清醒患者俯卧位通气护理质量评价指标的构建

刘鹏婷; 张学

doi:10.16766/j.cnki.issn.1674-4152.003569

清醒患者俯卧位通气护理质量评价指标的构建

doi: 10.16766/j.cnki.issn.1674-4152.003569

刘鹏婷¹,
张学^2, ,

1.
山西白求恩医院(山西医学科学院)，山西医科大学第三医院，同济山西医院血液内科，山西太原 030032
2.
山西白求恩医院(山西医学科学院)，山西医科大学第三医院，同济山西医院中心手术部

基金项目:

山西省卫生健康委科研课题 2023124

详细信息

通讯作者:
张学，E-mail：646949504@qq.com

中图分类号: R47 R459.6
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- 文章访问数: 44
- HTML全文浏览量: 17
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2023-05-12
- 网络出版日期: 2024-07-22

Establishment of nursing quality evaluation index of awake prone position ventilation

LIU Pengting¹,
ZHANG Xue^{2
, ,}

1.
Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, Shanxi 030032, China

摘要

摘要: 目的构建清醒患者俯卧位通气护理质量评价指标，为评价清醒患者俯卧位通气护理质量提供一定的理论参考依据。方法以“结构-过程-结果”三维质量结构模型为指导，通过文献分析法、半结构化访谈法，经课题组分析，逐步形成清醒患者俯卧位通气护理质量评价指标条目，2022年11月—2023年1月采用目的抽样法，对25名分别来自山西、陕西、河南5所三甲医院具有呼吸、急危重症等相关经验的护理以及公共卫生领域的专家进行2轮德尔菲专家函询，经统计学处理，根据指标的重要性得分和变异系数，最终确立清醒患者俯卧位通气护理质量评价指标。结果 2轮专家函询咨询问卷回收率均为100%，专家权威系数为0.960，2轮肯德尔和谐系数为0.136、0.160(P＜0.01)，最终形成的评价指标包含3项一级指标、9项二级指标、51项三级指标三项指标。结论本研究构建的清醒患者俯卧位通气护理质量评价指标具有较高可靠性、科学性和实用性，指标权重设置合理，可为护理管理者评价临床护士实施清醒患者俯卧位通气的护理质量提供理论参考依据，也可以为全面提升临床护士实施清醒患者俯卧位通气护理质量提供操作指引和决策依据。
- 清醒俯卧位通气 /
- 护理质量 /
- 德尔菲法 /
- 三维结构 /
- 评价指标
Abstract: Objective To construct a scientific and feasible nursing quality evaluation index for prone ventilation in awake patients, and to provide a comprehensive, standardized and quantifiable theoretical framework for evaluating the nursing quality of prone ventilation in awake patients. Methods Guided by Donabedian's "structure-process -result" three-dimensional quality structure model, the research group conducted literature analysis and semi-structured interview to gradually formulate the evaluation indexes for nursing quality during prone ventilation in awake patients. Objective sampling was adopted from November 2022 to January 2023. Two rounds of Delphi expert consultation were conducted on 25 nursing and public health experts with respiratory, acute and critical care experience from 5 tertiary hospitals in Shanxi, Shaanxi and Henan. After statistical processing, the evaluation indexes of nursing quality of prone ventilation for awake patients were finally established according to the importance scores and coefficient of variation of the indexes. Results The recovery rates for both rounds of expert correspondence consultation questionnaires were 100%. The expert authority coefficient was 0.960, and the Kendall harmony coefficient were 0.136 and 0.160 (P < 0.01). The final evaluation index of prone ventilation nursing quality for conscious patients was composed of 3 primary indexes, 9 secondary indexes and 51 tertiary indexes. Conclusion The evaluation index of prone ventilation nursing quality for awake patients established in this study is highly reliable, scientific and practical. The weight of the index is set reasonably to provide a theoretical reference for nursing managers to evaluate the nursing quality of clinical nurses implementing prone ventilation for awake patients. It also provide operational guidance and decision-making basis for comprehensively improving the nursing quality of clinical nurses implementing prone ventilation for awake patients.
- Awake prone ventilation /
- Quality of care /
- Delphi method /
- Three-dimensional structure /
- Evaluation index

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表 1 25名函询专家基本情况

Table 1. Basic information of 25 experts

基本情况	类别	人数	构成比(%)
年龄(岁)	31~40	14	56.00
	41~50	9	36.00
	＞50	2	8.00
最高学历	硕士	12	48.00
	本科	13	52.00
职称	高(副高)级	11	44.00
	中级	14	56.00
工作年限(年)	8~15	14	56.00
	15~20	10	40.00
	＞20	1	4.00
专业领域	护理管理	8	32.00
	呼吸科	9	36.00
	重症医学	8	32.00

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表 2 专家意见协调程度

Table 2. Coordination degree of expert opinions

指标	条目	第一轮			第二轮
指标	条目	Kendall's W值	χ²值	P值	Kendall's W值	χ²值	P值
Ⅰ级指标	3	0.040	1.368	0.504	0.132	4.500	0.105
Ⅱ级指标	9	0.098	28.297	＜0.001	0.164	53.071	＜0.001
Ⅲ级指标	51	0.155	165.670	＜0.001	0.159	192.065	＜0.001
总体		0.136	193.708	＜0.001	0.160	249.270	＜0.001

