| Objective:To construct nursing quality evaluation indicator system of specific,sensitive and clinically applicable for intravenous thrombolytic among acute ischemic stroke patients,which based on the structure-process-outcome quality model proposed by Donabedian A.So as to provide a reference for clinical evaluation and monitoring the patients.Method:1.Formed evaluation indicator initially:Using literature analysis retrieved literatures and extract evaluation indicators after analyzing,sorting and summarizing literature.The field investigation the first-line nursing content of patients and noted the points of nursing evaluation,nursing measures,and nursing observation.Abstract into measurable indicators,combined with literature analysis,adding,deleting and revising evaluation indicators.Totals of 7 experts were selected for assessment in the fields of emergency nursing,neurology nursing and medicine,etc.And combined the feedback with discussion of group meeting,the revised "Expert enquiry questionnaire(first round)" was formed.2.Determined evaluation indicator:Using Delphi method for two rounds consultations.using Excel2010 and SPSS24.0 for data statistical analysis,describing measurement data with (?)ąs and count data with frequency and percentage.The degree of expert opinion coordination is expressed by Kendall's W,using non-parametric tests of multiple related samples for significance test,the tests level is 0.01.3.Calculated the indicator weight:Using AHP software Yaahp 9.0 to establish a hierarchical structure model,construct a judgment matrix,conduct consistency test,determine each indicator weight and combination weight.Results: After two round of Delphi,we constructed nursing quality evaluation indicator system for intravenous thrombolytic among acute ischemic stroke patients,consist of 3 first-level indicators,13 second-level indicators and 53 third-level indicators.The 23 experts included were stroke centers from 19 grade A hospital in 12 provinces.The effective response rates of two rounds were both 100%,authority coefficients were 0.896,0.902,coefficients of concordance were 0.224,0.318,and P values were less than 0.001.The results of the AHP show that the consistency check ratio CR of all levels of indicators is <0.1,indicating that there is no logical error in the indicator system,and the weight distribution is consistent.The weights of the first-level indicators are: process indicator 0.491,structure indicator 0.312,and result indicator 0.198.The top three indicators are: completeness rate of nursing records(0.0444),Patient / family satisfaction(0.0441),staff training institution(0.0435).Conclusion:The study developed the nursing quality evaluation indicator system based on Donabedian's "structure-process-results" quality model,covering 3 first-level indicators,13 second-level indicators and 53 third-level indicators.The constructed indicator system is scientific and reasonable,which emphasizes characteristics of care and practicability.It can provide a reference for scientific evaluation of intravenous thrombolytic care and improve the quality of care. |
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