以质量求发展,以服务铸品牌

护理学报 ›› 2023, Vol. 30 ›› Issue (6): 1-6.doi: 10.16460/j.issn1008-9969.2023.06.001

• 研究生园地 •    下一篇

基于结构-过程-结果模型构建结肠镜检查患者护理敏感性质量指标体系

蔡文文1a,2,张星星1b,叶敏珊1a,2,罗艳霞1a,2,阮伟清1a,李加1a   

  1. 1.南方医科大学南方医院 a.惠侨医疗中心;b.普外科,广东 广州 510515;
    2.南方医科大学 护理学院,广东 广州 510515
  • 收稿日期:2022-10-24 出版日期:2023-03-25 发布日期:2023-04-12
  • 通讯作者: 阮伟清(1975-),女,广东韶关人,本科学历,副主任护师,护士长,硕士研究生导师。E-mail:jamela@sina.com
  • 作者简介:蔡文文(1998-),女,浙江温州人,本科学历,硕士研究生在读。
  • 基金资助:
    广东省科技计划项目(2020A1414040014)

Construction of nursing sensitive quality indicator system for patients undergoing colonoscopy based on structure-process-outcome model

CAI Wen-wen1a,2, ZHANG Xing-xing1b, YE Min-shan1a,2, LUO Yan-xia1a,2, RUAN Wei-qing1a, Li Jia1a   

  1. 1a. Huiqiao Medical Center; 1b. Dept. of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;
    2. School of Nursing, Southern Medical University, Guangzhou 510515, China
  • Received:2022-10-24 Online:2023-03-25 Published:2023-04-12

摘要: 目的 构建结肠镜检查患者护理敏感性质量指标,为结肠镜检查护理质量评价及管理提供参考依据。方法 参考结构-过程-结果模型理论为框架依据,采用循证方法、Delphi法及层次分析法构建结肠镜检查护理敏感性质量指标体系及计算各级指标权重。结果 2轮Delphi专家函询问卷有效回收率分别为89%、92%,专家权威系数为 0.890、0.904,专家协调系数为0.160、0.299(P<0.001),指标体系一致性检验达到标准(CR<0.1)。最终指标体系包含一级指标3项,二级指标6项,三级指标20项。结论 结肠镜检查患者护理敏感性质量指标体系具有科学性与实用性,可为结肠镜检查护理质量持续改进提供指导。

关键词: 结肠镜检查, 结构-过程-结果模型, 循证, Delphi法, 护理敏感性质量指标

Abstract: Objective To construct a nursing sensitive indicator system for patients undergoing colonoscopy, and to provide reference for the evaluation and management of colonoscopy nursing quality. Methods Taking structure-process-outcome model as the theoretical framework, a nursing sensitive indicators system for colonoscopy care was constructed through evidence-based method and Delphi method, and analytic hierarchy process was used to calculate the weights of indicators at each level. Results The effective recovery rate of the two rounds of Delphi expert consultation was 89% and 92%; the authority coefficient 0.890 and 0.904; and coordination coefficient of expert 0.160 and 0.299, respectively (P<0.001). The final nursing sensitive indicator system had good consistency (CR<0.1), and consisted of 3 first-level, 6 second-level, and 20 third-level indicators. Conclusion The nursing sensitive indicator system for patients undergoing colonoscopy is scientific and practical, which provides guidance for continuous improvement of colonoscopy care quality.

Key words: colonoscopy, structure-process-outcome model, evidence-based, Delphi method, nursing sensitive indicator

中图分类号: 

