Study On The Establishment Of The Evaluation Index System Of First Class Nursing Quality

First class nursing is the focus of nursing classification,which is usually an important indicator for nursing quality.With the increasing number of patients and the reforming of the medical system along with the changing of the medical model, the old mode of first class nursing can not meet the patients' increasing requirements and the rapid development of nursing fields.Nursing quality in different hospitals is thus uneven,if things continue,not only nursing quality but also the whole medical quality will be impaired.Evaluation of nursing quality is an important part of improvement of nursing quality and is also the core of the management of the nursing quality,which provide reference bases for standardizing nursing quality.Evaluation index system is the instrument to evaluate nursing quality,which is the guarantee for the improvement of nursing quality.At present,there is no unified evaluation index system of first class nursing quality in our country and most of the evaluation indexes in use are local standards, which will bring about unfair and unscientific evaluation outcome for hospitals, especially for hospitals at the same level.In doing so,enthusiasm of nursing practice will be seriously impaired and which is harmful for the improvement of the nursing quality.Objective To structure scientific and unified evaluation indexes of first class nursing quality to provide reference bases for standardizing first class nursing quality.MethodsWith Delphi method,22 experts in the area of quality of nursing supervision, clinical nursing and nursing education were investigated for two times.Based on the opinions of the experts,evaluation indexes of first class nursing quality were set up. The experts come from 10 provinces and municipalities.Age range is from 37 to 53,and the average age is 47.32±5.80.Working years of these experts range from 11 to 38,the mean is 47.32±5.80.all the experts are above assistant professor academic rank.8 of them(36.4%) have high technical title and 14 of them(63.6%) have vice-senior title.The basic principles and methods for setting up evaluation indexes of first class nursing quality were discussed by view study and theory study.The pilot survey was carried out with self-designed questionnaire to improve the questionnaire.The results were analyzed according to the experts' opinions.Analytic Hierarchy Process (AHP) was used to calculate the weights of indicators in grade one and grade two. And the experts' evaluation was used to calculate the weights of indicators in grade three.In the study,describing statistics was used to analyze demographic constitution of experts.Mean and coefficient of variance was used to describe the experts' opinion of the importance of the item;and the coefficient of Kendall's W,percentage of questionnaire received and authority degree of experts were used to examine the reliability and representation of expert consultation.The data were analyzed with statistical package of social sciences(SPSS) 13.0 and Excel2003. Results1.The reliability and consistency of the Expert ConsultationAccording to the demographic factors,the experts show higher education level. The percentage of experts with bachelor's degree and that with Master's degree are 50.0%and 31.8%respectively.The percentage of experts working more than 20 years is 40.9%,more than 30 years is 31.8%.In addition,authority degree of experts is beyond 0.8.Therefore,based on practice and theory,the consultation of experts had high reliability.The percentage of questionnaire received from 2 rounds of experts consultation were more than 80%.It shows the enthusiasm and support of the experts. The coefficient of Kendall's W of 2 rounds were 0.385 and 0.415(p=0.000) respectively,which provides sufficient evidence of high consistency among experts opinions.2.screen evaluation indexes and set weights of indexesUsing Likert 5-scale method to describe the experts' opinion of the importance of the item,and the mean beyond 3.5 and the coefficient of variance less than 0.3 were used to screen indexes.Conclusions could be drawn according to the statistics above.On the other hand,mean of item had been used to calculate the Saaty sign.According to the analytic hierarchy process,indicators in grade one and grade two were used to establish the multi-rank judge matrix.And the weights of items were then identified.The value of RI showed that evaluation index system of first class nursing quality had logical consistency.And the experts' evaluation was used to calculate the weights of indicators in grade three.In the evaluation indicator system, the weight coefficients of grade one including structure quality,process quality and outcome quality were 0.268,0.614 and 0.117 respectively(CR=0.063).And the items with maximal and minimal weights of 13 indicators in grade two were illness observation(0.183),Therapeutic nursing(0.183)and basic life nursing(0.023) respectively(CR=0.020);And the items with maximal weights of 39 indicators in grade three were medication nursing(0.061),the performance of treatments (0.061)and the correct rate of nursing intervention(0.061).Kendall's W=0.343,χ~2=286.92(P=0.000).ConclusionsAfter 2 rounds of experts consultation and statistics analysis,the evaluation index system of first class nursing quality was established.Finally the significance of establishing of the evaluation index system of first class nursing quality was discussed.1.Establishment of the evaluation index system of first class nursing qualityBased on the theory and methodology of evaluation,and on the related authoritative literatures,the evaluation index system of first class nursing quality was established,which were composed of three classes of items:three indicators in grade one(structure nursing quality,process nursing quality and outcome nursing quality), thirteen indicators in grade two and thirty-nine indicators in grade three.Of three indicators in grade one,structure nursing quality indicator includes three items in grade two and ten items in grade three;process nursing quality indicator includes seven items in grade two and twenty-three items in grade three;outcome nursing quality indicator includes three items in grade two and six items in grade three.And the weights of items were identified.The reliability analysis of the 2 rounds expert consultations showed that the expert consultations had good reliability and representation.2.the characteristics of the evaluation index system of first class nursing quality With the research to establish the the evaluation index system of first class nursing quality,the evaluation of first class nursing quality was improved.The evaluation index system of first class nursing quality established with Delphi and AHP highlights the following features:first,evaluation index system of first class nursing quality insures scientific and valid nature,which could provide reference bases for standardizing first class nursing quality.Second,the process quality should be paid more attentions.By doing so,nursing quality could be improved continuously. Third,first class nursing needs nurses with high professional quality,indicating the training for professional quality of nurse should be enhanced.Fourth,patients take part in the evaluation of nursing quality,which could fully reflect the concept of patient first and meet the trends for increasing evaluation by patients.3.Significance of the establishment of the evaluation index system of first nursing qualityQuantification of the evaluation index system of first nursing quality made it comparable and objective in evaluating first nursing quality.And by setting up the weights of items the evaluation index system could be calculated more easily,which would provide quantificational and objective method in evaluating first nursing quality.In addition,establishing a unified evaluation index system of first nursing quality in China would meet the need of standardizing the management of clinical nursing quality,would be consistent with the requirement of evaluating nursing quality in different hospitals according to the unified standard,and would be in line with the need of the nationwide hospital quality review.What's more,the evaluation system revealed the important elements to ensuring the first nursing quality,which could not only evaluate the first nursing quality but also provide guidance to nursing practice.