the decision-making processes for the secondary use of nursing data for outcome analyses.

Effect of foot reflexology on pain and physiological indicators in postoperative patients:A systematic review and meta-analysis

Aim:To determine the effect of foot reflexology intervention on pain and physiological indicators in postoperative patients.Data resources:The Cochrane library,PubMed,EMBASE,MEDLINE,SCOPUS,CINAHL,China National Knowledge Infrastructure(CNKI),VIP,and Wan Fang Data were searched from inception until January2020.Review methods:Studies were screened according to the PICOS principle.The methodological quality was assessed with Cochrane Risk of Bias Tool.Meta-analysis was performed using RevMan 5.3 software.Results:5 randomized clinical trials involving 318 participants were included in the meta-analysis.There were significant differences in pain and heart rate in postoperative patients between the two groups.Conclusion:The foot reflexology intervention decrease the postoperative pain and heart rate for the postoperative patients.It can be considered to be an effective non-pharmaceutical therapy to reduce the postoperative pain and heart rate.The evidence is not enough to prove the effectiveness of reducing postoperative blood pressure,respiratory rate,pulse rate and oxygen saturation using the foot reflexology.

持续质量改进联合护理质量指标在减少动静脉内瘘穿刺损伤中的应用研究

目的 探讨持续质量改进及护理质量指标控制在降低动静脉内瘘穿刺损伤发生的护理实践中的作用。方法 以降低动静脉内瘘穿刺损伤作为质量控制目标,以2022年8、11月于北京大学人民医院血液透析室应用动静脉内瘘作为血管通路的患者为研究对象,8月质量改进前治疗的123例患者为对照组,11月质量改进后的125例患者为观察组,通过联合采用动静脉内瘘穿刺损伤发生率、各内瘘穿刺方法占比、血管超声使用率、患者穿刺满意度作为护理质量指标,每月汇总分析指标结果及发生原因,针对性进行护理质量管理与改进措施。结果 对照组患者共穿刺1 810例次,发生穿刺损伤10例次,动静脉内瘘穿刺损伤发生率为0.55%(10/1 810);观察组患者穿刺1 733例次,发生损伤3例次,动静脉内瘘穿刺损伤发生率为0.17%(3/1 733)。疑难血管通路穿刺损伤发生率下降(P=0.039),绳梯穿刺法占比上升至63%,血管超声使用率由4%(5/123)增加至100%(P<0.001),患者对穿刺满意度增加(P<0.001)。结论 联合应用血液透析专科护理质量指标,实施持续质量改进管理,可降低动静脉内瘘穿刺损伤发生率。

基于Delphi法构建手术室围术期低体温预防管理评价指标体系

目的 构建手术室围术期低体温预防管理评价指标体系。方法 2022年2月,以结构-过程-结果三维质量评价模式为理论框架,参考相关文献拟定手术室围术期低体温预防管理评价指标体系,采用德尔菲法对来自手术室护理管理、院内感染、麻醉领域的23名专家进行2轮专家函询,采用优序图法确定指标权重系数。结果 2轮专家函询的积极系数分别为100.0%和95.7%,专家权威系数分别为0.946和0.934,各项指标变异系数(CV)均<0.25,Kendall’s W值分别为0.419和0.359(均P<0.001),最终构建了包含3项一级指标、9项二级指标、53项三级指标的手术室围术期低体温预防管理评价指标体系。结论基于Delphi法构建手术室围术期低体温预防管理评价指标体系有较好的科学性和可靠性,可为手术室护理管理者提供参考,有利于临床开展科学、规范、统一的质量评价。

新生儿伤口造口专科护理敏感指标体系的构建

目的构建新生儿伤口造口专科护理敏感指标体系。方法于2023年3-4月基于文献回顾及半结构式访谈,拟定新生儿伤口造口专科护理敏感指标初级条目池,通过2轮专家函询进行修订并确定指标体系,运用层次分析法确定各指标权重。结果2轮函询问卷的有效回收率均为100%,专家权威系数分别为0.855、0.900,肯德尔和谐系数分别为0.148~0.180、0.240~0.279(均P<0.05),最终形成了包含一级指标3项、二级指标11项、三级指标22项的新生儿伤口造口专科护理敏感指标体系。结论本研究构建的指标体系过程严谨、科学,具有新生儿专科特色,可为新生儿伤口造口护理质量评价提供参考依据。