  • R473.57
[1] Fernández-Landa MJ, Aginagalde AH, Arana-Arri E, et al.Quality indicators and patient satisfaction in colonoscopy[J]. Gastroenterol Hepatol,2019,42(2):73-81.DOI:10.1016/j.gastrohep.2018.07.006.
[2] Kim SY, Kim HS, Park HJ.Adverse events related to colonoscopy: global trends and future challenges[J]. World J Gastroenterol, 2019, 25(2):190-204. DOI:10.3748/wjg.v25.i2.190.
[3] Zhao S, Wang S, Pan P, et al.Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis[J]. Gastroenterology, 2019, 156(6):1661-1674. DOI:10.1053/j.gastro.2019.01.260.
[4] Afaneh T, Abu-Moghli F, Ahmad M.Nursing-sensitive indicators: a concept analysis[J]. Nurs Manag (Harrow), 2021, 28(3): 28-33. DOI:10.7748/nm.2021.e1982.
[5] 赵诗雨, 喻姣花. 专科护理质量敏感性指标研究进展[J]. 护理研究, 2019, 33(8):1342-1346. DOI:10.12102/j.issn.1009-6493.2019.08.014.
[6] 裴理辉, 柴宇霞, 贾亚南, 等. 百草枯中毒患者口腔溃疡护理质量敏感指标的构建及应用[J]. 护理学报, 2021, 28(11):62-65. DOI:10.16460/j.issn1008-9969.2021.11.062.
[7] 周梅花, 刘丽娟, 谢红珍, 等. 内镜质量规范化管理评价指标体系的构建[J]. 护士进修杂志, 2017, 32(10): 867-871. DOI:10.16821/j.cnki.hsjx.2017.10.002.
[8] 熊宇, 徐玉兰, 胡灵芝, 等. 层次分析法构建消化内镜微创治疗围术期护理质量评价指标体系[J].护理学杂志, 2017, 32(17): 43-46. DOI:10.3870/j.issn.1001-4152.2017.17.043.
[9] 宗杰. 护理质量敏感指标对消化内镜感染质控管理的评价及质量持续改进的影响[J]. 护理实践与研究, 2020, 17(21): 124-126. DOI:10.3969/j.issn.1672-9676.2020.21.047.
[10] 朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994. DOI:10.16821/j.cnki.hsjx.2017.21.025.
[11] Dicenso A, Bayley L, Haynes RB.Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009, 12(4):99-101. DOI:10.1136/ebn.12.4.99-b.
[12] 韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读[J]. 中国循证儿科杂志,2013,8(4):316-319. DOI:10.3969/j.issn.1673-5501.2013.04.017
[13] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967.
[14] 潘秋花, 王贺, 李萍. 消化内镜护理质量指标评价体系的构建[J]. 国际医药卫生导报,2021,27(8):1259-1262. DOI:10.3760/cma.j.issn.1007-1245.2021.08.039.
[15] Lund M, Trads M, Njor SH, et al.Quality indicators for screening colonoscopy and colonoscopist performance and the subsequent risk of interval colorectal cancer: a systematic review[J]. JBI Database System Rev Implement Rep, 2019, 17(11):2265-2300. DOI:10.11124/JBISRIR-2017-003927.
[16] Valori R, Cortas G, De Lange T, et al.Performance measures for endoscopy services: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative[J]. Endoscopy,2018,50(12):1186-1204. DOI:10.1055/a-0755-7515.
[17] 朱秀琴, 郑娜, 赵豫鄂, 等. 消化内科护理质量监测指标的构建及实施[J]. 中华现代护理杂志, 2018, 24(6):638-642. DOI:10.3760/cma.j.issn.1674-2907.2018.06.005.
[18] Day LW, Cohen J, Greenwald D, et al.Quality indicators for gastrointestinal endoscopy units[J]. Video GIE, 2017, 2(6): 119-140. DOI:10.1016/j.vgie.2017.02.007.
[19] Kaminski MF, Thomas-Gibson S, Bugajski M, et al.Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative[J]. Endoscopy, 2017, 49(4): 378-397. DOI:10.1055/s-0043-103411.
[20] 熊宇, 胡灵芝, 刘媛, 等. 消化内镜微创治疗围手术期护理质量评价指标体系的构建[J]. 护理管理杂志, 2017, 17(9):647-650.DOI:10.3969/j.issn.1671-315X.2017.09.014.
[21] Rex DK, Schoenfeld PS, Cohen J, et al.Quality indicators for colonoscopy[J]. Am J Gastroenterol, 2015, 110(1):72-90. DOI:10.1038/ajg.2014.385.
[22] Sung JJ, Ng SC, Chan FK, et al.An updated Asia Pacific Consensus Recommendations on colorectal cancer screening[J]. Gut, 2015, 64(1):121-132. DOI:10.1136/gutjnl-2013-306503.
