Construction And Application Of Breastfeeding Nursing Quality Evaluation Index System Based On Three-dimensional Quality Structure Model

ObjectiveIn this study,Donabedian’s "structural-process-result" three-dimensional quality structure model was adopted as the theoretical framework,literature review,Delphi and analytic hierarchy process were used to construct the evaluation index system of breastfeeding nursing quality,and preliminary application research was conducted.This study provides evaluation tools for clinical evaluation of breastfeeding nursing effect,so as to improve the quality of breastfeeding nursing and improve the purity of breastfeeding nursing The breast-feeding rate provides a basis for decision-making.Methods1.A research team was established to review the literature on the quality of breastfeeding nursing at home and abroad and consult the latest guidelines to extract the evaluation indicators affecting the exclusive breastfeeding rate and the quality of breastfeeding nursing.After the literature screening,the literature quality was evaluated using the three-dimensional quality structure model as the theoretical framework for the breastfeeding nursing quality evaluation index system.2.The Delphi method was used for two rounds of expert letter inquiry,and the constructed index system was modified according to the expert opinions,index deletion standard and group discussion opinions.3.The hierarchical analysis method is used to calculate the index weight of all levels,determine the proportion of each index in the total evaluation index system,and test the consistency of the formed index system.4.All the indicators in the "key link of postpartum breastfeeding" in the index system were selected for the preliminary application study in the postpartum ward,and the change of exclusive breastfeeding rate in discharge before and after the application of the index system was observed,a four-grid table was used to test whether the difference in rate values was statistically significant.Results1.Article Review This study finally included 15 literature,literature quality and grade is:Ⅰa 2,Ⅱ a 2,Ⅱ b 3,Ⅲa 2,Ⅲb 1,Ⅳa 4,Ⅳb 1,Ⅴa 1,Ⅴb 2,research team of literature screening,analysis,extract the relevant index content build breastfeeding nursing quality evaluation index system draft,including 3 level 1,11 secondary indicators,58 tertiary indicators.2.Delphi In this study,two rounds of expert correspondence inquiry were conducted,and the recovery rate of questionnaires was 93.93%and 100%respectively,and the Cr of both rounds was 0.964,greater than 0.7,which fully indicates the high degree of authority and high credibility of the results.The research team members modified the index system according to the standard and the modification opinions given by experts in the two rounds of letters,in the second round of letter inquiry,the second and third-level indexes of Kendall harmony coefficient were 0.147 and 0.152.After the two rounds of expert letter inquiry,the expert opinions tended to be consistent,and finally formed the breastfeeding nursing quality evaluation index system consisting of 3 first-level indicators,11 second-level indicators and 59 third-level indicators.3.Step analysis The results of hierarchical analysis showed that the CR ratio of all hierarchical indexes was 0.000～0.0890,all<0.1,indicating that there is no logical error among all levels in the index system and the weight distribution has good consistency.The rate of exclusive breastfeeding from discharge before the application of the index system was 19.5%,and that of discharge after 1 month,2 months and 3 months was 20.9%,23.2%and 30.1%,respectively.By the chi-square test,χ2=10.926,P=0.012,(P<0.05),indicating that the difference of discharge exclusive breastfeeding rate in four months was statistically significant,and the application of the index system improved the rate of discharge exclusive breastfeeding.Conclusions1.In this study,Donabedian’s "structure-process-result" Three dimensional mass structure model was taken as the theoretical model,and the first draft of the index system was constructed through literature review.The index system includes the whole process of breastfeeding nursing,and the evaluation of the index system is comprehensive and reflects the specialty characteristics.2.The scientificity and reliability of the evaluation index system was guaranteed through Delphi method and hierarchical analysis method.In the preliminary application stage,by comparing the changes of the exclusive breastfeeding rate from discharge before and after the application of the index system,the numerical and objective evaluation of the index system has good results.