Construction Of Evaluation Indicator System For Pulmonary Rehabilitation Nursing Quality Of Patients With COPD In A Stable Period

ObjectiveThis study aims to through the literature analysis,semi-structured interviews,Delphi method and analytic hierarchy process,based on Donabedian "structure-process-result" three dimensional quality structure model,constructs a set of quality index system of pulmonary rehabilitation nursing in patients with COPD stable stage,which makes it scientific,systematic and clinical applicability,and provides a theoretical basis and reference standard for scientific and objective evaluation of lung rehabilitation nursing quality.Methods1.According to the literature of lung rehabilitation in COPD stable period,the quality evaluation index of lung rehabilitation related nursing was extracted by literature analysis.2.Eight medical staff were selected to obtain clinical practice index through semistructured interview method,and a framework of evaluation index system of lung rehabilitation related quality in patients with COPD stable period was preliminarily constructed.3.Using the Delphi method,40 and 37 qualified experts were selected for two rounds of inquiry,and the index system was modified according to the expert opinion.The index was screened by a "boundary value method" to form the final index system.4.The analytic hierarchy process is used to determine the weight of each index,and the consistency test is carried out.5.The field investigation method was used to carry out the empirical research of four indicators by using the checklist: "patients' awareness rate of knowledge related to rational oxygen therapy","compliance rate of the standard use of lung inhalation device",and "compliance rate of standard execution of respiratory function exercise","Patient satisfaction".Results1.Received three first-level indicators,structure,process and results,ten secondary indicators,74 measures of three-level nursing quality evaluation index system.2.The results of the consultation showed that: the recovery rates of the two rounds of the questionnaire were 92.5%(37/40),94.6%(35/37),Cr was 0.809 and 0.820,and the enthusiasm and authority of experts were high.(2)the W coefficients of the two rounds of consultation were 0.121 and 0.263 respectively,and the P values of the significance test results were all less than 0.01,indicating a reasonable degree of expert coordination.3.The weights of the three first-level indexes were structural(0.1396),process(0.5278),outcome(0.3325);the first three of the second-level indexes were evaluation of the effect of pulmonary rehabilitation(0.2217),observation of the condition of rehabilitation(0.2061),the nursing practice of pulmonary rehabilitation(0.1458);the first five of the combined weights were heart rate,rhythm,respiration,blood pressure,oxygen saturation monitoring(0.1017),observation of the patient's: sweating,etc.the evaluation of motor ability(0.0443),conscious symptoms such as palpitation,chest tightness,chest pain,dizziness(0.0404),patient satisfaction(0.0383),and the CR values of consistency test for all levels of indicators <0.1.4.Data collected for four indicators within three months were 73.3%(88/120),86.7%(104/120),96.7%(116/120),53.2%(117/220),70.9%(156/220),and 87.3%(192/220)of patients' knowledge of reasonable oxygen treatment.The compliance rate of respiratory function exercise was 52.9%(74/140),71.4%(100/140),and 80.0%(112/140),and the patient satisfaction rate was 76.92%(150/195),84.62%(220/260),and 90.60%(212/234).all of which were improved to different degrees,indicating the continuous improvement of the quality of special care.Conclusion1.This study is based on the scientific and advanced theoretical model,based on evidence-based analysis results,combining qualitative and quantitative studies,and adopting a variety of research methods,to gradually build a comprehensive and distinct evaluation index system for pulmonary rehabilitation nursing quality of patients with COPD in a stable period,which is scientific and systematic.2.In this study,two rounds of expert consultation were conducted,and reliable results were obtained,showing good enthusiasm of experts,a high degree of authority,and a reasonable degree of concentration and coordination of expert opinions.3.In this study,the AHP method and Delphi method were combined,and all the hierarchical indexes passed the consistency test,and the weight allocation was reasonable and effective.4.Four indicators of data have been proven to reflect the quality of care effectively,can be used in clinical practice.