Establishment Of Nursing Quality Evaluation Indicator System For Premature With Respiratory Distress Syndrome

ObjectiveTo establish a nursing quality evaluation index system for respiratory distress syndrome(RDS)of premature based on Donabedian conceptual,and determine the weight of each indicator,which can provide reference for nursing managers and clinical workers to evaluate nursing quality of premature infants with respiratory distress syndrome,and promoted the continuous improvement of nursing quality.Methods1.Through the literature research and content analysis method to search and review domestic and foreign literature related to the quality of care of premature infants with respiratory distress syndrome,extract potential nursing quality evaluation indicators.2.The individual depth interview was carried out in ten medical staff by applying semi-structured interview guidelines.We summarize the interview data to extract relevant evaluation indicators.3.Hold an expert group meeting to discuss further and determine the name,category,calculation formula,and collection method of each indicator.According to expert opinions,the indicators were revised,and an indicator system for evaluating the quality of care for premature infants with respiratory distress syndrome was preliminarily drawn up.4.According to the preliminary nursing evaluation index of premature infants with respiratory distress syndrome,the questionnaire was prepared,and the importance of each index was scored by Likerts5 grade scoring method.Using the Delphi method,we conducted three rounds of expert letter inquiries to 24 experts in the fields of neonatal critical care,nursing management,and neonatal clinical medicine.5.Use SPSS24.0 to analyze the results of expert correspondence,use Analytic Hierarchy Process(AHP)to establish a hierarchical structure model for each indicator,construct a pairwise comparison judgment matrix,and check the consistency of the judgment matrix.The consistency coefficient CR was less than 0.1.We then calculated the weight of each index.Results1.A total of 64 literatures were included in this study.Guided by the three-dimensional quality structure model of "structure-process-result" and combined with the special disease characteristics of premature infants’ respiratory distress syndrome,two analysts preliminarily extracted 41 tertiary indicators,and summarized 11 secondary indicators of similar indicators in the same category.2.Analysis of interview data according to interview results,9 nursing quality evaluation indexes of premature infants with respiratory distress syndrome were added.3.After discussion by experts,it is considered that the preliminarily extracted indicators conform to their classification categories,and 10 new indicators are added according to expert opinions.The evaluation index pool of nursing quality for premature infants with respiratory distress syndrome was preliminarily drawn up,including 3 firstlevel indicators,12 second-level indicators and 59 third-level indicators.4.The effective recovery rates of three rounds of expert letters are 80.00%,92.86%and 92.31%,respectively,and the expert authority coefficient is 0.88,which shows that the experts are highly motivated and authoritative.The Kendall W coordination coefficient of the three rounds of inquiry are 0.303,0.212 and 0.236,respectively,and the nonparametric test is P < 0.05,which reflects the consistency of expert opinions.The nursing quality evaluation index system for respiratory distress syndrome(RDS)of premature infants is composed of 3 first-level indicators,13 second-level indicators and 43 third-level indicators.5.The analytic hierarchy process constructs the index hierarchy model and pairwise judgment matrix and carries out consistency test,and the consistency coefficient Cr < 0.1.The weights of the first-level indicators are: structure index(0.1958),process index(0.4934)and result index(0.3108).The top three weights of secondary indicators are NICU specialist care(0.1383),delivery room resuscitation(0.1383),nosocomial infection(0.1026)and safety adverse events(0.1026).The top three indexes are: the implementation rate of resuscitation standard in prime time(0.0922),the incidence of ventilator-associated pneumonia(0.0684),and the incidence of unplanned extubation(0.0684).ConclusionThe positive factor for the three rounds of letter inquiries and the authoritative coefficient is higher,and the region is widely distributed.The experts have good representativeness and high credibility.The constructed RDS nursing quality evaluation system for preterm infants is scientific.The content covers all aspects of the nursing service of premature infants with respiratory distress syndrome.It can provide a reference basis for in-depth clinical evaluation of the nursing quality of premature with respiratory distress syndrome and promote the continuous improvement of nursing quality.