基于三维结构模型的肿瘤内科标准化护理体系构建

侯庆梅; 杨丽华; 张紫嫣; 段培蓓; 朱春勤; 修闽宁

doi:10.16766/j.cnki.issn.1674-4152.003610

基于三维结构模型的肿瘤内科标准化护理体系构建

doi: 10.16766/j.cnki.issn.1674-4152.003610

1.
江苏省中医院肿瘤内科，江苏南京 210029
2.
江苏卫生健康职业学院护理学院，江苏南京 211800
3.
江苏省中医院护理部

基金项目:

江苏省中医药科技发展计划项目 YB2020011

详细信息

通讯作者:
杨丽华，E-mail：yanglihua17@sina.com

中图分类号: R473.73 R730.5
计量
- 文章访问数: 13
- HTML全文浏览量: 7
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-01
- 网络出版日期: 2024-09-05

Construction of standardized nursing system in oncology department based on three-dimensional structural model

1.
Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, China

摘要

摘要: 目的构建肿瘤内科抗肿瘤治疗患者标准化护理体系，为促进肿瘤专科护理工作标准化、规范化、精细化和程序化运作提供依据。方法以系统工程三维结构模型为理论框架，通过文献研究和课题组成员反复讨论拟定肿瘤内科抗肿瘤治疗患者标准化护理体系初稿，选取江苏省12家三级医院肿瘤医疗护理等相关领域专家24名，进行两轮Delphi专家咨询。两轮均计算专家函询积极系数、专家意见的权威程度以及Kendall协调系数等。课题组整理专家咨询结果，分析指标结构和条目，确定肿瘤内科抗肿瘤治疗患者标准化护理体系。结果最终构建包含3个一级指标(时间维、知识维、逻辑维)、15个二级指标、105个三级指标的肿瘤内科标准化抗肿瘤治疗患者护理体系指标。两轮专家函询后，各指标重要性赋值均数为3.88~4.96，变异系数为0.041~0.244。两轮专家咨询问卷有效回收率均为100.0%；专家权威系数分别为0.876、0.885；肯德尔协调系数分别为0.216、0.198(P < 0.001)。结论基于三维结构模型的肿瘤内科抗肿瘤治疗患者标准化护理体系构建方法科学，条目可靠，能够为全面规范践行肿瘤内科临床护理提供路径指引。
- 肿瘤内科 /
- 抗肿瘤治疗 /
- 标准化护理 /
- 护理质量 /
- 体系构建
Abstract: Objective To build a standardized nursing system for medical oncology and provide a basis for promoting the standardization, refinement and procedural operation of oncology specialist nursing work. Methods Using the three-dimensional structural model of system engineering as the theoretical framework, the first draft of a standardized nursing system for anti-tumor treatment patients in the oncology department was drafted through literature research and repeated discussions among project team members. Twenty-four experts in the field of oncology medical nursing and related fields from 12 tertiary hospitals in Jiangsu Province were selected for two rounds of Delphi expert consultation. Both rounds calculated the positive coefficient of expert inquiry, the authority of expert opinions, and the Kendall coordination coefficient. The research group compiled the results of expert consultations, analyzed the indicator structure and items, and determined the standardized nursing system for anti-tumor treatment patients in the oncology department. Results The final construction included 3 primary indicators (time dimension, knowledge dimension, logic dimension), 15 secondary indicators, and 105 tertiary indicators for the standardized anti-tumor treatment patient care system in the oncology department. After two rounds of expert inquiries, the average assigned values of the importance of each indicator were 3.88-4.96, and the coefficient of variation was 0.041-0.244. The effective response rates for both rounds of expert consultation questionnaires were 100.0%. The expert authority coefficients were 0.876 and 0.885, respectively. The Kendall coordination coefficients were 0.216 and 0.198, respectively (P < 0.001). Conclusion The construction method of standardized nursing system based on the three-dimensional structural model in the medical oncology is scientific and the items are reliable, which can provide path guidance for the comprehensive and standardized practice of clinical nursing in medical oncology.
- Medical oncology /
- Anti-tumor therapy /
- Standardized nursing /
- Nursing quality /
- System construction

HTML全文

图 1 抗肿瘤治疗患者标准化护理体系框架图

Figure 1. Framework for standardized nursing in oncology

下载: 全尺寸图片幻灯片

表 1 专家意见协调程度

Table 1. Degree of expert opinion coordination

指标	第1轮				第2轮
指标	条目数	Kendall W值	χ²值	P值	条目数	Kendall W值	χ²值	P值
一级指标	3	0.185	8.857	0.012	3	0.146	7.000	0.030
二级指标	16	0.215	77.371	＜0.001	15	0.244	82.081	＜0.001
三级指标	101	0.219	526.776	＜0.001	105	0.191	477.868	＜0.001
总体	120	0.216	617.733	＜0.001	123	0.198	578.942	＜0.001

