河北省三级综合医院护理质量敏感性指标的构建

发布时间：2018-01-12 01:08

本文关键词：河北省三级综合医院护理质量敏感性指标的构建　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:构建科学、敏感、实用的河北省三级综合医院护理质量敏感性指标,为省内医院护理质量评价提供相关依据。方法:第一阶段:通过理论分析、证据总结与专家半结构式访谈法对护理质量敏感性指标进行初步设计。通过理论分析,初步搭建指标体系框架结构;采用美国霍普金斯循证护理实践理论和方法,对搜索到的文献进行质量评价及证据总结;通过目的抽样对省内14名护理质量管理专家进行半结构式访谈,根据内容分析法量化访谈内容。通过以上步骤,研究小组组内讨论形成初始指标体系。第二阶段:通过Delphi专家函询法确定最终敏感性指标体系。基于初始指标体系编制函询问卷,将初始体系中各指标名称、定义、意义及计算公式全部编入问卷中;通过目的抽样,选取省内14家三级综合医院34名专家进行函询;采取Likert 5级评分法请专家分别对每项指标的重要性及可行性进行评判。通过分析各指标均数、标准差、变异系数及专家所提意见对指标进行修改;采用专家积极系数、权威系数分析函询专家意见的可靠性;采用Kendall协调系数W检验评价专家之间意见的一致性。结果:第一阶段:通过理论分析,采取质量三维模型搭建基本框架,将一级指标划分为结构指标、过程指标及结果指标三个维度;通过证据总结共纳入28篇文献,28项二级指标;通过内容分析法筛选出在全部访谈中出现频次2的指标共32项。最终经小组讨论形成初始指标体系包含一级指标3项,二级指标31项。第二阶段:第一轮结束后,1名信息中心专家失访,1名信息中心专家自评表填写为不熟悉,最终32名专家完成3轮函询。专家平均年龄为47.22±5.67岁,本专业工作工作年限13.44±8.61年;具有硕士学位占28.10%,具有副高以上职称占100%;在3轮函询中,专家积极系数在94%-100%。第一轮有22名专家提出115条修改意见,增加二级指标1个,删除二级指标9个;第二轮有14名专家提出32条修改意见,增加二级指标2个,删除二级指标3个;第三轮有6名专家提出16条修改意见,删除二级指标1个。专家权威系数为0.84±0.09,变异系数为0.00-0.22,Kendall协调系数在0.09-0.24(P0.05),表明专家之间意见协调水平较好,函询结果可信度较高。结论:河北省三级综合医院护理质量敏感性指标最终体系:3项一级指标:(结构指标、过程指标、结果指标),20项二级指标,每项指标均有详细的定义、意义、计算公式及评价方法。通过循证、半结构式访谈及德尔菲法构建的本土化护理质量敏感性指标具有科学性、严谨性,对护理管理及临床护理工作具有一定的指导意义。
[Abstract]:Objective: to construct a scientific, sensitive and practical index of nursing quality sensitivity in tertiary comprehensive hospitals of Hebei Province, and to provide relevant basis for the evaluation of nursing quality in hospitals in Hebei Province. Methods: the first stage: through theoretical analysis. The sensitivity index of nursing quality was preliminarily designed by means of evidence summary and expert semi-structured interview. The frame structure of the index system was preliminarily set up through theoretical analysis. Using Hopkins' theory and method of evidence-based nursing practice, the quality evaluation and evidence summary of the searched literature were carried out. Objective to conduct semi-structured interviews with 14 nursing quality management experts in the province by sampling and quantifying the interview content according to the content analysis method. The second stage: the final sensitivity index system was determined by Delphi expert letter method. Based on the initial index system, the questionnaire was compiled. The names, definitions, meanings and calculation formulas of each index in the initial system are included in the questionnaire. Through sampling, 34 experts were selected from 14 tertiary general hospitals in the province. Using the Likert 5 grade scoring method, the experts are asked to judge the importance and feasibility of each index, and the index is modified by analyzing the mean, standard deviation, coefficient of variation and the advice of the expert. Using expert positive coefficient and authority coefficient to analyze the reliability of expert opinion; Kendall coordination coefficient W was used to test the consistency of evaluation experts' opinions. Results: the first stage: through theoretical analysis, the quality three-dimensional model was adopted to build the basic framework. The primary index is divided into three dimensions: structural index, process index and result index. A total of 28 second-level indexes were included in 28 articles of literature through evidence summarization. Through content analysis, 32 indexes with frequency 2 appeared in all interviews were selected. Finally, the initial index system consisted of 3 first-grade indicators after group discussion. Second stage: after the end of the first round, one information center expert lost a visit and one information center expert self-assessment form was filled out as unfamiliar. The average age of the experts was 47.22 卤5.67 years old, and the working years of their major was 13.44 卤8.61 years. Have a master's degree to occupy 28.1010, have a subtropical high above the title of 100; In the three rounds of letters, the positive coefficient of experts was 94- 100. In the first round, 22 experts put forward 115 amendments, adding 1 secondary index and deleting 9 second-level indexes; In the second round, 14 experts put forward 32 amendments, adding 2 secondary indicators and 3 deleting secondary indicators; In the third round, 6 experts proposed 16 amendments, one index was deleted, the authority coefficient of experts was 0.84 卤0.09, and the coefficient of variation was 0.00-0.22. The coordination coefficient of Kendall is 0.09-0.24p 0.05, which indicates that the level of coordination among experts is better. Conclusion: the final system of sensitivity index of nursing quality in three general hospitals of Hebei province is 3: 1 (structural index, process index, result index) and 20 secondary indexes. Each index has detailed definition, significance, calculation formula and evaluation method. The sensitivity index of local nursing quality constructed by evidence-based, semi-structured interview and Delphi method is scientific and rigorous. It has certain guiding significance to nursing management and clinical nursing work.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R47

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