Construction And Application Of Nursing Sensitive Quality Indicator For The Elderly Hip Arthroplasty

ObjectivesFirstly,based on the Johns Hopkins Nursing Evidence-Based Practice(JHHEBP)and the three-dimensional quality management type of Donabedian"Structure-Process-Result",a nursing sensitive quality index system for elderly hip arthroplasty was constructed by combining quantitative and qualitative research methods,and the scientific importance,clinical rationality and practical operability of the index system were analyzed.Secondly,carried out the clinical application research of the indicator system,compared the nursing quality of elderly hip arthroplasty before and after the implementation,explored the sensitivity of the three dimensions of"Structure-Process-Result"clinical outcomes,and verify the clinical applicability of the indicator system.It is a powerful tool for nursing managers to conduct quality evaluation,aiming to reduce the occurrence of complications of elderly hip arthroplasty,decrease the long of stay time,promote the functional recovery,improve discharge satisfaction.MethodsMethods of constructing nursing sensitive quality indicators for the elderly arthroplasty:(1)Evidence-based analysis method:develop a’subject word+free word’literature retrieval strategy,search Chinese and Foreign databases,retrieve the references of the included literature,evaluate the quality and grade of the included literature basing on the JHNEBP standard.(2)Semi-structure interview method:using the objective sampling method to select the interviewees.Each interview was about 30-45 minutes.The voice data was transcribed into text according to Colaizzi seven-step analysis method within 24 hours after the interview.(3)Delphi method:This was an important method of this research.The selected experts adopted the universality,authority,and voluntariness principles,,using Likert 5-level scoring rule back to back.The questionnaire response rate represents the experts positive coefficient,and the judgment basis coefficient,familiarity degree and authority degree of themselves are calculated according to their self-assessment.The Kendall coefficient W represents the coordination degree.The correspondence can be terminated when the experts opinions are consistent.(4)Analytic Hierarchy Process(AHP):Construct the judgment matrix and carry out the weight analysis.If the consistency ratio CR<0.1,the consistency was good;If CR>0.1,the judgment matrix needed to be adjusted until it passed the consistency test.Methods of applying nursing sensitive quality indicators for the elderly:(5)Quasi-experimental research method:Design a case-control trial to estimate the sample size based on the two independent sample t-test calculation formula,and screen indicators according to pilot hospitals application conditions.Establish a research group for indicator data collection and quality evaluation,revise relevant data collection methods in clinical trials,and verify the Spearman consistency of evaluators.r _S>0.7indicates high consistency and can be used for formal research.By training nurses on professional knowledge of elderly hip arthroplasty and practicing emergency plans for elderly hip arthroplasty,analyzing the data results before and after the application of the nursing sensitive quality indicator system for elderly hip arthroplasty.Statistic methods:Excel 2019,SPSS 26.0 and Graph Pad Prism 9.3.0 software were used for data collection and analysis.The counting data is described by frequency and percentage,and the measuring data is described by mean and standard deviation.Two independent samples t-test and chi-square test were used for quantitative data,and chi-square test was used for qualitative data,ifα=0.05,P<0.05 has statistical difference.ResultsResults of constructing nursing sensitive quality indicators for the elderly:(1)A total of 5146 literatures were selected through the database and manual search,and the search date was from the database establishment to March 2022.Among them,4370 were in foreign languages,556 were in Chinese,10 were guideline,706 were duplicated,and 535 were initially obtained after reading the title.After further reading the abstract,there was remaining 72 articles,and the quality of the literature was further evaluated,excluding non-English literature,quality grade C,non-access to obtain the full text,questionnaires,conferences,and finally 14 articles were included.The evaluation results of literature quality and grade are as follows:1 of gradeⅠA,5 of gradeⅡA,2 of gradeⅡB,3 of gradeⅢA,1 of gradeⅢB,2 of gradeⅣA.Combining the included indicators of these literature under the circumstance in our country.(2)The interviewees were 2 orthopedic department directors,4 orthopedic head nurses and 3 orthopedic nursing backbones.The interview content was refined into three themes:’support of senior managers’,’professional quality of nurses’and’specialized nursing for the elderly’.The interviewees in this study highly recognized the importance of the project and actively participated in the construction of China National Database of Nursing Quality.This interview improved and unified the data calculation formula and data collection method in the outline of nursing sensitive quality index system for elderly hip arthroplasty.The outline of sensitive indicators system was improved by the evidence-based data and interviewers view together.If more than 2 interviewees had the same opinion on one indicator item,it should be adopted.