| ObjectiveBased on the theoretical framework of Donabedian "structure-process-outcome" three-dimensional quality structure model,this study aims to construct a scientific and practical evaluation indicator system for nursing quality after adult liver transplantation.The weight of each indicator was determined by analytic hierarchy process,and then select some indicators for clinical application according to the weight and clinical demand to provide reference for nursing quality management of adult liver transplantation.Methods1.The preliminary construction of index system:(1)The nursing quality indicators were extracted by analyzing relevant literatures at home and abroad.(2)The evaluation index system of nursing quality after liver transplantation for adults was established by semi-structured interviews with nine medical staff engaged in liver transplantation and literature analysis results.2.The determination of index system and the calculation of indicators weight:(1)Use Delphi method,20 experts were selected to conduct letter consultation on the preliminarily constructed index system,and the indicators were modified according to the expert opinions,then finally the evaluation index system of nursing quality after adult liver transplantation was determined.(2)Employ analytic hierarchy process and Yaahp12.3 software to calculate the weight and combination weight of each index,and the consistency test was carried out,then finally the evaluation index system of nursing quality after adult liver transplantation was determined.3.Preliminary application of monitoring indicators: Four indicators including “oral administration rate of immunosuppressants after liver transplantation”,“early activity rate after liver transplantation”,“respiratory function training rate after liver transplantation”and “dietary contraindications awareness rate of patients after liver transplantation” were selected for clinical application.The convenience sampling procedures were used to choose adult liver transplantation patients form the department of organ transplantation in a tertiary comprehensive hospital in Qingdao as the research objects.Totally 40 patients before the implementation of adult liver transplantation nursing quality evaluation index(June to August 2021)were selected as the control group,while another 42 patients after the implementation of the indicators(October to December2021)were selected as the observation group.Patients in the control group received nursing quality management after liver transplantation according to the nursing routine and related nursing system,whereas patients in the observation group received nursing quality management using the evaluation indicator system for nursing quality after adult liver transplantation.Results1.The results of literature review: In the end,28 literatures were included in this study.By analyzing the included literature and combining clinical practice,forming the preliminarily framework and related items of the quality evaluation index system for adults after liver transplantation.2.The results of semi-structured interview: A total of 9 medical staff were interviewed,through the collation and analysis of the interview data,3 themes including influence factors of quality of nursing care after liver transplantation in adults,nursing emphases after liver transplantation and outcomes after liver transplantation and 10 subtopics were extracted.So as to deeply supplement and improve the contents of the preliminary draft of quality evaluation index system for adults after liver transplantation.3.In this study,The effective recovery rate of the questionnaires were 95.24%,100%,which indicating a high degree of expert participation.The authority coefficient(Cr)were0.853,0.879,which indicating a high degree of expert authority.The Kendall’W were0.108,0.184,and the difference was statistically significant(P<0.01),which indicating their opinions tended to be consistent.Finally,an index system for nursing quality after adult liver transplantation was formed,which included 3 first-level indicators,9second-level indicators and 46 third-level indicators.4.The results of analytic hierarchy process: The weights of the three first-level indicators were in the following order: structure(0.400),process(0.400),result(0.200).Among the second-level indicators,the first three of the the combined weights were organization and personnel(0.197),special disease nursing measures(0.133)and health education(0.133).Among all the three-level indicators,the first five combined weights were the allocation of nurses of different levels(0.197),the compliance rate of dietary contraindication knowledge of patients after liver transplantation(0.167),the compliance rate of health education awareness after liver transplantation(0.167),the satisfaction degree of pain management(0.155),and Per capita on-the-job training hours of specialized posts(0.124).CR values were all < 0.1.5.The results of preliminary application of monitoring indicators: The oral administration rate of immunosuppressants after liver transplantation from June to August in 2021 and from October to December in 2021 were 78.75% and 88.10%,respectively;The early activity rate after liver transplantation were 84.11% and 90.14%,respectively;The respiratory function training rate after liver transplantation were 67.50% and84.76%,respectively;The dietary contraindications awareness rate of patients after liver transplantation were 78.86% and 86.15%,respectively.The difference was statistically significant(P < 0.05).ConclusionIn this study,with "structure-process-results" three-dimensional quality structure model as the theoretical framework,the evaluation index system of nursing quality after adult liver transplantation was constructed by Delphi method and analytic hierarchy process,it shows that the system is comprehensive,scientific and reliable.The application of indicators can help nursing managers to timely find the weak spots of nursing quality after adult liver transplantation,effectively carry out supervision,and then promote continuous improvement of nursing quality. |
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