Construction Of Evaluation Indicator System For Nutritional Nursing Quality Based On Three-dimensional Quality Structure Model

Objective(1)To construct an evaluation indicator system of nutritional nursing quality based on three-dimensional quality structure model.(2)To establish the weight of nutritional nursing quality evaluation indicator system.Methods(1)Literature research was used to integrate relevant domestic and foreign literatures and preliminarily screened related indicators of nutritional nursing quality evaluation;Selected 8 nursing managers,5 doctors and 7 nurses for semi-structured interviews using the purposive sampling method,and to extract nutritional nursing quality evaluation indicators in line with China’s national conditions.Based on the threedimensional quality structure model,the draft of nutritional nursing quality evaluation indicator system was formed.(2)Adopted the expert meeting method,7 experts in the fields of nursing management,clinical nursing and nutrition were invited to discuss and modify the indicators of the evaluation indicator system draft,and formulated the first edition of nutritional nursing quality evaluation indicator system.(3)Invited 15 experts from 9 Grade III Level A hospitals in 6 provinces and cities across the country for expert consultation.The importance of all indicators was assessed through two rounds of expert consultation,and the draft of the nutritional nursing quality evaluation indicator system was revised according to the expert opinions,the finally nutritional nursing quality evaluation indicator system was established.(4)Analytic Hierarchy Process was used to establish the weight and combined weight of each indicator,and the consistency test was carried out.Results(1)On the basis of literature research and semi-structured interview,the nutritional nursing quality evaluation indicator system draft was formed,including 3first-level indicators,namely structure indicators,process indicators and outcome indicators,and 11 second-level indicators,namely staffing,equipment and environment,organizational structure and institutional norms of nutritional nursing,nutritional nursing education and training,nutritional screening and evaluation,nutritional nursing practice,nutritional nursing document,nursing effect,nutritional nursing complication and adverse event,satisfaction,utilization of medical resources and 53 third-level indicators.(2)The first edition of nutritional nursing quality evaluation indicator system was formed through the expert meeting method,including 3 first-level indicators,7second-level indicators and 19 third-level indicators.Each third-level indicator contains indicator description,calculation method and data collection method.(3)The questionnaire recovery rates of the two rounds of expert consultation were 80% and93.75%.The degree of expert authority of the two rounds were 0.866 and 0.860 respectively,and the Kendall W were 0.163(P<0.001)and 0.101(P < 0.05).The final nutritional nursing quality evaluation indicator system consists of 3 first-level indicators,7 second-level indicators and 22 third-level indicators(6 structure indicators,9 process indicators and 7 outcome indicators).(4)The Analytic Hierarchy Process shows that CR of all indicators is less than 0.1,indicating a high degree of consistency of the indicator system.The weight order of the 3 first-level indicators is the same,which is 0.333.Among the second-level indicators,the top 3 indicators of combined weight were nutritional risk screening and assessment(0.222),nutritional nursing effect(0.222)and staffing and training(0.165).Among the third-level indicators,the top 3indicators of combined weight were accuracy of nutritional risk screening(0.148),compliance rate of nutritional nursing rules and regulations(0.104),and compliance of patients’ dietary behavior(0.088).Conclusion(1)Based on the three-dimensional quality structure model,this study constructed the nutritional nursing quality evaluation indicator system,including 3 firstlevel indicators,7 second-level indicators and 22 third-level indicators.Each three-level indicator contains indicator description,calculation method and data collection method.The construction method of the indicator system was scientific and reliable,and the indicator system had strong practicability and feasibility.(2)The second-level indicators with the highest weight was nutritional risk screening and assessment,nutritional nursing effect,and the third-level indicators with the highest weight was the accuracy of nutritional risk screening,which provides a basis for the monitoring priorities of the indicator system,so as to facilitate clinical evaluation and improvement of nutrition nursing quality.