Construction Of Nursing Quality Evaluation Index For Elderly Patients With Unstable Angina By Clinical Nursing Pathway

ObjectiveThrough field observation and in-depth interviews with geriatrics nurses,and based on evidence to construct the evaluation index of nursing quality of elderly patients with unstable angina,the purpose of this study is to conveniently and intuitively evaluate the nursing quality of elderly patients with unstable angina applied with clinical nursing pathway,so as to improve the quality and efficiency of clinical nursing and improve the satisfaction of patients.MethodsThis study is divided into two parts:The first part is the qualitative research on the nursing quality evaluation indexes of elderly patients with unstable angina by clinical nursing pathway.First,the field observation method was used to observe the evaluation indexes of nursing quality in geriatrics department.Then,by using the method of objective sampling,the geriatric nurses in a tertiary general hospital were selected as the interviewees for in-depth interview.NVivo 11 software was used to code the documents,and the Colaizzi 7-step phenomenological data analysis method was used to analyze the interview data.The second part is to construct the evaluation index of nursing quality of elderly patients with unstable angina based on evidence Methods: We searched CBM,CNKI,Wanfang,VIP and other Chinese and Englishdatabases,including Ovid,JBI,PubMed,CBM,CNKI,Wanfang,VIP,and other Chinese and English databases,and included the literature that met the standards and evaluated the quality level.Finally,the evaluation indicators of nursing quality for elderly patients with unstable angina were screened out.ResultsIn the first part,based on the results of field observation and in-depth interview,it is concluded that there are three first-class,seven second-class and 19 third-class indicators for the elderly patients with unstable angina,and the approval rate of the first,second and third-class indicators are all100%.In the second part,through literature retrieval,screening and evaluation,14 eligible literatures were included,including 3 guidelines and 11 original studies(6 were grade A and 5 were grade B).The evaluation indexes of nursing quality for elderly patients with unstable angina were extracted,including 2 first-class,2 second-class and 16 third-class indicators.After discussing the results of the two parts,three first level indicators,seven second level indicators and 27 third level indicators were constructed.The first level indicators included structural indicators,process indicators and outcome indicators.The second level indicators included nursing duration,nursing quality,patient safety,patient compliance,satisfaction,economic benefits and patient outcomes.The third level indicators included nursing hours(one structural indicator)The compliance rate of pain assessment,the awareness rate of health education,the implementation rate of hydration treatment of nurses after coronary intervention,the number of nursing defects,the accident rate of patients transported in hospital,the physical restraint rate of hospitalized patients,the implementation rate of intravenous hydration of patients after coronary intervention(7 processindicators);nurses' satisfaction,patient satisfaction,hospitalization expenses,hospitalization days,self-care ability,indwelling catheter Unplanned extubation rate,incidence of pressure ulcers in hospitalized patients,incidence of falls / falls,incidence rate of complications,catheter related infection rate,compliance rate of 8h in patients after coronary intervention,incidence rate of 30 days after discharge,incidence of 6months after discharge,readmission rate,mortality rate of hospital,incidence of restenosis,limitation of physical activity,self-protection awareness,treatment dependence Compliance(19 outcome indicators).Conclusion:(1)Combined with the results of the first and second parts,the construction of clinical nursing pathway for elderly patients with unstable angina nursing quality evaluation indicators include 3 first-class,7second-class,27 third-class indicators,see Appendix 2.According to the characteristics of elderly patients and unstable angina disease,the 27 indicators were included in the evaluation of nursing quality of elderly patients with unstable angina who applied clinical nursing pathway.(2)The application of special nursing sensitive indicators to evaluate the nursing quality of elderly patients with unstable angina by clinical nursing pathway is helpful to continuously improve the quality of nursing work.(3)When evaluating the nursing quality of elderly patients with unstable angina pectoris by clinical nursing pathway,we should focus on the patient outcomes.The outcome oriented indicators can make nurses more objective and forward-looking in the nursing process.(4)The Seattle Angina Questionnaire(SAQ)and Angina Nursing Questionnaire(NAQ)can be integrated to evaluate the physical activity limitation,disease cognition,self-protection awareness and treatmentcompliance of elderly patients with unstable angina by clinical nursing pathway.Meanwhile,the non quantitative evaluation indexes can be considered to use the scales or questionnaires with high reliability and validity at home and abroad.