CAJ | 학술논문

[目的]构建综合医院胃肠外科具有专科特异性的护理质量评价指标，并确定各级指标权重，为建立专科护理质量评价体系提供参考依据。[方法]采用查阅文献资料及专家访谈法，借鉴 Donabedian 提出的“结构过程结果”理论框架初步建立综合医院胃肠外科护理质量评价指标后，应用德尔菲法就建立的各级评价指标进行函询，结合重要性赋值采用层次分析法确定各级指标权重。[结果]综合医院胃肠外科护理质量评价指标包含3个一级指标、8个二级指标和34个三级指标。专家对构建的指标意见协调性好，一致性水平较高。各级指标权重中一级指标中突出过程质量；二级指标中权重排名前3位的分别是制度流程、人力资源、不良事件；三级指标中排名前5位的分别为上消化道大出血应急预案知晓率、专科常见并发症的护理制度及流程执行率、专科操作技能培训考核合格率、血管导管相关血流感染发生率、留置导尿管相关泌尿系感染发生率。[结论]本研究中采用质性和量性相结合的方法建立护理质量评价指标可信度较高，可初步在临床上探讨其适用性，为进一步探讨构建各专科特色的护理质量评价指标提供参考依据。在评价过程中突出过程质量，兼顾结构和结果质量，可促进临床护理质量持续改进。
[목적]구건종합의원위장외과구유전과특이성적호리질량평개지표，병학정각급지표권중，위건립전과호리질량평개체계제공삼고의거。[방법]채용사열문헌자료급전가방담법，차감 Donabedian 제출적“결구과정결과”이론광가초보건립종합의원위장외과호리질량평개지표후，응용덕이비법취건립적각급평개지표진행함순，결합중요성부치채용층차분석법학정각급지표권중。[결과]종합의원위장외과호리질량평개지표포함3개일급지표、8개이급지표화34개삼급지표。전가대구건적지표의견협조성호，일치성수평교고。각급지표권중중일급지표중돌출과정질량；이급지표중권중배명전3위적분별시제도류정、인력자원、불량사건；삼급지표중배명전5위적분별위상소화도대출혈응급예안지효솔、전과상견병발증적호리제도급류정집행솔、전과조작기능배훈고핵합격솔、혈관도관상관혈류감염발생솔、류치도뇨관상관비뇨계감염발생솔。[결론]본연구중채용질성화량성상결합적방법건립호리질량평개지표가신도교고，가초보재림상상탐토기괄용성，위진일보탐토구건각전과특색적호리질량평개지표제공삼고의거。재평개과정중돌출과정질량，겸고결구화결과질량，가촉진림상호리질량지속개진。
Objective:To construct the nursing quality evaluation index of gastrointestinal surgery with specialist specificity in general hospitals,and to determine the weight of all levels of indexes,so as to provide the evidences for establishing the specialist care quality evaluation systems and carrying out the specialist care quality evalua-tion.Methods:After accessing to literatures and expert interviews,learning from the theoretical framework of“structure process outcome”raised by Donabedian and initially establishing the nursing quality evaluation in-dexes of gastrointestinal surgery in general hospitals.The Delphi method was applied for letter consult on the established all levels of evaluation indexes,combined with the importance of assignment and using analytic hier-archy process(AHP)to determine the weights of all levels of indexes.Results:Nursing quality evaluation inde-xes of gastrointestinal surgery in general hospitals included 3 primary indicators,8 secondary indicators and 34 third indicators.Experts had good coordination and higher consistency on the indicators.In weight of all levels of indexes,in the first level indicators in the process quality was outstanding in primary indicators;the top 3 in secondary indicators were in turn the system process,human resources and adverse events;the top 5 in third in-dicators were respectively emergency plan awareness rate of upper digestive tract bleeding,execution rate of nursing system and process of specialist common complications,pass rate of specialist skills training assess-ment,incidence of catheter related bloodstream infection and incidence of indwelling catheter related urinary tract infection.Conclusion:The established nursing quality evaluation indexes based on qualitative and quantita-tive methods had the better credibility,and can be used in clinical practice to probe into the applicability,to pro-vide a reference basis for further building the special feature of nursing quality evaluation indexes.In the process of evaluation,it can promote the continuous improvement of clinical nursing quality to focus on process quality and take into account the structure and results quality.