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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (4): 251-258.

• 论著 • 上一篇    下一篇

新生儿危重症护理管理质量评价指标体系的初步构建

刘林霞1,2,张玉侠1,吕天婵1,胡晓静1   

  1. 1 复旦大学附属儿科医院护理部 上海，201102; 2 现在上海健康医学院工作
  • 收稿日期:2016-08-29 修回日期:2016-08-29 出版日期:2016-08-25 发布日期:2016-08-25
  • 通讯作者: 张玉侠

Construction of quality indicators to assess the quality of neonatal intensive care unit nursing: a pilot study

LIU Lin-xia1,2, ZHANG Yu-xia1, LV Tian-chan1, HU Xiao-jing1   

  1. 1 Nursing Department,Children′s Hospital of Fudan University, Shanghai 201102, China; 2 Now at Shanghai University of Medicine and Health Science
  • Received:2016-08-29 Revised:2016-08-29 Online:2016-08-25 Published:2016-08-25

PDF

2081

被引次数

15

摘要：

目的 构建NICU护理质量评价指标体系，促进NICU全面质量的持续改进，提升危重新生儿救治成功率和生命质量。方法 基于“结构-过程-结果”理论模型搭建NICU护理质量评价指标逻辑关系，结合我国医院管理的相关政策法规和NICU建设管理标准，参考儿童、成人和危重症护理质量评价指标并结合新生儿疾病特点，初步建立NICU护理质量评价指标并进行定义，咨询专家以咨询计分法采取不记名2轮护理质量评价指标问卷咨询，提出删除、拆分、添加、修改和合并的意见，取第2轮问卷咨询指标赋分值，构建判断矩阵，确定护理质量评价指标的权重关系。结果 来自中国9省市12所三级甲等妇幼保健院或儿童专科医院48名专家应邀参与了问卷咨询，2轮问卷咨询均得到了100%的回复。根据“结构-过程-结果”理论模型建立并定义了67个评价指标（结构19个，过程18个，结果30个），第1轮问卷咨询中，删除8个、拆分1个、添加4个、修改4个、合并2个指标；第2轮问卷咨询中，删除5个指标，无拆分、添加、修改和合并指标，对3个一级、14个二级、58个评价指标（结构16个，过程18个，结果24个）权重和组合权重计算结果显示，一、二和三级指标重要性赋值均数分别为4.6~4.9、4.1~4.9和3.7~5.0，满分频率分别为60.4%~88.6%、25.6%~90.7%和6.3%~97.9%，呈现一、二和三级指标重要性赋值均数和满分频率范围值逐渐宽泛的趋势。一、二和三级指标一致性系数均<0.1，均具有满意的一致性。结论 以“结构-过程-结果”为理论基础搭建的58个三级NICU护理质量评价指标，取得了咨询专家一致的认同，为更深入的相关研究鉴定了重要基础。

Abstract:

Objective The aim of this study was to develop a composite index indicators of Neonatal Intensive Care Unit（NICU） quality and thus to promote the continuing improvement of NICU overall quality, improve the success rate of treatment and quality of life in the critical newborns.Methods Based on Donabedian′s model which provided the framework, the study was established premilinarily and defined as composite index indicator of NICU quality through combining with the relevant policies，laws of national hospital management, construction and management standards of NICU. Meanwhile, pediatric, adult and intensive care quality indicators were well referenced. Two rounds of questionnaires were delivered. The expert panel members exchanged their opinions anonymously through letters of inquiry and then provided recommendations for delete, add, split, revise and merge. After the two rounds, Analytic Hierarchy Process was adopted to calculate weights of nursing quality indicators through erecting the judgment matrix. Results Forty-eight NICU experts in 12 tertiary maternal and child health hospital or children′s hospital spread across 9 provinces in China participated in two rounds of Delphi panels and all panel members responded. Sixty-seven indicators including 19 structure indicators, 18 process indicators and 30 outcome indicators were established based on the Donabedian′s model. In the first round, 8 were deleted, 1 was splited, 4 were added, 4 were revised and 2 were merged while only 5 were deleted without other changes in the second round. The Analytic Hierarchy Process was used to determine the weight of the ultimate composite indicator of NICU quality(16 structure indicators, 18 process indicators and 24 outcome indicators). Statistical data showed that the mean importance scores of 3 first-level indicators, 14 second-level indicators and 58 third-level indicators were 4.6-4.9、4.1-4.9, 3.7-5.0,0.310 8, 0.493 4, 0.195 8, and the full mark rate was 60.4%-88.6%、25.6%-90.7%, 6.3%-97.9% respectively, which had shown a wider tendency of the range. The three levels indicators were well consistency with the consistency ration (CR) less than 0.1.Conclusion Based on the Donabedian′s model, 58 NICU nursing quality indicators which reached a reliable consensus within the panel members were identified. The study offered the instructive probe for further researches.