医养服务机构质量评价指标体系的构建与初步应用

目的以“结构-过程-结果”理论为框架,构建医养服务机构质量评价指标体系并初步应用。方法基于文献研究、小组讨论、德尔菲法及层次分析法,确定评价指标体系和各指标权重。应用该指标体系在长沙市3家医养服务机构进行现场评价。结果共进行2轮函询,专家权威系数分别为0.915和0.927,协调系数分别为0.211和0.164,最终确定一级指标3个,二级指标13个,三级指标53个。评价指标体系的Cronbach'sα系数为0.786,平均内容效度指数为0.862。在3家医养服务机构进行的预调查效果较好。结论医养服务机构质量评价指标体系信度、效度较好。构建的指标科学、合理、实用性强,能有效评价医养服务机构质量并发现问题。

体外循环下心血管外科术后谵妄管理审查指标制定及障碍因素分析

目的:评估体外循环下心血管外科病人术后谵妄管理证据在临床的应用现状,构建审查指标,分析循证实践的障碍与促进因素,为临床制定策略提供依据。方法:以知识转化模式(knowledge to action framework,KTA)为指导,系统检索、评价、汇总证据,制定审查指标并明确审查方法,2022年8月20日—9月30日进行基线审查,根据基线审查结果分析循证实践过程中的障碍和促进因素,并制定相应的策略。结果:共纳入35条证据,对证据进行遴选,最终纳入23条适合临床的最佳证据、27条审查指标。其中10条审查指标的准确执行率为0,9条审查指标准确执行率低于30%,4条审查指标准确执行率较高,在80%以上。对审查指标逐条分析后,明确主要障碍因素为制度流程建立不足、术后谵妄护理工具构建不完善、医护间合作欠佳、护理人员认知缺乏、环境支持不足、人力资源不足等。结论:基于最佳证据和专业判断构建的审查指标科学、有效,具有适宜性和可行性,障碍因素及促进因素分析与变革策略的制订可为体外循环下心血管外科术后谵妄管理临床实践提供保障。

心功能等级化康复护理在心肌梗死介入术后患者中的应用

目的:探讨心功能等级化康复护理在心肌梗死介入术后患者中的应用效果。方法:选取2021年4月1日~2022年11月30日心血管科收治的120例心肌梗死介入术后患者作为研究对象,按照随机数字表法分为参照组和干预组各60例,对照组实施常规康复护理,干预组实施心功能等级化康复护理措施。比较两组心功能指标、肢体功能[采用简式Fugl-Meyer评定量表(FMA)]、心绞痛发作频次、首次下床时间、平均住院时间、心脏不良事件发生情况。结果:干预4周后,两组凝血酶原时间(PT)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)指标水平均优于入院1 d(P<0.05),且干预组优于参照组(P<0.01);干预4周后,两组FMA中下肢评分、上肢评分、总得分均高于入院1 d(P<0.05),且干预组高于参照组(P<0.01);干预组心绞痛发作频次、心脏不良事件发生例数均少于参照组(P<0.05),首次下床时间、平均住院时间均短于参照组(P<0.05)。结论:对心肌梗死介入术后患者采取心功能等级化康复护理,有利于提高心脏、肢体功能水平,减少心绞痛发作频次,缩短首次下床时间和住院时间,降低心脏不良事件发生率。

前馈控制理论下肠内营养护理模式在脓毒症患者中的应用

目的 探讨前馈控制理论下肠内营养护理模式在脓毒症患者中的应用效果。方法 通过便利抽样法选取2019年1月至2022年12月南通市第三人民医院住院治疗的脓毒症患者200例,以随机数字表法将其分为对照组和试验组,各100例。对照组采用常规肠内营养护理,试验组在对照组的基础上行前馈控制理论下肠内营养护理。比较护理前后两组机体营养状态、炎性因子水平及病情状态恢复情况。结果 护理后,试验组腹泻、腹胀、呕吐、胃潴留总不良反应发生率低于对照组(P<0.05);护理后,两组白蛋白、前白蛋白、血红蛋白均高于护理前,且试验组高于对照组(P<0.05);两组急性生理学和慢性健康状况Ⅱ评分均低于干预前,且试验组低于对照组(P<0.05)。结论 前馈控制理论下肠内营养护理模式可提升脓毒症患者的营养状态,降低炎症因子水平,促进急性病情和慢性病情的恢复。