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表 3 清醒患者俯卧位通气护理质量指标体系专家咨询结果

Table 3. Expert consultation results on nursing quality index system of prone ventilation in awake patients

指标	重要性得分	变异系数
1 结构指标	4.87±0.36	0.074
1.1 资源配置	4.87±0.35	0.072
1.1.1 护士能级构成比	4.77±0.65	0.136
1.1.2 床护比	4.33±0.48	0.111
1.1.3 具备康复科技师或呼吸治疗师至少1名	4.85±0.57	0.118
1.1.4 具备由护士、医生、康复科技师和呼吸治疗师组成的多学科俯卧位管理团队	4.33±0.66	0.152
1.2 俯卧位通气护理管理制度流程	4.87±0.35	0.072
1.2.1 制定清醒患者俯卧位通气护理管理制度	4.30±0.60	0.14
1.2.2 制定清醒患者俯卧位通气护理管理流程	4.03±0.72	0.179
1.2.3 制定清醒患者俯卧位通气体位摆放操作流程及注意事项	4.80±0.41	0.085
1.2.4 制定清醒患者俯卧位通气护理理论与操作培训计划	4.50±0.51	0.113
1.2.5 制定清醒患者俯卧位通气护理相关不良事件应急预案	4.57±0.50	0.109
1.3 培训与考核	4.90±0.88	0.112
1.3.1 护士俯卧位通气培训内容覆盖全面率	4.56±0.08	0.014
1.3.2 护士技能操作考核合格率	4.48±0.12	0.026
1.3.3 护士俯卧位通气知识考核合格率	4.76±0.02	0.006
2 过程指标	4.88±0.16	0.036
2.1 护理评估	4.88±0.26	0.048
2.1.1 评估患者生命体征和意识状态	4.64±0.42	0.016
2.1.2 评估患者病情状态	4.68±0.32	0.068
2.1.3 评估患者的肺功能状态	4.70±0.26	0.032
2.1.4 评估患者的血流动力学状态	4.60±0.12	0.044
2.1.5 评估患者俯卧位通气禁忌证	4.94±0.11	0.010
2.1.6 评估患者肢体运动情况	4.62±0.36	0.076
2.1.7 评估患者俯卧位受压部位皮肤状况	4.46±0.33	0.078
2.1.8 评估患者心电导联与皮肤的连接情况	4.62±0.28	0.014
2.1.9 评估患者管路(气管导管)情况	4.44±0.29	0.069
2.1.10 评估患者进食时间	4.67±0.06	0.008
2.1.11 评估实施清醒俯卧位所需用物	4.87±0.11	0.012
2.2 计划与实施	5.00±0.00	0.000
2.2.1 俯卧位通气相关知识宣教合格率	4.77±0.43	0.090
2.2.2 制定个性化的清醒患者俯卧位通气护理计划	4.63±0.49	0.106
2.2.3 选择适合不同清醒患者俯卧位通气治疗体位	4.90±0.31	0.063
2.2.4 实施清醒患者俯卧位通气人员站位与职责分工	4.83±0.24	0.011
2.2.5 俯卧位用物准备齐全率	4.97±0.18	0.036
2.2.6 清醒患者俯卧位通气的执行率	4.88±0.23	0.067
2.2.7 清醒患者俯卧位通气规范落实率	4.93±0.25	0.051
2.2.8 吸氧面罩或鼻导管固定规范落实率	4.87±0.18	0.086
2.2.9 护士动态评估病情的落实率	4.57±0.73	0.160
2.2.10 连续俯卧位通气时长达标率	4.60±0.55	0.120
2.2.11 俯卧前和俯卧后1h评估患者血氧饱和度和呼吸频率的正确率	4.80±0.25	0.091
2.2.12 终止清醒俯卧位通气时机选择的正确率	4.73±0.50	0.109
2.2.13 患者肢体摆放功能位的达标率	4.88±0.20	0.017
2.2.14 患者受压部位衬垫措施落实合格率	4.88±0.13	0.036
2.3 病情观察	4.90±0.88	0.112
2.3.1 动态观察患者血氧饱和度	4.56±0.08	0.014
2.3.2 观察患者有效俯卧位姿势	4.48±0.12	0.026
2.3.3 观察患者累计有效俯卧位时长	4.87±0.21	0.021
2.3.4 严密检查氧合辅助设备的连接情况	4.76±0.02	0.006
2.4 文书记录清醒俯卧位通气相关记录合格率	4.43±0.50	0.113
3 结果指标	4.82±0.23	0.041
3.1 效果评价	4.96±0.25	0.044
3.1.1 血氧饱和度的改善情况	4.55±0.28	0.040
3.1.2 患者的耐受程度	4.76±0.24	0.043
3.1.3 疾病的转归	4.88±0.13	0.036
3.1.4 患者及家属的体验感和满意度	4.93±0.21	0.132
3.2 不良事件	4.86±0.33	0.047
3.2.1 压力性损伤的发生率	4.56±0.09	0.013
3.2.2 跌倒坠床的发生率	4.66±0.37	0.051
3.2.3 非计划性拔管的发生率	4.53±0.27	0.040
3.2.4 心律失常的发生率	4.51±0.30	0.042
3.2.5 周围神经损伤的发生率	4.46±0.12	0.055

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