Construction Of Quality Evaluation Index System Of Respiratory Rehabilitation Nursing Based On "Three-dimensional Quality Structure" Model

PurposeThis paper aims to construct a practical and operable respiratory rehabilitation nursing quality evaluation index system,promote respiratory rehabilitation nursing to be scientific and standardized,and perfect the quality of respiratory rehabilitation nursing.MethodBy using literature review and semi-structured interviews,the item pool for evaluation index of nursing quality of respiratory rehabilitation was established based on the "structure-process-outcome" quality evaluation model proposed by Avedis Donabedian.The Delphi method was adopted to conduct two rounds of expert consultation with 31 experts from Beijing,Shanghai,Sichuan,Chongqing,Hubei and other provinces and cities.The importance of the index was assigned by the experts and suggestions for the revision of the index items are put forward.The experts' enthusiasm,authority and opinion coordination were analyzed by the calculation of related coefficients.Based on Delphi method and analytic hierarchy process,the weight of each index was determined and the consistency test was carried out.According to the constructed evaluation index system of respiratory rehabilitation nursing quality,the questionnaire for evaluation of respiratory rehabilitation nursing quality was compiled.In order to test the reliability and validity of the index system,and improve the evaluation index system of respiratory rehabilitation nursing quality,preliminary investigations were conducted at 16 medical institutions in Chongqing from December 2019 to January 2020.Results1.Basic information of expert: 31 experts,from 20 hospitals in Beijing,Shanghai,Chongqing,Sichuan,Hubei and other provinces and cities,participated in the consultation,and they are major in rehabilitation nursing management,clinical nursing,clinical medicine respectively.Age: 16 experts were aged from 30-39,accounting for 51.6%.8 experts were aged from 40-49,accounting for 25.8%.7 experts aged 50 and above,accounting for 22.6%.Education background: 23 experts are undergraduates,accounting for 74.2%;8 experts are master or above,accounting for 25.8%.Professional title: 6 experts are supervisor nurse,accounting for 19.4%.25 experts are associate professor of nursing and above,accounting for 80.6%.Departments: 15 experts come from Pneumology Departmen,accounting for 48.4%.11 experts come from rehabilitation department,accounting for 35.5%.5 experts come from ICU,accounting for 16.1%.Professional field: 2 experts are major in Clinical Medicine,accounting for 6.4%.14 experts are major in Clinical Care,accounting for 45.2%.15 experts are major in Nursing Administration,accounting for 48.4%.Hospital grade: 26 experts come from Top three hospitals,accounting for 83.9%.5 experts come from grade-A hospital of second class,accounting for 16.1%.Years of working: 24 experts are with working experience from 10 years to 19 years,accounting for 77.4%.7 experts are with 20 years working experience and above,accounting for 22.6%.2.31 experts took part in the two rounds consultations.31 consultation forms are given out in the first round consultation,all were recovered with a recovery rate of 100%,among which 16 experts proposed revision suggestions.31 consultation forms are given out in the second round consultation,all were recovered with a recovery rate of 100%,among which 5 experts proposed revision suggestions.In the two rounds consultation,criterion(Ca)is 0.905 and 0.940;Familiarity(Cs)is 0.839 and 0.90;Authority coefficient(Cr)are 0.872 and 0.922,respectively.The expert coordination coefficients of one,two,three indicators are 0.583,0.498 and 0.407,which have statistical significance checked by Kendall testing method(P <0.01).3.The weight values of the first-level index are structure quality 0.085,process quality 0.597,and outcome quality 0.318,respectively.The weight values of the second-level index are nursing staff management 0.207,nursing quality management system 0.207,facility management 0.055,respiratory rehabilitation nursing ability 0.531,rehabilitation evaluation 0.476,health education 0.333,nursing effect evaluation 0.875,nursing satisfaction evaluation 0.125 respectively.C.R.values of all level indicators are less than 0.1.The weight values are reasonable and with good consistency4.The Cronbach's alpha coefficient of evaluation index system is 0.930.The Cronbach's alpha coefficient of first-level index line in 0.703 ~0.936.The Cronbach's alpha coefficient of second-level index line in 0.765~0.889.all Cronbach's alpha coefficients are bigger than 0.7,which indicates that the internal consistency of the indicator system is good.All the entries are significantly correlated with the total score(P < 0.05),and the correlation degree is the medium height.All the first-level index are significantly correlated with the total score(P < 0.05),and the correlation degree is height.The correlation coefficient between the score of first-level indexes and the total score is bigger than the pertinence coefficients among the level indicators.5.The constructed evaluation index system of respiratory rehabilitation nursing quality consists of three dimensions: structure quality,process quality and result quality,which includes 3 first-level indexes,9 second-level indexes,and 46 third-level indexes.ConclusionA respiratory rehabilitation nursing quality evaluation index system,which includes 3 first-level indexes,9 second-level indexes,and 46,third-level indexes was constructed by utilizing literature review,semi-structured interviews and Delphi method.Weight values of each index was determined by analytic hierarchy process.Each index weight is set reasonably,and the reliability and validity of the evaluation index system are good.The constructed index system is scientific,systematic and comprehensive.It can provide a practical and operable assessment tool for respiratory rehabilitation nursing management,and it also can perfect the nursing quality of respiratory rehabilitation.