Establishment of Shanghai community nursing quality indicators system: Based on Donabedian's structure-process-outcome approach theory
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摘要: 目的 以结构-过程-结果理论构建上海市社区护理质量管控指标体系,旨在为全面提升社区护理管理质量内涵提供评价工具。 方法 以Donabedian结构-过程-结果理论,编制社区护理质量管控指标体系专家咨询问卷;采用目的抽样选取基层卫生机构政府管理人员、基层医疗管理人员、高校社区护理授课教授、资深社区护理管理等专家进行两轮专家咨询,结合专家意见及指标界值筛选法对指标体系进行评价。 结果 专家积极系数为94%;权威系数为0.85;总协调系数W第一轮为0.253(χ2=311.285,P<0.01);第二轮为0.401(χ2=498.971;P<0.01);结构指标包括组织架构、人员、制度、护理培训等及相应6项三级指标;过程指标包括资源、环境管理、社区护理质量管理、参与社区重点人群管理、参与家庭医生团队签约工作、安宁疗护、居家护理等及相应15项三级指标;结果指标包括护理安全(不良)事件、服务对象满意率、护理质控达标率、社区护士培训率、社区护士考核合格率、工作创新及成果推广及相应27项三级指标。 结论 根据“结构-过程-结果”模式构建的社区护理质量评价体系具有较好的可靠性、可操作性及前瞻性,能够反应社区护理运行、护理质量、护理服务等状况,亦能够帮助社区护理管理者依据评价体系全面地建设护理队伍。Abstract: Objective To construct Shanghai community nursing quality evaluation indicators system in order to provide an evaluation tool for comprehensively improving the quality of community nursing. Methods According to Donabedian's structure-process-outcome approach theory, an expert consultation questionnaire about evaluation of community nursing quality indicators system was prepared. Two rounds of Delphi consultation were conducted by purposive sampling and selecting experts such as primary medical management personnel, administrative personnel of primary health institutions, community nursing managers and professors of community nursing major in colleges and universities. Results Data analysis showed that expert positive coefficient was 94% and coefficient of authority was 0.85. Two rounds of enquiry for Kendall coefficient results were 0.253 (χ2=311.285, P<0.01) and 0.401 (χ2=498.971, P<0.01). The structural indicators included organizational structure, staff composition, rules and regulations, nursing training and 6 corresponding three-level indicators; Process indicators include resources, environment management, community care quality management, participation in community key population management, participation in Family doctor service team, hospice care, home care and 15 corresponding third-level indicators; The outcome indicators include nursing safety events, satisfaction rate of service objects, compliance rate of nursing quality control, training rate of community nurses, assessment qualified rate of community nurses, work innovation and achievement promotion and corresponding 27 three-level indicators. Conclusion The community nursing quality evaluation system based on the "structure-process-result" model has good reliability, operability and prospective, which can reflect the community nursing operation, nursing quality, nursing service and other conditions, and can also help community nursing managers to comprehensively develop nurse teams.
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