构建护理质量敏感指标推动普外科优质护理质量持续改进
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摘要
目的探讨普外科护理质量敏感指标的构建及在科室优质护理质量持续改进中的应用效果。方法采用Delphi法设立9项普外科护理质量敏感指标,将其运用于科室手术患者优质护理中。对每个月的监测数据进行收集,开展动态分析,基于所得结果对护理质量进行持续改进。比较护理质量敏感指标应用前后的科室护理质量评分、患者对护理工作满意度及护理不良事件发生率。结果本次研究活动2轮专家权威系数依次为0.86、0.88,证实此次所选的专家具有比较高的权威性,专家意见变异系数依次为0～0.49、0～0.60,提示专家在各级指标的关键性方面的观点相同。护理质量敏感指标应用后,分级护理、专科技术能力、身份辨识、健康教育、护理文书书写及规范化服务评分高于应用前(P<0.01)。护理质量敏感指标应用后,患者满意度评分高于应用前(P<0.01),患者错误用药、导管堵塞及感染、导管拔管及脱落、跌倒及坠床发生率均低于应用前(P<0.05)。结论护理质量敏感指标的构建和应用能够提升普外科优质护理质量的持续改进,降低护理不良事件发生风险。
Objective To establish the nursing sensitive quality indicators in department of general surgery, and investigate the application value of indicators in continuously improvement of nursing quality. Methods Totally 9 nursing sensitive quality indicators were established by the Delphi method. Nursing management based on nursing sensitive quality indicators were carried out, and monthly monitoring data were dynamically analyzed for further quality improvement of nursing service. The outcomes in nursing quantity assessment, patient satisfaction with nursing service and incidence of nursing adverse events were observed and compared before and after implementation of sensitive quality indicators. Results The authority coefficient was 0.86 and 0.88 in two rounds of expert consultation, respectively. The coefficient of variation ranged from 0-0.49 and from 0-0.60 in two rounds of expert consultation, indicating a consistency in evaluation results of experts. After implementation of nursing sensitive quality indicators, there was a significant increase in assessment of hierarchical nursing, specialized nursing, patient identification, health education, records writing and standardized service(P<0.01), so was the patient satisfaction(P<0.01). The incidences of drug misuse, catheter dislocation and unplanned withdrawal, falling and falling from bed dropped after implementation of nursing sensitive quality indicators(P<0.05). Conclusion Establishment of nursing sensitive quality indicators is essential to continuously improve the nursing quality in department of general surgery.
Objective To establish the nursing sensitive quality indicators in department of general surgery, and investigate the application value of indicators in continuously improvement of nursing quality. Methods Totally 9 nursing sensitive quality indicators were established by the Delphi method. Nursing management based on nursing sensitive quality indicators were carried out, and monthly monitoring data were dynamically analyzed for further quality improvement of nursing service. The outcomes in nursing quantity assessment, patient satisfaction with nursing service and incidence of nursing adverse events were observed and compared before and after implementation of sensitive quality indicators. Results The authority coefficient was 0.86 and 0.88 in two rounds of expert consultation, respectively. The coefficient of variation ranged from 0-0.49 and from 0-0.60 in two rounds of expert consultation, indicating a consistency in evaluation results of experts. After implementation of nursing sensitive quality indicators, there was a significant increase in assessment of hierarchical nursing, specialized nursing, patient identification, health education, records writing and standardized service(P<0.01), so was the patient satisfaction(P<0.01). The incidences of drug misuse, catheter dislocation and unplanned withdrawal, falling and falling from bed dropped after implementation of nursing sensitive quality indicators(P<0.05). Conclusion Establishment of nursing sensitive quality indicators is essential to continuously improve the nursing quality in department of general surgery.
引文
[1] 管咏梅, 楼建华. 儿科护理敏感性质量指标的发展及应用[J]. 中国护理管理, 2014, 14(12): 1345-1346.
[2] 阐玉英, 姚文英, 许志玉, 等. 关键接触点管理在儿科优质护理服务中的应用研究[J]. 中西医结合护理(中英文), 2016, 2(12): 5-7.
[3] SOLOMONS N M, SPROSS J A. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review[J]. J Nurs Manag, 2011, 19(1): 109-120.
[4] LEWIS L C. Charting a new course: advancing the next generation of nursing-sensitive indicators[J]. J Nurs Adm, 2014, 44(5): 247-249.
[5] 郭欣, 陈赟, 施雁. 基于Donabedian质量理论构建的护理质量评价标准之间影响关系的研究现状[J]. 护理学杂志, 2014, 29(9): 92-94.