电视胸腔镜下纵膈肿瘤切除围术期护理敏感指标体系的构建

目的:构建电视胸腔镜下纵膈肿瘤切除围术期护理敏感指标体系,旨在为促进医院专科护理质量的提升提供参考。方法:以“结构-过程-结果”三维质量评价模型为基础框架,通过文献回顾、半结构式访谈和院内专家会议法,初步拟定电视胸腔镜下纵膈肿瘤切除围术期护理质量敏感指标体系,采用德菲尔函询法修改与论证,采用层次分析法确定权重。结果:2轮专家函询问卷的回收率分别为85.71%和100.00%,第2轮函询专家的专家权威系数(Cr)为0.897,指标的重要性均分为4.23~5.00分,变异系数(CV)为0.000~0.147;2轮函询的肯德尔协调系数分别为0.714和0.825(P<0.05)。构建的电视胸腔镜下纵膈肿瘤切除围术期护理敏感指标体系包括3个一级指标、8个二级指标、46个三级指标。结论:构建的电视胸腔镜下纵膈肿瘤切除围术期护理敏感指标体系科学、可靠,筛选出的评价指标可系统地为胸外科专科护理质量的持续改进提供依据。

早期肢体功能训练护理在脑梗死患者中的应用效果及对改善患者生活质量的作用分析

目的 探究确诊脑梗死疾病患者的护理方案,主要分析早期肢体功能训练作用。方法 选取2021年1月-2023年1月60例脑梗死患者展开研究,根据护理方式分组,其中行常规护理的30例为对照组,行早期肢体功能训练的30例为观察组,对比两组效果。结果 观察组护理有效率高于对照组(P<0.05);观察组疾病指标优于对照组(P<0.05);观察组生活质量评分高于对照组(P<0.05)。结论 对确诊脑梗死患者实施早期肢体功能训练护理,可提升疗效,改善疾病指标和生活质量,值得临床推广。

急诊成人体外心肺复苏护理质量敏感指标体系的构建

目的 构建急诊成人体外心肺复苏(ECPR)护理质量敏感指标。方法 本研究基于文献回顾、半结构式访谈拟定专家函询问卷,采用德尔菲法对24位专家进行问卷函询确立指标,运用层次分析法确定指标权重。结果 本研究共开展两轮专家函询,函询问卷有效回收率分别为92.31%、100.00%,专家权威系数分别为0.852、0.875,肯德尔协调系数分别为0.138、0.215(P<0.01),最终形成包含3个一级指标、7个二级指标和17个三级指标的急诊成人ECPR护理质量敏感指标。结论 急诊成人ECPR护理质量敏感指标具有较强的科学性、可靠性和实用性,可为临床应用中客观评价ECPR护理质量提供参考。

急性胰腺炎患者早期液体复苏管理审查指标的制订及障碍因素分析

目的 全面评估急性胰腺炎患者早期液体复苏管理相关证据的应用现状,制定审查指标,分析障碍因素及促进因素。方法 以知识转化框架(KTA)为理论框架,确定临床问题,组建循证团队,系统检索、评价及整合证据,制订审查指标及明确审查方法。于2022年5月1日-10月1日进行临床审查,并根据审查结果分析障碍因素及促进因素,制订行动策略。结果 该研究最终纳入15条最佳证据,制订了16条审查指标,其中15条审查指标执行率<60%。对审查结果逐条分析得出主要障碍因素:证据不可及,改变了既往工作模式;潜在采纳者认知度不够,相关知识和技能有待提高,证据转化会增加临床工作量;实践环境缺乏基于证据相关流程和变革所需设备,多学科沟通渠道不畅。主要促进因素:本院为复旦大学循证护理证据应用基地,已有多项循证项目成功转化经验;转化科室为江苏省重点专科,有变革所需要的各类人才储备,医护合作氛围良好,积极性高,学习能力强。结论 急性胰腺炎患者早期液体复苏管理的临床实践与最佳证据间尚存在较大差距,通过深入辨析障碍因素,制定相应的行动策略,促进证据向临床有效转化,以保障急性胰腺炎患者早期液体复苏执行的安全性及合理性。