本文關(guān)鍵詞：河北省三級綜合醫(yī)院護(hù)理質(zhì)量敏感性指標(biāo)的構(gòu)建　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:構(gòu)建科學(xué)、敏感、實用的河北省三級綜合醫(yī)院護(hù)理質(zhì)量敏感性指標(biāo),為省內(nèi)醫(yī)院護(hù)理質(zhì)量評價提供相關(guān)依據(jù)。方法:第一階段:通過理論分析、證據(jù)總結(jié)與專家半結(jié)構(gòu)式訪談法對護(hù)理質(zhì)量敏感性指標(biāo)進(jìn)行初步設(shè)計。通過理論分析,初步搭建指標(biāo)體系框架結(jié)構(gòu);采用美國霍普金斯循證護(hù)理實踐理論和方法,對搜索到的文獻(xiàn)進(jìn)行質(zhì)量評價及證據(jù)總結(jié);通過目的抽樣對省內(nèi)14名護(hù)理質(zhì)量管理專家進(jìn)行半結(jié)構(gòu)式訪談,根據(jù)內(nèi)容分析法量化訪談內(nèi)容。通過以上步驟,研究小組組內(nèi)討論形成初始指標(biāo)體系。第二階段:通過Delphi專家函詢法確定最終敏感性指標(biāo)體系�；诔跏贾笜�(biāo)體系編制函詢問卷,將初始體系中各指標(biāo)名稱、定義、意義及計算公式全部編入問卷中;通過目的抽樣,選取省內(nèi)14家三級綜合醫(yī)院34名專家進(jìn)行函詢;采取Likert 5級評分法請專家分別對每項指標(biāo)的重要性及可行性進(jìn)行評判。通過分析各指標(biāo)均數(shù)、標(biāo)準(zhǔn)差、變異系數(shù)及專家所提意見對指標(biāo)進(jìn)行修改;采用專家積極系數(shù)、權(quán)威系數(shù)分析函詢專家意見的可靠性;采用Kendall協(xié)調(diào)系數(shù)W檢驗評價專家之間意見的一致性。結(jié)果:第一階段:通過理論分析,采取質(zhì)量三維模型搭建基本框架,將一級指標(biāo)劃分為結(jié)構(gòu)指標(biāo)、過程指標(biāo)及結(jié)果指標(biāo)三個維度;通過證據(jù)總結(jié)共納入28篇文獻(xiàn),28項二級指標(biāo);通過內(nèi)容分析法篩選出在全部訪談中出現(xiàn)頻次2的指標(biāo)共32項。最終經(jīng)小組討論形成初始指標(biāo)體系包含一級指標(biāo)3項,二級指標(biāo)31項。第二階段:第一輪結(jié)束后,1名信息中心專家失訪,1名信息中心專家自評表填寫為不熟悉,最終32名專家完成3輪函詢。專家平均年齡為47.22±5.67歲,本專業(yè)工作工作年限13.44±8.61年;具有碩士學(xué)位占28.10%,具有副高以上職稱占100%;在3輪函詢中,專家積極系數(shù)在94%-100%。第一輪有22名專家提出115條修改意見,增加二級指標(biāo)1個,刪除二級指標(biāo)9個;第二輪有14名專家提出32條修改意見,增加二級指標(biāo)2個,刪除二級指標(biāo)3個;第三輪有6名專家提出16條修改意見,刪除二級指標(biāo)1個。專家權(quán)威系數(shù)為0.84±0.09,變異系數(shù)為0.00-0.22,Kendall協(xié)調(diào)系數(shù)在0.09-0.24(P0.05),表明專家之間意見協(xié)調(diào)水平較好,函詢結(jié)果可信度較高。結(jié)論:河北省三級綜合醫(yī)院護(hù)理質(zhì)量敏感性指標(biāo)最終體系:3項一級指標(biāo):(結(jié)構(gòu)指標(biāo)、過程指標(biāo)、結(jié)果指標(biāo)),20項二級指標(biāo),每項指標(biāo)均有詳細(xì)的定義、意義、計算公式及評價方法。通過循證、半結(jié)構(gòu)式訪談及德爾菲法構(gòu)建的本土化護(hù)理質(zhì)量敏感性指標(biāo)具有科學(xué)性、嚴(yán)謹(jǐn)性,對護(hù)理管理及臨床護(hù)理工作具有一定的指導(dǎo)意義。
[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 鹵5.67 years old, and the working years of their major was 13.44 鹵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 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R47

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