下载: 导出CSV

表 2 肿瘤内科抗肿瘤治疗患者标准化护理体系指标(x±s，分)

Table 2. Indicators of standardized nursing system in medical oncology (x±s, points)

指标	重要性评分	变异系数	指标	重要性评分	变异系数	指标	重要性评分	变异系数
时间维	4.75±0.44	0.093	免疫增强药	4.13±0.95	0.230	卧床患者翻身	4.38±0.71	0.163
入院当天	4.42±0.78	0.176	抗过敏药	4.38±0.71	0.163	药物过敏查对	4.54±0.72	0.159
按入院流程接待	4.29±0.81	0.188	止痛药	4.71±0.69	0.147	化疗药物配制及给药	4.88±0.45	0.092
及时风险评估	4.75±0.53	0.112	抗凝药	4.25±0.99	0.233	靶向药物配制及给药	4.96±0.20	0.041
全面准确专科评估	4.83±0.38	0.079	补益药	3.88±0.95	0.244	免疫药物配制及给药	4.96±0.20	0.041
正确执行医嘱	4.67±0.87	0.186	专科常见疾病理论	4.33±0.87	0.200	自购药物管理	4.88±0.34	0.069
基础护理	4.25±0.85	0.199	胃癌	4.83±0.38	0.079	腔内灌注配制及给药	4.83±0.48	0.100
专科处置应对	4.79±0.41	0.087	肠癌	4.83±0.48	0.100	生物安全柜使用	4.75±0.53	0.112
入院健康指导	4.46±0.98	0.219	肺癌	4.88±0.34	0.069	口服化疗给药	4.83±0.38	0.079
化疗前	4.67±0.56	0.121	乳腺癌	4.79±0.41	0.087	口服靶向给药	4.83±0.38	0.079
检查检验评估	4.67±0.64	0.137	宫颈癌	4.67±0.87	0.186	阿片类药物给药	4.83±0.38	0.079
营养评估	4.67±0.64	0.137	肝癌	4.46±0.78	0.175	中药饮片发放	4.38±1.06	0.241
血管通路功能评估	4.83±0.38	0.079	食管癌	4.75±0.44	0.093	血管活性药输注	4.54±0.88	0.195
社会心理状况评估	4.42±0.65	0.148	抗肿瘤副反应宣教	4.75±0.53	0.112	放疗护理	4.58±0.97	0.213
积极应对处理	4.50±0.83	0.185	白细胞减少	4.96±0.20	0.041	化疗药外渗处理	4.88±0.45	0.092
化疗期	4.83±0.48	0.100	血小板减少	4.96±0.20	0.041	化疗药外溢处理	4.83±0.38	0.079
跌倒风险评估	4.67±0.64	0.137	贫血	4.79±0.41	0.087	血管通路并发症处理	4.88±0.34	0.069
密切观察急性反应	4.92±0.28	0.057	腹泻	4.79±0.41	0.087	化疗废弃物处理	4.75±0.53	0.112
准确执行化疗医嘱	4.96±0.20	0.041	便秘	4.75±0.44	0.093	化疗防护规范	4.67±0.64	0.137
健康教育	4.50±0.98	0.217	乏力	4.58±0.58	0.127	专科文件书写规范	4.50±0.78	0.173
化疗后	4.63±0.58	0.124	呕吐	4.71±0.55	0.117	专科护理技术	4.83±0.38	0.079
跌倒风险评估	4.83±0.38	0.079	纳差	4.88±0.34	0.069	PICC置管	4.79±0.41	0.087
营养风险评估	4.71±0.55	0.117	疼痛	4.83±0.48	0.100	PICC/CVC维护	4.96±0.20	0.041
检查检验评估	4.67±0.56	0.121	失眠	4.75±0.53	0.112	PORT使用及维护	4.96±0.20	0.041
密切观察病情变化	4.96±0.20	0.041	过敏	4.25±0.85	0.199	专科检查配合	4.46±0.72	0.162
化疗副反应应对	4.88±0.34	0.069	水肿	4.63±0.58	0.124	肺穿刺	4.58±0.72	0.156
出院	4.42±0.65	0.148	脱发	4.21±0.93	0.221	肝穿刺	4.63±0.65	0.140
及时出院指导	4.75±0.44	0.093	口腔溃疡	4.71±0.55	0.117	胃肠镜	4.71±0.62	0.133
床单元终末处理	4.00±0.83	0.209	末梢神经炎	4.67±0.56	0.121	淋巴结穿刺	4.54±0.78	0.172
化疗间歇期	3.96±0.75	0.190	手足综合征	4.58±0.58	0.127	专科仪器使用	4.46±0.93	0.209
居家检验监测	4.46±0.59	0.132	腔内灌注健康教育	4.42±0.65	0.148	心电监护仪	4.58±0.72	0.156
副作用监测与随访	4.58±0.50	0.110	逻辑维	4.92±0.28	0.067	心电图机	4.25±0.85	0.199
导管居家维护	4.63±0.58	0.124	专科工作流程	4.71±0.55	0.117	输液泵	4.75±0.61	0.128
康复指导	4.46±0.66	0.148	入院护理	4.29±0.95	0.222	微量注射泵	4.63±0.71	0.154
知识维	4.96±0.20	0.041	晨晚间护理	4.17±0.82	0.196	便携式化疗泵	4.83±0.48	0.100
专科用药指引	4.92±0.41	0.083	交接班	4.54±0.72	0.159	简易呼吸器	4.50±0.78	0.173
化疗药	4.96±0.20	0.041	出院护理	4.33±0.82	0.188	空气压力治疗仪	4.25±1.03	0.243
靶向药	4.88±0.45	0.092	转床	4.21±0.72	0.171	专科质量控制	4.75±0.53	0.112
免疫药	4.83±0.48	0.100	危重患者转运	4.67±0.96	0.206	专科核心项目	4.83±0.48	0.100
抑酸止吐药	4.38±0.77	0.176	转入患者接收	4.38±1.01	0.232	重点患者质量	4.75±0.53	0.112
保肝护肾药	4.21±0.93	0.221	检查安排	4.25±0.79	0.187	各班次质量	4.63±0.77	0.166

