| Objective Based on Donabedian's "Structure- Process- Result" mode to construct a scientific,systematic and operable nursing sensitive quality indicator system in respiratory medicine,and conduct empirical research, aiming to provide references for evaluating quality of care in a more scientific and rational way.Methods1. Based on JHNEBP model to conduct a evidence synthesis and evidence-based analysis of domestic and foreign studies about nursing sensitive quality indicators, laying the foundation for nursing sensitive quality indicators localization in respiratory medicine.2. Adopted semi-structured interview to acquire indicators that meeting clinical nursing practice demands.3. Adopted Delphi method to construct nursing sensitive quality indicator system in respiratory medicine, and conducted reliability tests with Cronbach's ? coefficient and Bland-Altman difference analysis diagram.4. Adopted AHP method to set indicator's weight.5. Adopted scene investigation method to conduct empirical research on COPD patients' respiratory function exercise specification implementation rate, inhalants specification usage rate and ventilator-associated pneumonia care bundle's compliance.Results1. A total of 33 studies were included, forming into 11 categories: nurse resources, nurse structure, patient risk assessment and prevention, clinical nursing practice,hospital-acquired infections, nursing adverse events, patient outcomes / complications,patient-related functional status, patient satisfaction, nurse-related results, medicalresource utilization. 45 general nursing sensitive quality indicators were divided into7 structural indicators, 9 process indicators, and 29 outcome indicators.2. A total of 22 qualified experts were invited for Delphi expert consultation. The results showed:(1) The two rounds effective response rates were 100%, 90.9%, Cr coefficients were 0.820, 0.865 respectively, which indicated the experts' enthusiasm and authority were favorable.(2) In the first round, the mean score, standard deviation, and full mark rate of 98 indicators were 3.063~5.000, 0~0.932, and 0~100% respectively, in the second round, the values of 86 indicators were 3.450~5.000, 0~0.759, 5%~100%,indicating the concentration of experts opinion was high.(3) In the first round, 51.0%indicators' CV> 0.1, in the second round, the proportion dropped to 30.7%, indicating the consistency of experts opinion was gradually increased; W coefficient of two rounds were 0.131, 0.286, significance test results showed the P values was less than0.001, which means the consistency of expert opinions was acceptable. Reliability test showed:(1) overall Cronbach's ? coefficient was 0.911, each level's Cronbach's ?coefficient was greater than 0.8, which indicated the questionnaire had a good internal consistency.(2)Bland-Altman difference analysis diagram also indicated an acceptable reliability.3. The weigh of structure, process, outcome was 0.200, 0.400, 0.400, CR = 0.052, less than 0.1; the CR values of 14 secondary indicators were also less than 0.1, top 5 were clinical nursing practice, patient risk assessment and prevention, nurse resources,hospital-acquired infections and nursing adverse events; the CR values of 68 third degree indicators were also less than 0.1, top 10 were nurse-patient ratio, work experience, pressure, fall, ventilator-associated pneumonia incidence, catheter-related bloodstream infection incidence, the total number of nurses, nurse On-the-job training,patient satisfaction of care, drug safety management practices.4. The rate of COPD patients' respiratory function exercise specification implementation,inhalants specification usage and ventilator-associated pneumonia care bundle'scompliance were 61.25%, 77.50% and 93.75% respectively, ICC = 0.956.Conclusions1. This study based on the understanding of current research, meet the patient safety goals,nursing quality management needs and specialist nursing trends, adopted scientific theoretical model and evidence-based analysis, combined qualitative and quantitative research together, used multiple research methods to construct nursing sensitive quality indicator system in respiratory medicine, which was scientific and systematic.2. Reliable results were obtained by Delphi method, the experts' enthusiasm and authority were favorable, the concentration and consistency of experts opinion were high and acceptable, and the questionnaire had a good internal consistency.3. This study combined AHP method and Delphi method to set indicator's weight, which strengthen the logical and scientific of experts judgment, the consistency test results showed that all the CR value was less than 0.1, indicating that the weight distribution was reasonable.4. COPD patients' respiratory function exercise specification implementation rate,inhalants specification usage rate and ventilator-associated pneumonia care bundle's compliance had a different degree of volatility, ICC was greater than 0.75, the consistency of survey results was favorable, indicators had highly nursing sensitive and clinical applicability. |
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