Construction Of Sensitive Indicators Of Nutritional Nursing Quality For Gastric Cancer Patients

ObjectiveOur view aims to take the three-dimensional quality structure model “structureprocess-result” as theoretical basis,based on the literature research and used Delphi method and analytic hierarchy process building scientific,reliable and rational sensitive indicators of nutritional nursing quality for gastric cancer patients,so as to provide evidence for scientific monitoring and evaluation of nutritional nursing quality for gastric cancer patients in the future.Methods1.Literature research method: Eight Chinese and English databases were searched from inception to August 2021 for collecting relevant literatures on nutritional nursing quality evaluation of gastric cancer patients.Hand searches also were conducted in the reference lists of the included literatures.In addition,four commonly used guideline websites were also searched for collecting relevant gastric cancer guidelines.2.Group discussion method: We established a research discussion group to sort out and analyze nutritional nursing quality indicators in the included literatures,including their significance,calculation formula and data collection method,preliminarily established sensitive indicators.Then,we compiled the Delphi questionnaire,selected Delphi experts,analyzed and discussed about the experts’ opinion.3.Delphi method: The Delphi method was used to conduct two rounds of with 30 experts in our view.The data were analyzed by Excel2019,SPSS25.0.The reliability of Delphi results was analyzed by using the effective response rate of questionnaire,expert authority coefficient,variation coefficient,Kendall coordination coefficient and so on.Meanwhile,we combined the inclusion criteria of indicators with experts’ opinion modifying,adding,or deleting some indicators to finally determine the sensitive indicators of nutritional care quality for gastric cancer patients.4.Analytic hierarchy process: Based on the results of the second round of Delphi,we calculated the weight of sensitive indicators and conduct consistency test by using analytic hierarchy process.Results1.Literature research results: After preliminary screening and re-screening,thirteen literatures were included.After two rounds of face-to-face group discussions,we initially established the sensitive indicators of nutritional care quality for gastric cancer patients,including three first-class indicators,ten second-class indicators and 48third-level indicators.Based on the above indicators,we compiled the delphi questionnaire,and 30 experts from 13 top three hospitals in seven provinces were selected.2.Delphi results: The effective response rates of the two rounds of Delphi questionnaires were 83.33% and 88.00%.The experts’ authority coefficients of the two rounds of Delphi were 0.872 and 0.900.The indicators’ variation coefficients of the two rounds of Delphi were 0.000～0.445 and 0.000～0.181.The indicators’ Kendal coordination coefficients of the two rounds of Delphi were 0.132～0.170 and0.145～0.188,with P values less than 0.05.The mean score of indicators importance of the two rounds of Delphi ranged from 3.440～5.00 to 4.227～5.000,the standard deviation was ranged from 0.000～1.530 to 0.000～0.780,and the full score ratio was ranged from 0.240～1.000 to 0.409～1.000.In the first round of Delphi,ten indicators were modified,nine were deleted,and three were added.A total of seven indicators were deleted in the second round of Delphi,and finally the sensitive indicators of nutritional care quality for gastric cancer patients were identified,including three firstclass indicators,nine second-class indicators and 35 third-class indicators.3.Weight calculation results: The weights of first-class indicators were 0.2500（structure indicator）,0.5000（process indicator）and 0.2500（result indicator）.The weights of second-class indicators were 0.04085（facilities and equipment）,0.07425（human resources）,0.1349（education and training on nurses）,0.0998（nutrition risk screening and assessment）,0.0702（health education）,0.165（parenteral nutrition nursing operation skill）,and 0.165（parenteral nutrition nursing operation skill）,0.125（patient outcome）,0.125（nursing effect evaluation）.Among the 35 third-class indicators,the top ten of combined weights were satisfaction rate of patients to nutritional nursing,awareness rate of patients to knowledge about nutrition care,incidence rate of parenteral nutrition related complications,nutritional risk screening rate,parenteral nutrient solution configuration specification rate,venous catheter maintenance specification rate,nutrition tube position confirmation rate,nurse nutrition knowledge training rate,nursing operation skill examination pass rate,incidence rate of enteral nutrition related complications.ConclusionsOur view built the sensitive indicators of nutritional nursing quality for gastric cancer patients,including facilities and equipment,human resources,the nurse education and training,and evaluation of nutritional risk screening,health education,enteral nutrition nursing procedures,parenteral nutrition nursing procedures,patient outcomes and nursing effect evaluation of nine aspects a total of 35 third-class indicators.The sensitive indicators are scientific,reliable and rational,which can strengthen the standardization of nutritional care for gastric cancer patients and provide evidence for scientific evaluation and monitoring of nutritional care quality in the future,so as to promote the continuous improvement of overall nursing quality.