下载: 导出CSV

参考文献(20)

[1]	SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[2]	LEE T, CLARKE J M, JAIN D, et al. Precision treatment for metastatic non-small cell lung cancer: a conceptual overview[J]. Cleve Clin J Med, 2021, 88(2): 117-127. doi: 10.3949/ccjm.88a.19148
[3]	FICHTNER-FEIGL S. Biology-and location-oriented precision treatment of rectal cancer: present and future[J]. Visc Med, 2020, 36(5): 381-387. doi: 10.1159/000510488
[4]	张义玲, 方梅. 标准护理流程在颅底区肿瘤患者围手术期中的效果观察[J]. 中国肿瘤临床与康复, 2022, 29(4): 472-475. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK202204022.htm ZHANG Y L, FANG M. Efficacy of perioperative standardized nursing processes in patients with skull base tumors[J]. Chinese Journal of Clinical Oncology and Rehabilitation, 2022, 29(4): 472-475. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK202204022.htm
[5]	LANCASTER E, WICK E. Standardized care pathways as a means to improve patient safety[J]. Surg Clin North Am, 2021, 101(1): 49-56. doi: 10.1016/j.suc.2020.08.011
[6]	朱春勤, 史文洁, 王晓庆, 等. 基于三维结构模型的胸外科标准化护理体系的构建[J]. 护理学杂志, 2021, 36(12): 46-49. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202112013.htm ZHU C Q, SHI W J, WANG X Q, et al. Development of a standardized nursing system in thoracic surgery department based on the three-dimensional morphology of systems engineering[J]. Journal of Nursing Science, 2021, 36(12): 46-49. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202112013.htm
[7]	王林波, 王璐. 基于霍尔三维结构的现代质量工程技术框架研究[J]. 中国质量, 2022, 43(3): 49-53. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZH202203008.htm WANG L B, WANG L. Research on modern quality engineering technology framework based on Hall 3D structure[J]. China Quality, 2022, 43(3): 49-53. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZH202203008.htm
[8]	陈大川, 余怡, 刘跃龙. 基于系统工程学的建设工程造价标准体系构建[J]. 土木工程与管理学报, 2021, 38(6): 25-30. https://www.cnki.com.cn/Article/CJFDTOTAL-WHCJ202106004.htm CHEN D C, YU Y, LIU Y L. Framework of construction project cost standard system based on systems engineering[J]. Journal of Civil Engineering and Management, 2021, 38(6): 25-30. https://www.cnki.com.cn/Article/CJFDTOTAL-WHCJ202106004.htm
[9]	陈明昊. 城市轨道交通工程建设标准体系研究综述与构建方法[J]. 标准科学, 2021(11): 38-49. https://www.cnki.com.cn/Article/CJFDTOTAL-SJBZ202111008.htm CHEN M H. Overview and establishing methods for the engineering construction standards system of urban metro transport[J]. Standard Science, 2021(11): 38-49. https://www.cnki.com.cn/Article/CJFDTOTAL-SJBZ202111008.htm
[10]	ESFAHANI K, ROUDAIA L, BUHLAIGA N, et al. A review of cancer immunotherapy: from the past, to the present, to the future[J]. Curr Oncol, 2020, 27(Suppl2): S87-S97.
[11]	COLONNA S, SWEETENHAM J, BURGON T B, et al. A better pathway? Building consensus and engaging providers with feedback to improve and standardize cancer care[J]. Clin Breast Cancer, 2019, 19(2): e376-e384. doi: 10.1016/j.clbc.2018.12.010