[23] MacIntosh D, Dubé C, Hollingworth R, et al. The endoscopy global rating scale-Canada: development and implementation of a quality improvement tool[J]. Can J Gastroenterol, 2013, 27(2):74-82. DOI:10.1155/2013/165804.
[24] Armstrong D, Barkun A, Bridges R, et al.Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy[J]. Can J Gastroenterol, 2012, 26(1): 17-31. DOI:10.1155/2012/173739.
[25] Borgaonkar MR, Hookey L, Hollingworth R, et al.Indicators of safety compromise in gastrointestinal endoscopy[J]. Can J Gastroenterol, 2012, 26(2):71-78.DOI:10.1155/2012/782790.
[26] Sifri R, Wender R, Lieberman D, et al.Developing a quality screening colonoscopy referral system in primary care practice: a report from the national colorectal cancer roundtable[J]. CA Cancer J Clin, 2010, 60(1):40-49. DOI:10.3322/caac.20048.
[27] Lieberman D, Nadel M, Smith RA, et al.Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the national colorectal cancer roundtable[J]. Gastrointest Endosc, 2007, 65(6):757-766. DOI:10.1016/j.gie.2006.12.055.
[28] Rembacken B, Hassan C, Riemann JF, et al.Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy(ESGE)[J].Endoscopy, 2012, 44(10):957-968. DOI:10.1055/s-0032-1325686.
[29] 陈艳, 谭思源, 张悦, 等. 综合性医院手术室专科护士培训方案的设置与实践[J]. 护理实践与研究, 2016, 13(2): 132-135. DOI:10.3969/j.issn.1672-9676.2016.02.064.
[30] 黄宝宏. 层次分析法在评价应用中的统计学审视[J]. 中国卫生统计,2008,25(2):201-203.DOI:10.3969/j.issn.1002-3674.2008.02.030.
[31] 余茴香, 刘樱, 胡保红, 等. 基于三维质量模式构建围术期癌症病人营养护理质量评价指标体系[J]. 护理研究, 2022, 36(3):386-392.DOI:10.12102/j.issn.1009-6493.2022.03.002.
[32] Cai W, Zhang X,Luo Y,et al.Quality indicators of colonoscopy care:a qualitative study from the perspectives of colonoscopy participants and nurses[J]. Bmc Health Serv Res, 2022, 22(1):1064. DOI:10.1186/s12913-022-08466-5.
[33] 翟静妤. 质量管理对消化内镜清洗消毒效果的影响[J]. 中国医刊, 2018, 53(6):669-671. DOI:10.3969/j.issn.1008-1070.2018.06.027.
[34] 国家卫生健康委. 国家卫生健康委关于印发《全国护理事业发展规划(2021-2025年)》的通知[EB/OL].(2022-04-29)[2023-02-02].http://www.gov.cn/zhengce/zhengceku/2022-05/09/content_5689354.htm.
[35] 蒋蓉, 张素, 胡雪慧, 等. 消化内镜专科护士培训及职业发展需求的调查研究[J]. 中国护理管理, 2021, 21(3): 425-429. DOI:10.3969/j.issn.1672-1756.2021.03.020.
[36] 路琴, 季红莉, 黄慧, 等. Bristol大便性状分型量表对拟行肠镜检查老年人肠道准备的指导价值[J]. 中华老年多器官疾病杂志, 2021, 20(9):665-668. DOI:10.11915/j.issn.1671-5403.2021.09.139.
[37] 马彦君, 杨新惠, 高鸿亮, 等. 结肠镜检查中盲肠插管率的预测因素分析[J]. 中国内镜杂志, 2021, 27(10):46-51. DOI:10.12235/E20210423.
[38] 王亚军, 杨幼林. 结肠镜检查不良事件及处理方法的临床研究进展[J]. 国际消化病杂志, 2019, 39(5):325-328;340. DOI:10.3969/j.issn.1673-534X.2019.05.005.
[39] 国家卫生健康委办公厅. 国家卫生健康委办公厅关于印发超声诊断等5个专业医疗质量控制指标(2022年版)的通知[EB/OL].(2022-05-11)[2023-02-02].http://www.nhc.gov.cn/yzygj/s7657/202205/56765f0f512f4f058efc4169a0e1c639.shtml.
[40] 李纯香, 王贤君, 郑少端. 结肠镜检查前肠道准备FMEA护理模式的应用研究[J]. 基层医学论坛, 2022, 26(11):124-126. DOI:10.19435/j.1672-1721.2022.11.041.
[41] Heslop L, Lu S, Xu X.Nursing-sensitive indicators: a concept analysis[J]. J Adv Nurs, 2014, 70(11):2469-2482. DOI:10.1111/jan.12503.
[42] Gallagher RM, Rowell PA.Claiming the future of nursing through nursing-sensitive quality indicators[J]. Nurs Adm Q,2003,27(4):273-284.DOI:10.1097/00006216-200310000-00004.
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