(3)This study selected 25 experts from 10 Class A tertiary hospitals in 10 provinces and cities,including Liaoning,Sichuan,Zhejiang,Jiangsu,Shandong and Beijing.Correspondence experts were mainly engaged in orthopedic nursing,nursing management and medical management.Their age coverage was 33～68 years old,and their working time was 10～49 years,educational background including 3 doctors,8 masters and 12undergraduates;There were 11 senior professional titles,6 deputy senior professional titles,2 doctoral supervisors and 12 postgraduate supervisors.In the first round of expert correspondence,25 questionnaires were distributed,22 were valid,and the effective recovery rate was 88%.The experts’judgment basis coefficient was 0.925,the familiarity degree was 0.800,the authority degree was 0.862;the experts’coordination coefficient:index importance was 0.443,the calculation formula accuracy was 0.453,and the data collection method operability was 0.444.In the second round of expert correspondence,23questionnaires were distributed,23 were effectively recovered,and the effective recovery rate was 100%.The experts’judgment basis coefficient was 0.915,the familiarity degree was 0.813,and the authority degree was 0.864;the expert coordination coefficient:index importance was 0.482,the rationality of the calculation formula was 0.501,and the operability of the data collection method was 0.509.The coordination coefficient of the second round of expert correspondence was higher than that of the first round,indicating that the experts’opinions tended to be consistent.In the first round of expert correspondence,16 experts put forward constructive suggestions,and in the second round,4 experts put forward modification suggestions.The final constructed nursing sensitive quality index system for elderly hip arthroplasty included 3 first-level indicators,12 second-level indicators and 40 third-level indicators.(4)The CR value of the first-level index judgment matrix was 0.0000～0.0131,both<0.1,with good consistency.The CR value of the second-level index judgment matrix was 0.0000～0.0516,both<0.1,with good consistency.The CR value of the three-level index judgment matrix was<0.1,among them,the highest weight of the incidence of dislocation of prosthesis was 0.0789,then nurse-patient ratio 0.0741,patient satisfaction at discharge 0.0708,discharge follow-up implementation rate 0.0588,electrotherapy instrument matching rate 0.0548,the passing rate of the knowledge for the elderly hip arthroplasty of nurses 0.0444,the passing rate of the perioperative nursing process for the elderly hip arthroplasty of nurses 0.0444,the correct rate of the metatarsal flexion and extension exercise 0.0411,the implementation rate of pre-operation preparation propaganda and education for the elderly hip arthroplasty 0.0411,the constituent ratio of nurses at different levels 0.0370,and the incidence of fall was 0.0367,indicating that the three-level index had good consistency.Results of applying nursing sensitive quality indicators for the elderly arthroplasty:(5)The pre-trial was conducted by three evaluators to examine the three indicators of the 5 same patients,namely"Barthel score accuracy","pain assessment accuracy",and"posture placement qualification rate".The Spearman correlation coefficient was calculated,and the inter evaluator reliability of the three indicators was 0.914,0.893,and 0.940(>0.7),indicating good consistency among different evaluators.This study validated a total of 36 tertiary indicators,but due to objective factors,the following 4 indicators were not clinically validated:Harris score accuracy,ADL score accuracy,anxiety/fear intervention effectiveness,and6MWT trial.To compare and analyze the changes of clinical outcomes before and after the implementation of the nursing sensitive quality index system for elderly hip arthroplasty.The qualified rate of nurses’knowledge of elderly hip arthroplasty was 45%vs 79%(P=0.022),and the qualified rate of nurses’emergency plan for elderly hip arthroplasty was 55%vs 86%(P<0.05);The correct rate of Barthel score increased by72%vs 91%(P<0.05),the correct rate of Caprini score increased by 82%vs 97%(P<0.05),and the correct rate of functional exercise increased by 69%vs 91%(P<0.05);The Harris score,ADL score and discharge satisfaction of elderly hip arthroplasty were significantly improved(P<0.05),and the incidence of complications decreased by 18%vs 4%(P<0.05).The incidence of delirium was also significantly reduced by 32%vs 12%(P<0.05).The effective rate of constipation intervention 50%vs 70%(P=0.630)and the implementation rate of discharge follow-up32%vs 36%(P=0.673)had no significantly statistical differences.Conclusions(1)The nursing sensitive quality index system for the elderly hip arthroplasty is scientific,reasonable a nd operable,including 3 first-level indicators,12 second-level indicators and 40 third-level indicators.(2)After the nursing sensitive quality index system of elderly hip arthroplasty clinical application,the incidence of complications has been reduced by 14%and the long of stay time has been reduced by 2.26d,discharge satisfaction has been improved by 3.23%,and the patient rehabilitation process Harris score has been promoted by 2.04.It has good clinical applicability,sensitivity and feasibility.