| Background There has been a continuous struggle between humans and infectious diseases,and the introduction of novel infectious diseases as well as the prevalence of classic infectious diseases have increased the danger of infection with acute and chronic infectious diseases in a growing number of populations.Building an infectious diseases specialty is crucial in order to handle these problems,and nurse management are increasingly focusing on,struggling with,and interested in studying the quality of care in infectious diseases.For nursing management professionals,improving the standard of specialized care while ensuring the safety of patients and healthcare workers with contagious diseases has taken priority.Understanding the degree of nursing quality and executing effective management require scientific quality evaluation.The development of a specialized nursing quality evaluation index system and an impartial assessment of nursing quality are essential to managing nursing quality.The infectious disease department is a location where patients with infectious diseases are concentrated,involving a variety of illnesses and infectious sources,while the environment of the infectious disease specialty is more complex than that of other departments due to the hidden nature of infectious diseases and the high risk of occupational exposure.The quality of nursing care in infectious disease specialties cannot currently be objectively evaluated,making it impossible to direct the ongoing improvement of nursing quality in infectious disease specialties.Instead,there is a lack of a systematic,scientific,and specialty-specific system for evaluating nursing quality.Objectives The aim of this study is to develop a scientific,standardized,and systematic nursing quality evaluation index system for the infectious disease specialty,to apply the evaluation system to clinical practice,to research the state of nursing quality in the infectious disease specialty,to comprehend the true feelings of nurse leaders and quality control nurses in using the evaluation tool to verify the scientific and practicality of the index system,and to.Methods 1.Literature research method The relevant literature on nursing care,nursing quality assessment,and other related topics was reviewed in CNKI,Wanfang,Web of Science,Pubmed,and other Chinese and English databases,consult books,norms and guidelines like Accreditation Standards for Tertiary Hospitals(2020 version),Medical Quality Control Indicators for Nursing Specialties(2020 version),Prevention and Control Program for Novel Coronavirus Infection and related norms and guidelines,etc.The findings from the study served as the basis for designing the outline of the qualitative interview and screening the entries for the quality evaluation index system for specialty care in infectious diseases.2.Qualitative interview method At three tertiary general hospitals,21 infectious disease physicians,nurses,nursing managers,infection control nurses,and inpatients with infectious diseases participated in qualitative interviews.Colaizzi 7-step content analysis method was used to organize the interview data.The subjects were improved,and a draft of the nursing quality evaluation index system for infectious disease specialty was created based on the three-dimensional quality model of "structure-process-outcome".3.Delphi method Two rounds of expert correspondence were implemented from August to September 2022 by distributing emails,inviting 21 experts in the fields of infectious disease nursing,infectious disease medicine,nursing management,and infection prevention and control to evaluate the importance and feasibility of the indicators and to propose modifications.Based on the principles of indicator selection combined with the discussion and agreement of the research group,the quality evaluation indicator system for infectious disease specialist nursing was determined.4.Analytic Hierarchy Process Based on Yahhp10.1 software,the steps of AHP were followed to establish a hierarchical structure model,construct a judgment matrix,determine the weights of each indicator and the combination weights and conduct consistency tests to more accurately understand the importance of each evaluation indicator in the overall evaluation of the quality of specialist infectious disease care.5.Cross-sectional study Based on the results of the nursing quality evaluation index system and weights for infectious disease specialty formed by the study,standardized scores and scoring methods were set for the index items,a nursing quality evaluation table for infectious disease specialty was formed,and a perception questionnaire for the use of the evaluation form was designed.Using the convenience sampling method,10 infectious disease specialties from different regions of tertiary general hospitals were selected for the applied study,and the researcher was mainly assisted by nurse leaders and quality control nurses to collect and evaluate data related to the quality of care in the department from October to December in 2022.The TOPSIS method based on MATLAB 2022 a was used to analyze and compare the quality of care in infectious disease specialties.Based on the evaluation results,we analyzed the current situation of the quality of care in infectious disease specialties.Descriptive statistics were used to analyze the data collectors’ perceptions of using the evaluation form.Results 1.Infectious disease specialty care quality evaluation index system 1.1 Results of the literature study We discovered through a thorough search of pertinent literature databases and the study of related materials that adverse events occur during the course of infectious disease specialty care,affecting patient outcomes and nursing care quality,and that nursing care quality evaluation standards are not yet standardized and lack a scientific and systematic nursing care quality evaluation system.The quality of nursing care evaluation in infectious disease specialties differs from other departments due to the strong specialization of infectious diseases and the complexity of infectious diseases,particularly in terms of environmental settings,specialized skill requirements,infection prevention and control management,and psychological care.We also discovered that the primary theoretical framework for the development of nursing quality evaluation index systems is the threedimensional quality model of "structure-process-outcome".The design and execution of the qualitative interviews,as well as the development of the quality evaluation index system for infectious disease specialties,were all based on the literature