| Objective:To establish scientific,sensitive and pragmatic nursing-sensitive quality indicators which can contribute to evaluate nursing quality in tertiary general hospitals in Hebei Province.Methods:The first stage: To make a preliminary design for the nursing-sensitive quality indicator by employing the theoretical analysis,the evidence summarization and the semi-structured interviews of the experts.To construct the frame structure of the indicator system preliminarily;to make the quality assessment and the evidence summarization for the searched documents by employing the theory of Johns Hopkins Nursing Evidence-based Practice;to make the semi-structured interviews of the 14 nursing quality management experts in the province choosing by using the purposive sampling and quantify the interview by the method of content analysis.The second stage: To determine the final index system by the Delphi technique.To write the name,the definition,the meaning and the computational formula of the indicators in the preliminary system in the questionnaire;to choose 34 nursing quality management experts in the province to investigate by employing the purposive sampling;to invite the experts to judge the importance and the feasibility of each indicator by using the Likert scale.To modify the indicators by analyzing the mean,the standard deviation and the variable coefficient of the indicators and the advices proposed by the experts;to analyze the reliability of the advices proposed by the experts by employing the expert positive coefficient and the authority coefficient;to employ the Kendall's coefficient of concordance(W)to test the consistency of the advices of the experts.Results:The first stage: To divide the primary indicator into structure indicator,process indicator and the result indicator by using the 3D model of the quality to conduct the basic framework through the theoretical analysis;to bring into28 documents and 28 secondary indicators by employing the evidence summarization;to select 32 indicators appear more than twice in all the interviews by using the method of the content analysis.Finally,preliminary indicator system is formed through the group analysis.3 primary indicators and 31 secondary indicators are included.The second stage:After the first stage,one expert of the information center loses to follow up and one expert of the information center writes“unfamiliar” in the self-evaluation table and 32 experts participate in the three rounds investigation.The average age of the experts is 47.22±5.67 and the years of working in this profession are 13.44±8.61;the percentage of experts with master's degree is 28.10% and the percentage of experts with associate senior professional title is 100%.After 3 rounds of experts consultation,the enthusiasm coefficient of experts was 94%-100%.In the first round,115 advices are proposed by 22 experts and one secondary indicator is added and 9are deleted.In the second round,32 advices are proposed by 14 experts and 2secondary indicators are added and 3 are deleted.In the third round,16 advices are proposed by 6 experts and one secondary indicator is deleted.The expert authority coefficient is 0.84±0.09;the variable coefficient is 0.00-0.22 and the Kendall's coefficient of concordance is 0.09-0.24(P<0.05),which show good concordance between the experts and the high reliability of the result of the investigation.Conclusion:The final system of the nursing-sensitive quality indicators for the large size tertiary comprehensive hospitals in Hebei Province: 3primary indicators:(structure indicator,process indicator and result indicator),20 secondary indicator,every indicator has the detailed definition,meaning,computational formula and the assessment method.The localized nursing-sensitive quality indicators constructed through evidence-basednursing,semi-structured interview and the Delphi method provide guidance for the nursing management and the clinical care. |
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