Construction Of Evaluation Index System Of Nursing Risk For Clinical Departments In 3-A-Grade General Hospital

Objective:This study aimed at exploring and establishing an evaluation index system of nursing risk for clinical departments in 3-A-grade general hospitals,and developing a scientific,reasonable and applicable tool for assessing nursing risk in clinical departments,so as to provide guidance and reference for nursing managers to allocate scientific human resources,quantify performance appraisal and allocate reasonable performance.Methods:First of all,we studied the status of nursing risk assessment in clinical departments through the literature review,and combined with the present clinical situation,then we developed a draft of the evaluation index system of nursing risk for clinical departments in 3-A-Grade General Hospital.Based on this,the index system was further revised by using group discussion method.Secondly,two rounds of expert consultation were carried out by Delphi method,and the index system was improved and established.Thirdly,using analytic hierarchy process to test the scientificity of the hierarchical structure of indicators and determine the weight of evaluation indicators at all levels.Finally,the questionnaire of nursing risk assessment in clinical departments was prepared by ourselves for pilot test,and the intrinsic quality of the index system was tested.Results:1.The evaluation index system of nursing risk for clinical departments in 3-A-grade general hospitals was consisted of 4 first-level indicators including patient factors,nurse factors,system factors and professional factors,11 second-level indicators and 52 third-level indicators.2.The results of expert consultation are reliable and authoritative.Two rounds ofexpert positive coefficients were 87.50% and 97.14%,the authority coefficients were0.893 and 0.894,the kendall coefficients were between 0.161 and 0.279(P<0.01).3.The model structure and weight setting of evaluation index system were scientific and reasonable.The weights of the 4 first-level indicators in the index model were patient factors(0.4445),nurse factors(0.2832),system factors(0.1072)and professional factors(0.1651).The weights of the 11 second-level indicators respectively were general condition(0.1158),disease condition(0.2815),social support condition(0.0472),basic quality(0.0944),core competence(0.1888)and organizational management(0.0415),support system(0.0295),practice environment(0.0150),collaboration(0.0212),nursing operational risk(0.1101)and nursing specialty characteristics(0.0550).The weights of three-level indicators ranged from0.0023 to 0.1225.4.The evaluation index system had good reliability and validity.The reliability of the index system was evaluated by the internal consistency coefficient(Cronbach’s alpha coefficient),the split half reliability and the test-retest reliability.The Cronbach’s α coefficient,the split half reliability and the test-retest reliability of the total index system were 0.945,0.903 and 0.831.The content validity was calculated according to the importance score of the consultant to the index,after two rounds of expert consultation,the scale-level content validity index was 0.980,and the item-level content validity index ranged from 0.850 to 1.000.The construct validity of the index system was estimated by correlation analysis and factor analysis.The correlation coefficient of the first-level indicators and the total system ranged from0.734 to 0.959(P<0.01 for all),correlation coefficients of the third-level indicators and the first-level indicators ranged from 0.413 to 0.828(P<0.01 for all).Exploratory factor analysis identified four principal factors,which accumulatively explained50.302% of total variance.Conclusion:This study established the evaluation index system of nursing risk for clinical departments in 3-A-grade general hospitals,which was combined qualitative with quantitative research methods.It had good reliability and validity,and could be used as an evaluation tool of nursing risk in clinical departments.So as to provide reference for nursing managers to carry out nursing human resource management and nursing staff performance allocation.