research and theoretical analysis,which also served as the framework for the study.1.2 Results of the qualitative interviews Four different themes were gleaned from in-person interviews with 21 pertinent employees.They are: "It is necessary to develop the infectious diseases specialty nursing quality evaluation system,the subjects related to the quality of nursing structure of infectious diseases specialty(adequate nursing staff,environment,and equipment;education,training,and ability requirements;system norms);and the subjects related to the quality of nursing process of infectious diseases specialty(nursing quality of specialty nursing,basic nursing,and safety management).The first draft of the evaluation index system for the quality of specialized nursing care for infectious diseases,including 3 firstlevel indexes,14 second-level indexes,and 78 third-level indexes,was drawn up,and the Delphi expert consultation questionnaire was compiled.1.3 Results of the Delphi expert correspondence In this study,a total of 21 experts from 11 provinces and cities in Shaanxi,Beijing,Anhui,Liaoning,Zhejiang,Chongqing,Shandong,Hubei,Hebei,Guangdong,and Xinjiang provinces in China were selected to participate in the subject correspondence,including 8 infectious disease nursing experts,3 infectious disease medical experts,8 nursing management experts and 2 infection prevention and control experts.The age of the experts consulted ranged from 38 to 60(47.50±6.16)years;their working years ranged from 13 to 37(23.10±6.35)years;their senior titles accounted for 90.48%;and their master’s degrees and above accounted for 42.86%.Two rounds of inquiry were carried out,23 questionnaires and 21 questionnaires were distributed,the recovery rates were 91.30% and 100%,respectively,the positive degree of experts was high,the coefficient of experts’ authority was 0.869,and the degree of authority was high;The second round’s degree of harmony was higher than the first,as evidenced by the Kendal harmony coefficients of the first and second rounds being statistically significant(P<0.05).This indicates that the expert opinions are focused and the study findings are trustworthy.Finally,a system of assessment indexes consisting of 3 first-level indexes,12 second-level indexes,and 63 third-level indexes,to measure the quality of nursing care in the infectious diseases specialty.1.4 Results of Analytic hierarchy process The weights of each level index and the combination weights were determined by AHP analysis,and the consistency test of the judgment matrix constructed by each level index was in line with the requirements(CR<0.1).The process index of the first-level index had the highest weight(W=0.4905),followed by the structure index(W=0.3119)and the outcome index(W=0.1976).Among the second-level indicators of the structure index,the top three combination weights were "systems and standards(W=0.3200)","theoretical knowledge and skills(W=0.2422)",and "education and training(W=0.1867)";among the second-level indicators of the process index,the top three combination weights were "infection control(W=0.3603)","specialty nursing practice(W=0.2726)",and "safety management(W=0.1985)";among the second-level indicators of the outcome index,the highest combination weight was "adverse events(W=0.7500)",followed by "satisfaction(W=0.2500)".2.Results of the application of the quality evaluation index system for infectious disease specialty care 2.1 Current status of quality of care in infectious disease specialties Using the infectious disease specialty nursing quality evaluation table,the nursing quality of 10 tertiary hospitals’ infectious illness specializations was assessed.The closeness values of each department to the ideal solution were analyzed using the TOPSIS approach,and they were ranked in order of perfection(H2,H8,H6,H4,H1,H5,H3,H7,H9,and H10).The analysis of the current situation reveals that the quality of nursing care varies somewhat among infectious disease specialties.Quality managers can improve the structural quality of infectious disease specialties in the following ways: increasing the number of nursing staff,especially the number of infectious disease specialist nurses;by actively forming multidisciplinary cooperation teams for infectious disease nursing;and by paying attention to the mental health of infectious disease specialist nursing staff.2.2 Perceptions of the use of the evaluation form for the quality of nursing care in infectious disease specialties All 10 data collectors believed that the evaluation form’s indicators were comprehensive and practicable;nine believed it could distinguish between the quality of care provided by various infectious disease specialties and be sensitive;eight believed it could reflect the quality of care provided by various infectious disease specialties and be valid;and they all expressed a willingness to use the evaluation form to ascertain the level of quality of care.In addition,the collectors all said that the scoring method for each item of this evaluation form was clearly set up and could comprehensively evaluate the quality of nursing care in the infectious disease specialty;however,it was relatively timeconsuming to use in the clinic and its simplicity could be improved.The quality evaluation can provide an understanding of the relative weaknesses in the quality of nursing care in the department and provide a direction for promoting continuous improvement of nursing quality.Conclusions The research techniques employed were scientific and rigorous,ensuring the validity and reliability of the index system.The comprehensive infectious disease specialist nursing quality evaluation index system covered structural quality,process quality,and outcome quality.The TOPSIS method can be used to analyze the results of nursing quality,which can reflect the nursing quality level of infectious disease specialty more realistically and,at the same time,verify the feasibility of the index.The definition,calculation formula,numerator denominator description,and specific scoring method of each index were set through the expert group discussion.The application study’s findings might offer specific recommendations and a benchmark for raising the standard of infectious disease specialized nursing care.This study offers a practical and scientific evaluation tool for the quality management of infectious disease specialty nursing,which has positive implications for the ongoing enhancement of the quality of infectious disease specialty nursing and serves as a reference for future in-depth studies on the subject. |
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