[6] 夏欢舞. 质控敏感指标在提升外科优质护理质量中的效果[J]. 中医药管理杂志, 2017, 25(4): 135-136.
[7] 高明榕, 白利平, 成守珍, 等. ICU护理质量敏感指标评价体系建立的研究[J]. 护理实践与研究, 2014, 11(7): 121-122.
[8] 张元红, 张洁, 赵丽, 等. 护理质量敏感指标质控小组的成立与运行效果[J]. 中国医科大学学报, 2018, 47(4): 370-372.
[9] 贺屏. 普外科开展优质护理服务的效果观察[J]. 国际护理学杂志, 2013, 32(8): 1840-1842.
[10] 张秀华, 刘丽, 王惠琴, 等. 精细化管理在手术室优质护理服务中的应用[J]. 全科护理, 2013, 11(34): 3231-3232.
[11] 郭秀敏. 3个护理质量敏感指标及其管理研究进展[J]. 中国护理管理, 2014, 14(9): 1001-1003.
[12] 陈霞, 唐明霞. 护理质量敏感指标在优质护理服务质量控制及持续改进中的应用[J]. 齐鲁护理杂志, 2018, 24(1): 117-119.
[13] WU Q, HUANG L H, XING M Y,et al. Establishing nursing-sensitive quality indicators for the operating room: A cross-sectional Delphi survey conducted in China[J]. Aust Crit Care, 2017, 30(1): 44-52.
[14] CONNOR J A, MOTT S, GREEN A, et al. Measurement of Quality of Nursing Practice in Congenital Cardiac Care[J]. Am J Crit Care, 2016 , 25(2): 128-35.
[15] 徐秋霞, 谢珊, 吴华. 二级精神专科医院护理敏感性质量指标的构建[J]. 中西医结合护理(中英文), 2018, 4(10): 104-107.
[16] 顾敏, 陈要武. 设立质量敏感指标推进普外科优质护理持续改进[J]. 护理学杂志, 2015, 30(13): 4-7.
[2] 阐玉英, 姚文英, 许志玉, 等. 关键接触点管理在儿科优质护理服务中的应用研究[J]. 中西医结合护理(中英文), 2016, 2(12): 5-7.
[3] SOLOMONS N M, SPROSS J A. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review[J]. J Nurs Manag, 2011, 19(1): 109-120.
[4] LEWIS L C. Charting a new course: advancing the next generation of nursing-sensitive indicators[J]. J Nurs Adm, 2014, 44(5): 247-249.
[5] 郭欣, 陈赟, 施雁. 基于Donabedian质量理论构建的护理质量评价标准之间影响关系的研究现状[J]. 护理学杂志, 2014, 29(9): 92-94.
[6] 夏欢舞. 质控敏感指标在提升外科优质护理质量中的效果[J]. 中医药管理杂志, 2017, 25(4): 135-136.
[7] 高明榕, 白利平, 成守珍, 等. ICU护理质量敏感指标评价体系建立的研究[J]. 护理实践与研究, 2014, 11(7): 121-122.
[8] 张元红, 张洁, 赵丽, 等. 护理质量敏感指标质控小组的成立与运行效果[J]. 中国医科大学学报, 2018, 47(4): 370-372.
[9] 贺屏. 普外科开展优质护理服务的效果观察[J]. 国际护理学杂志, 2013, 32(8): 1840-1842.
[10] 张秀华, 刘丽, 王惠琴, 等. 精细化管理在手术室优质护理服务中的应用[J]. 全科护理, 2013, 11(34): 3231-3232.
[11] 郭秀敏. 3个护理质量敏感指标及其管理研究进展[J]. 中国护理管理, 2014, 14(9): 1001-1003.
[12] 陈霞, 唐明霞. 护理质量敏感指标在优质护理服务质量控制及持续改进中的应用[J]. 齐鲁护理杂志, 2018, 24(1): 117-119.
[13] WU Q, HUANG L H, XING M Y,et al. Establishing nursing-sensitive quality indicators for the operating room: A cross-sectional Delphi survey conducted in China[J]. Aust Crit Care, 2017, 30(1): 44-52.
[14] CONNOR J A, MOTT S, GREEN A, et al. Measurement of Quality of Nursing Practice in Congenital Cardiac Care[J]. Am J Crit Care, 2016 , 25(2): 128-35.
[15] 徐秋霞, 谢珊, 吴华. 二级精神专科医院护理敏感性质量指标的构建[J]. 中西医结合护理(中英文), 2018, 4(10): 104-107.
[16] 顾敏, 陈要武. 设立质量敏感指标推进普外科优质护理持续改进[J]. 护理学杂志, 2015, 30(13): 4-7.