Preliminary Construction Of An Evaluation Index System For Oral Care Quality In Patients With Endotracheal Intubation

Objective:Based on the current situation of lack of standard oral care effect evaluation system and non-standard oral care operation for patients with orotracheal intubation in China,this study constructed an evaluation index system of oral care quality for patients with orotracheal intubation and tested its reliability and validity,aiming to clarify the key monitoring links of oral care and evaluate the quality of oral care.To reduce the incidence of oral care adverse events in patients with orotracheal intubation.Methods:This project is based on the theory of "structure-process-outcome".Through literature review and semi-structured interviews,the item pool of oral care quality evaluation indicators for patients with orotracheal intubation was initially formed.An expert letter consultation questionnaire on the evaluation index system of oral care quality for patients with orotracheal intubation was formed.The evaluation index system of oral care quality for patients with orotracheal intubation and the weight of indicators at each level were established through Delphi expert letter consultation and analytic hierarchy process.Finally,the reliability and validity of the oral care quality evaluation index system for patients with orotracheal intubation were tested.The details are as follows:1.Literature review: Comprehensively searched Pub Med,EMbase,CINAHL,Wanfang,Zhichou and other databases to understand the influential factors and high-quality evidence of oral care for patients with oral catheterization at home and abroad,and preliminarily determined the content of evaluation indicators.2.Semi-structured interview: The literature related to oral care and quality evaluation indicators for patients with orotracheal intubation was reviewed,and an interview outline was made.A total of 12 nursing managers and clinical nurses from three ICU s of a Classⅲ Grade A hospital in Shanxi Province who met the inclusion and exclusion criteria were interviewed by purposive sampling method.Colaizzi 7-step analysis method was used to sort out,analyze and classify the interview data and supplement the indicators.3.Delphi expert consultation method: 20 experts engaged in ICU nursing management or nursing education were selected to conduct two rounds of expert consultation by email.The items that did not meet the standards were deleted through the mean importance,coefficient of variation and full score ratio of the questionnaire filled by experts,and modified according to expert opinions and the results of the research group discussion.4.Analytic hierarchy process: through the establishment of analytic hierarchy process model,construction of judgment matrix,according to the data obtained from the second round of Delphi expert consultation to determine the weight of indicators and calculate the consistency coefficient,consistency test was carried out.5.Questionnaire survey method: The reliability and validity of the questionnaire were analyzed by calculating Cronbach’s alpha coefficient and split-half reliability coefficient,and the content validity index was calculated by experts’ content validity evaluation table.Results:1.Through systematic literature review,combined with the relevant content of the "Clinical Nursing Practice Guideline 2011" on oral care of patients with orotracheal intubation in airway care,referring to the group standard of "Oral Care for Adult Patients with orotracheal intubation and mechanical Ventilation in 2021" formulated by the Chinese Nursing Association,combined with the results of literature retrieval and semi-structured interview,The first draft of the oral care quality evaluation index system for patients with orotracheal intubation was preliminary formed,including 3 first-level indicators,11second-level indicators and 61 third-level indicators.2.A total of 20 experts were finally included in the consultation,and the effective recovery rate of the questionnaire was 80% and 100%.A total of 72 written opinions were put forward in the two rounds of consultation.The expert positive coefficients were 0.8and 1.0,the expert authority coefficients were 0.845 and 0.860,and the Kendall coordination coefficients were 0.198 and 0.207.Finally,the first draft of the oral care quality evaluation index system for orotracheal intubation patients was formed,including 3first-level indicators,9 second-level indicators,and 51 third-level indicators.3.Results of analytic hierarchy process: the weight of first-level indicators were:structure index(0.1958),process index(0.4934),outcome index(0.3108).The CR value was 0.0516,<0.1.The top four weights of the second-level indicators were oral care implementation(0.2469),oral care adverse events(0.2072),oral care evaluation(0.1233),and process monitoring(0.1233).CR values ranged from 0 to 0.0454,all <0.1.In the third-level indicators,the top five were the risk implementation rate of monitoring patients(0.0925),the completion rate of management standards(0.0573),the incidence of extenuation and damage of tracheal intubation(0.0519),the incidence of aspiration and asphyxia of patients(0.0408),the implementation rate of position preparation(0.0381).CR values ranged from 0 to 0.0315,all <0.1.4.The reliability and validity of the preliminary formed quality evaluation index system were analyzed,and the overall Cronbach’s α was 0.971,and the split-half reliability coefficient was 0.898.According to the responses of 6 experts to the content validity questionnaire,the content validity index CVI was 0.974.Conclusions:The oral care quality evaluation index system for patients with orotracheal intubation constructed in this study has scientific and reliable content,and the weight obtained is acceptable,which provides a reference for clinical nursing staff to evaluate the quality of care,improve the quality of care,and avoid adverse events.