[12]	杨丽萍, 段培蓓, 杨玲, 等. 肿瘤患者疼痛-疲乏-睡眠障碍症状群的研究现状及热点可视化分析[J]. 中华全科医学, 2023, 21(1): 139-143. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202301035.htm YANG L P, DUAN P B, YANG L, et al. Research status and visualization analysis of pain-fatigue-sleep disturbance symptom clusters in tumour patients[J]. Chinese Journal of General Practice, 2023, 21(1): 139-143. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202301035.htm
[13]	郑粉善, 曹沛莹, 华兴龙, 等. 乳腺癌患者需求量表的编制及信效度检验[J]. 中华护理杂志, 2022, 57(4): 469-475. doi: 10.3761/j.issn.0254-1769.2022.04.013 ZHENG F S, CAO P Y, HUA X L, et al. Development of a needs scale for breast cancer patients and the test of its reliability and validity[J]. Chinese Journal of Nursing, 2022, 57(4): 469-475. doi: 10.3761/j.issn.0254-1769.2022.04.013
[14]	浦凤燕, 郑叶平, 王宋超. 胃肠道肿瘤化疗护理质量评价体系的构建研究[J]. 护理与康复, 2021, 20(12): 11-15. https://www.cnki.com.cn/Article/CJFDTOTAL-HLKF202112004.htm PU F Y, ZHENG Y P, WANG S C. Research on construction of evaluation system on nursing quality of chemotherapy for gastrointestina cancer[J]. Nursing and Rehabilitation, 2021, 20(12): 11-15. https://www.cnki.com.cn/Article/CJFDTOTAL-HLKF202112004.htm
[15]	李娟, 苏霞, 杨梦娟, 等. 全病程护理管理模式在肿瘤科的实践[J]. 护理学杂志, 2021, 36(8): 40-43. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202108014.htm LI J, SU X, YANG M J, et al. Practice of disease whole-course nursing management model in oncology department[J]. Journal of Nursing Science, 2021, 36(8): 40-43. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202108014.htm
[16]	曾伟明, 石建伟, 俞文雅, 等. 家庭医生签约服务模式效果评价指标体系构建研究[J]. 中华全科医学, 2023, 21(5): 721-725. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202305001.htm ZENG W M, SHI J W, YU W Y, et al. Research on the construction of effectiveness evaluation index system for family doctor contract service model[J]. Chinese Journal of General Practice, 2023, 21(5): 721-725. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202305001.htm
[17]	李敏, 董玉祺, 李娜, 等. 北京市乡村医生岗位胜任力模型的构建[J]. 中华全科医学, 2023, 21(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202301001.htm LI M, DONG Y Q, LI N, et al. Construction of the post competency model of rural doctors in Beijing[J]. Chinese Journal of General Practice, 2023, 21(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202301001.htm
[18]	黑赏艳. 基于帕金森病患者报告的临床结局评价量表的研制及性能初步考评[D]. 广州: 广州中医药大学, 2018. HEI S Y. Development and evaluation of the Patient-Reported Outcome assessment scale of Parkinson disease[D]. Guangzhou: Guangzhou University of Chinese Medicine, 2018.
[19]	李海燕, 吴蓉蓉, 郑建秋, 等. 知信行护理模式在压力性尿失禁患者中的应用效果[J]. 中华全科医学, 2022, 20(10): 1805-1808. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202210043.htm LI H Y, WU R R, ZHENG J Q, et al. Study on the application effect of knowledge, belief and practice nursing model in patients with stress urinary incontinence[J]. Chinese Journal of General Practice, 2022, 20(10): 1805-1808. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202210043.htm
[20]	王清, 袁玲, 陈正香, 等. 临床科室亚专科护理建设的实践与效果评价[J]. 护理学杂志, 2021, 36(21): 47-50. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202121014.htm WANG Q, YUAN L, CHEN Z X, et al. Practice and effect evaluation of nursing subspecialty construction in clinical departments[J]. Journal of Nursing Science, 2021, 36(21): 47-50. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202121014.htm