Construction Of Nursing Quality Evaluation Index System For Urology Subspecialty In Operating Room Based On Three-dimensional Quality Model

Objective:Based on the "three-dimensional quality structure" model proposed by Donabedian as the theoretical framework,the evaluation index system of urology subspecialty nursing quality in operating room was constructed,and a scientific and structured tool was provided for evaluating the nursing quality of urology subspecialty in operating room.Methods:1.Retrieve relevant literatures of urology subspecialty in operating room at home and abroad by literature review method,consult the latest version of the relevant guidelines,extract relevant nursing quality evaluation indicators,and preliminarily formulate an evaluation index system for urology subspecialty nursing quality in operating room.2.Six doctors,nurses and anesthesiologists in the urology Subspecialty Group in the operating room were selected.The research group obtained the urology subspecialty nursing indicators in the operating room by using the semi-structured interview method,which further expanded and revised the previously proposed urology subspecialty nursing quality evaluation indicators in the operating room.3.Select 19 experts who meet the standard of Delphi expert correspondence method for two rounds of correspondence,delete and modify the constructed index system according to the modification opinions given by the experts,and form the final evaluation index system of Urology sub specialty nursing quality in the operating room in combination with the discussion opinions of the research group and the acceptance and exclusion standards of the indicators.4.Use analytic hierarchy process and yaahp12.0 software to calculate the weight of each index,and test the consistency of the formed index system.5.The reliability and validity of the nursing quality evaluation index system of Urology subspecialty in the operating room were tested by questionnaire.The reliability of the questionnaire was analyzed by calculating cronbach’salpha coefficient,and the content validity and structure validity of the questionnaire were tested by Pearson correlation analysis.Results:1.Literature review results: This study finally included 99 literatures.According to the content of the literature and the research and analysis of the literature by members of the research team,the relevant indicators for the evaluation of the nursing quality of the urology subspecialty in the operating room were extracted,and the indicators were classified and sorted to initially form the nursing quality of the urology subspecialty in the operating room.The framework of the evaluation index system.2.Semi structured interview results: through summarizing and discussing the interview contents of 6 medical,nursing and anesthesiologists,the topics were further simplified and refined,and indicators such as the allocation of nursing staff in the urology subspecialty in the operating room,the related knowledge and operating skills in the urology subspecialty in the operating room,the training in the urology subspecialty in the operating room,and the standardized use of special operating equipment in the urology subspecialty in the operating room were extracted,It will further optimize and supplement the early evaluation index system framework of Urology sub specialty nursing quality in operating room.3.Delphi expert correspondence results: a total of 19 experts completed two rounds of correspondence in this study.The effective recovery rates of the questionnaire were 94.7%and 100% respectively,and the authority coefficients were 0.864 and 0.869.The two rounds of correspondence(W < 0.01,Kendall)were statistically significant(P < 0.219).Finally,the evaluation index system of nursing quality of Urology subspecialty in operating room was determined,including 3 first-class indexes,19 second-class indexes and 61 third-class indexes.4.Results of analytic hierarchy process: the weights of primary indicators are: structural indicators(0.230),process indicators(0.648)and result indicators(0.122),CR value is 0.004 and CR < 0.1.Among the secondary indicators,the top three in terms of weight are the allocation and arrangement of nursing staff of Urology subspecialty in the operating room(0.518),instruments and equipment of Urology subspecialty in the operating room(0.147),and article management of Urology subspecialty in the operating room(0.179).The CR value is between 0 and 0.045,all of which are less than 0.1.The top five in the three-level indicators are the establishment of a urological sub specialist nursing team,which is divided according to the disease(stone group,tumor group,andrology group and female pelvic floor urine control group)(0.727),proficient in the standard use of urological sub specialist endoscopic instruments,optical mirrors,electronic mirrors and 3D lenses(0.289),and clearly grasp the placement of urological sub specialist surgical position(0.559),leg frame Sand pillow,large pillow and body position protection pad shall be kept reasonably and used in a standardized manner(0.412).Foreign body forceps,Eric irrigator and optical fiber shall be fully prepared and in good performance(0.491).CR value is between 0 ～ 0.096,all less than 0.1.The weight setting is reasonable,the internal logic is good,and the degree of consistency is high.5.Reliability and validity test results: the cronbach’salpha coefficient of the whole questionnaire is 0.930,the cronbach’salpha coefficient of the primary index is between 0.743 and 0.931,and the cronbach’salpha coefficient of the secondary index is between 0.710 and0.910,all of which are greater than 0.7.All items had significant correlation with the total score(P < 0.05),and the correlation was medium and high,indicating good content validity.There was a significant correlation between the first level indicators and the total score(P <0.05),and the correlation coefficient(r)between the first level indicators and the total score was greater than that between the first level indicators,indicating that the index system has good structural validity.Conclusion:Through literature review,semi-structured interview,Delphi expert correspondence and analytic hierarchy process,this study constructed a set of dialectical and scientific evaluation index system for the quality of urological sub specialty nursing in the operating room,which has high consistency,and tested the reliability and validity.The evaluation content of urological sub specialty nursing quality in the operating room is concrete and operable,which can effectively control the quality of urological sub specialty nursing in the operating room,At the same time,it provides reference for the establishment and development of other sub specialty nursing quality evaluation system in the operating room,and also provides reference for the quantitative evaluation of follow-up nursing sub specialty.