Construction Of Nursing-sensitive Quality Indicators System Of Enteral Nutrition Based On Evidence

Objective Based on the "structure-process-result" management model to bulid the nursing-sensitive quality indicators system of enteral nutrition in hospitalized adult patients,aiming to provide scientific,objective and quantitative monitoring basis for clinical enteral nutrition nursing quality.Methods1.Based on JHNEBP model to proceed a evidence-based analysis and evidence synthesis,establishing the foundation for nursing-sensitive quality indicators of enteral nutrition.2.Adopted group discussion method to obtain indicators that comforming clinical demands,and drafted nursing-sensitive quality indicators,calculation formulas and data collection methods of enteral nutrition3.Adopted Delphi method to improve and established the nursing-sensitive quality indicators system of enteral nutrition.4.Adopted AHP method to set the weight of nursing-sensitive quality indicators system of enteral nutrition.Results1.A total of 683 references were preliminarily retrieved and 19 articles were i ncluded after the first and second sieving,including 3 articles(15.8%)in IIA,7articles(36.8%)in IIIA,2 articles(10.5%)in IIIB,2 articles(10.5%)in IVA level,1 articles(5.3%)in IVB level,2 articles(10.5%)in VA level,and 2 articles(10.5%)in VB level.After face-to-face group discussion,the indicators in the lite rature were summarized and organized,and the drafted nursing-sensitive quality indicators system of enteral nutrition included 3 first-class indicators,6 second-cl ass indicators and 17 third-class indicators.2.The results showed:(1)The experts were highly motivated:the effective respo nse rates were 92% and 100%;The authoritative were high: Cr coefficients wer e 0.915,0.925.(2)The concentration degree of experts were high.The mean sco re of item importance in the first round were 4.000~4.957 and the standard de viation and full mark rate were 0.209~1.522 and 0.348~0.957%.In the second round,the mean score of item importance was 4.043~5.000,the standard deviat ion was 0.000~1.022,and the full score was 0.391~1.000.(3)The W coefficient of two rounds were 0.124~0.233 and 0.141~0.242,P<0.01.3.The weight of the first-level indicators were structure(0.1958),process(0.4934),and result(0.3108).The weight of the second-level indicators were nursing evaluation(0.2467),nursing implementation(0.2467),patient clinical outcome(0.20721),management system(0.13054),nursing effect evaluation(0.10359)an d facility allocation(0.06526).Among the 17 three-level indicators,the top 10 i ndicators were aspiration incidence(0.12433),nutritional risk screening(0.12335),nutritional ststus assessment(0.12335),patients with good knowledge of ent eral nutrition(0.06906),confirm feeding tube position(0.06836),nutrition profes sional group with regular training(0.06527),nurses with enteral nutrition knowl edge qualified(0.06527),feeding with the head of 30°to 45°bed up(0.05415),the proportion of enteral nutrition infusion pump(0.04351),feeding tube flu shing operated correctly(0.04290).Conclusion1.This study based on JHNEBP model for evidence-based analysis and evidence synthesis,establishing the foundation of nenteral nutrition nursing quality sensitivity index system.2.This study obtained reliable and stable results by Delphi method,and constructed scientific and reliable enteral nutrition nursing quality sensitivity index system finally.3.This study adopted AHP method to strengthen the logical of experts judgment.All levels' weight distributions were reasonable and have passed the consistency test.