Construction Of Nursing Sensitive Quality Indicators System For Colonoscopy Based On The Structure-Process-Outcome Model

BackgroundColonoscopy is the gold standard for colorectal cancer screening,which requires the intervention of medical and nursing teams to improve the efficiency of the examination.However,due to differences in medical culture and research protocols,there is still no standardized and unified nursing sensitive indicator system of colonoscopy to evaluate the quality of colonoscopy care at present,both at home and abroad.ObjectivesUsing the structure-process-outcome model as a framework guide for the indicators,the phenomenological and evidence-based methods were applied to determine the pool of entries for the quality indicators of colonoscopy care sensitivity,and the Delphi method and hierarchical analysis were used to construct a complete indicator system to provide a reference for standardizing the evaluation of colonoscopy care quality and quantitatively improving the level of colonoscopy care activities.Methods1.Phenomenological approach:Semi-structured interviews were conducted between November 2021 and January 2022 with a purposive sample of colonoscopy patients and nursing staff from the endoscopy unit of a tertiary hospital in Guangzhou,with audio recordings maintained during the interviews,and data analysis was performed using thematic analysis.2.Evidence-based research method:Analyze relevant literature and theories at home and abroad,and the initial pool of indicator entries was organized.3.Delphi expert correspondence method:The expert correspondence questionnaire was created based on the entries developed in the preliminary study,and two rounds of expert consultation were conducted with 25 nursing experts from nine provinces and cities,including Suzhou,Beijing,and Hubei,and the weights of the indicator entries were calculated using the hierarchical analysis method.Results1.A total of 11 patients and 7 caregivers were interviewed in formal interviews,which were included in the final data analysis.Colonoscopy patients expressed needs for colonoscopy-related health promotion methods and tools,colonoscopy team quality,and nurse support.The nurse group identified human resource,teamwork,nurse qualifications,infection control,proactive care,and patient safety outcomes as factors affecting the quality of colonoscopy care.2.The extracted pool of quality indicators for colonoscopy care sensitivity entries contained human resources,unit facility availability,nursing systems,nursing culture,nursing training programs,nursing mission tools,nursing assessment and risk prevention,pre-test management of attendee,intra-test nursing management practices,post-test nursing management practices,discharge mission and continuity of care management,anesthesia care and safety management,nursing mission management,nursing infection control practices,attendee outcome management,attendee complication rates,and attendee satisfaction.3.The constructed indicators system contains 3 primary indicators,6 secondary indicators and 20 tertiary indicators.The positive coefficients of experts in the two rounds of Delphi correspondence were 89%and 92%respectively;the authority coefficients were 0.89 and 0.91;the coordination coefficients were 0.16 and 0.30(P<0.001).The consistency test of the indicators system met the standard.ConclusionThis study combines qualitative and quantitative research,and uses the Donabedian "structure-process-outcome" three-dimensional quality assessment model as the indicator framework.The indicators constructed are scientific,systematic and practical,and the weights are used to reflect the importance of the indicators.The indicators can measure the quality of colonoscopy care in a more sensitive and comprehensive way,which is of guiding significance for improving the quality of colonoscopy care.