维持性血液透析患者营养筛查与评估护理质量敏感指标体系的构建  

Construction of sensitive index system for nutritional screening and evaluation of nursing quality in maintenance hemodialysis patients

作　　者：李玉平 孟欣 户俊凯 王桂华 张琳[1] Li Yuping;Meng Xin;Hu Junkai;Wang Guihua;Zhang Lin(Blood Purification Center,Henan Provincial People's Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院血液净化中心,郑州450000

出　　处：《中华现代护理杂志》2023年第21期2879-2885,共7页Chinese Journal of Modern Nursing

基　　金：中华医学会杂志社2021-2022年护理学科研究课题(CMAPH-NRP2021005)

摘　　要：目的建立一套科学、敏感且实用的维持性血液透析(MHD)患者营养筛查与评估护理质量敏感指标体系,为客观评价MHD患者营养筛查与评估护理质量提供参考依据。方法以Donabedian"结构-过程-结果"三维质量结构理论为指导,通过文献回顾和半结构式访谈,构建指标体系初稿;采用便利抽样法,于2022年9—10月选取来自全国6个省市的12家三甲医院的20名血液透析领域的临床护理及护理管理专家进行2轮专家函询,修订和确认指标体系。结果2轮专家函询的专家积极系数分别为95.00%和100.00%,专家权威系数分别为0.813和0.818,肯德尔和谐系数为0.121~0.257(P<0.05),各指标的变异系数均<0.30。经过2轮专家函询,最终构建的MHD患者营养筛查与评估护理质量敏感指标体系包括1项结构指标、7项过程指标、2项结果指标。结论本研究构建了包含10项指标的MHD患者营养筛查与评估护理质量敏感指标体系,具有科学性、实用性和专科特色,可用于规范血液净化中心营养筛查与评估护理工作,促进护理质量持续改进。Objective To establish a scientific,sensitive and practical sensitive index system for nutritional screening and nursing quality evaluation of maintenance hemodialysis patients,so as to provide reference for objective evaluation of nutritional screening and nursing quality evaluation of MHD patients.Methods Based on Donabedian three-dimensional quality structure theory of"structure-process-result",the first draft of the index system was constructed through literature review and semi-structured interview.From September to October 2022,a total of 20 clinical nursing and nursing management experts from the field of hemodialysis in 12 ClassⅢGrade A hospitals were selected for two rounds of expert letter consultation to revise and confirm the indicator system.Results The positive coefficient of the two rounds of expert correspondence were 95.00%and 100.00%,the expert authority coefficient were 0.813 and 0.818,the Kendall's harmony coefficients were 0.121-0.257(all P<0.05),and the coefficient of variation of each index was less than 0.30.After 2 rounds of expert letter consultation,the sensitive index system for nutritional screening and evaluation of nursing quality for maintenance hemodialysis patients was finally constructed,including 1 structural index,7 process index and 2 outcome index.Conclusions In this study,a sensitive index system of nutritional screening and evaluation of nursing quality for maintenance hemodialysis patients with 10 indicators is established,which was scientific,practical and specialized and could be used to standardize the nutritional screening and evaluation nursing work in blood purification centers and promote the continuous improvement of nursing quality.

关 键 词：透析 维持性血液透析 营养筛查 营养评估 护理质量 敏感性指标 

分 类 号：R473.5[医药卫生—护理学]