中医护理方案实施质量评价体系的构建

doi:10.3761/j.issn.0254-1769.2024.18.009

摘要/Abstract

摘要：

目的建立科学、系统的中医护理方案实施质量评价体系，为促进中医护理方案的规范实施和质量改进提供参考。方法 2023年10月—12月，组建研究小组，根据“结构-过程-结果”三维质量模型，并结合文献研究、焦点团体访谈，形成中医护理方案实施质量评价体系初稿，采用德尔菲专家函询和层次分析法制订中医护理方案实施质量评价体系。结果 2轮专家函询有效问卷回收率均为100%，专家权威系数分别为0.853、0.958，专家意见的肯德尔和谐系数分别为0.151、0.152。最终确定的中医护理方案实施质量评价体系包括结构、过程、结果3个一级指标；制度管理、实施管理、质量管理、效果评价、安全性评价、满意度评价等6个二级指标；中医护理方案实施管理制度、中医护理方案定期优化等18个三级指标。结论构建的中医护理方案实施质量评价体系具有科学性和可靠性，然其实用性尚需在临床实践中检验。

关键词: 结构-过程-结果, 中医护理方案, 实施质量, 评价体系, 德尔菲技术, 护理管理研究

Abstract:

Objective To establish a scientific and systematic quality evaluation system for the implementation of TCM nursing programs，and to provide references for promoting the standardized implementation and quality improvement of TCM nursing programs. Methods From October 2023 to December 2023，a research team was set up to form the first draft of the quality evaluation system for the implementation of TCM nursing programs based on the “structure-process-results” three-dimensional quality model，by combining literature research and focus group interviews，and the quality evaluation system for the implementation of TCM nursing programs was formulated by means of Delphi expert letter consultation and analytic hierarchy process. Results 2 rounds of professional consultations resulted in an excellent recovery rate of 100%；the expert authority coefficients were 0.853 and 0.958；the Kendall harmony coefficients of expert opinions were 0.151 and 0.152，respectively. Finally，the quality evaluation system of TCM nursing program implementation was determined，including 3 first-level indicators，including structure，process and result. There are 6 secondary indicators，including system management，implementation management，quality management，effect evaluation，safety evaluation，and satisfaction evaluation. There are 18 three-level indicators，including the implementation management system of TCM nursing program and regular optimization of TCM nursing program. Conclusion The quality evaluation system for the implementation of TCM nursing programs is scientific and reliable，but its practicability needs to be tested in clinical practice.

Key words: Structure-Process-Outcome, Traditional Chinese Medicine Nursing Program, Implementation Quality, Evaluation System, Delphi Technique, Nursing Administration Research

邵雅双, 苏倩, 吴白女, 阚亚楠, 包云春, 叶富英. 中医护理方案实施质量评价体系的构建[J]. 中华护理杂志, 2024, 59(18): 2244-2250.

SHAO Yashuang, SU Qian, WU Bainü, KAN Yanan, BAO Yunchun, YE Fuying. Construction of a quality evaluation system for the implementation of TCM nursing program[J]. Chinese Journal of Nursing, 2024, 59(18): 2244-2250.

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参考文献 17

[1]	国家中医药管理局. 关于印发中风等13个病种中医护理方案(试行)的通知[EB/OL]. (2013-05-16)[2023-07-18]. http://www.natcm.gov.cn.
	State Administration of Traditional Chinese Medicine. Notice on printing and distributing the Traditional Chinese Medicine nursing program for 13 kinds of diseases(Stroke etc.)[EB/OL]. (2013-05-16)[2023-07-18]. http://www.natcm.gov.cn.
[2]	国家中医药管理局. 关于印发促脉证(阵发性心房颤动)等20个病种中医护理方案(试行)的通知[EB/OL]. (2014-03-27)[2023-07-15]. http://www.natcm.gov.cn.
	State Administration of Traditional Chinese Medicine. Notice on printing and distributing the Traditional Chinese Medicine nursing program for 20 kinds of diseases(paroxysmal atrial fibrillation etc.)[EB/OL].(2014-03-27)[2023-07-15]. http://www.natcm.gov.cn.
[3]	国家中医药管理局. 关于印发胃疡等19个病种中医护理方案(试行)的通知[EB/OL]. (2015-09-08)[2023-07-15]. http://www.natcm.gov.cn.
	State Administration of Traditional Chinese Medicine. Notice on printing and distributing the Traditional Chinese Medicine nursing program for 19 kinds of diseases(stomach ulcers etc.)[EB/OL]. (2015-09-08)[2023-07-15]. http://www.natcm.gov.cn.
[4]	吴欣媛, 郭敬, 白杨. 中医护理方案结构化病历系统临床应用与实施[J]. 北京中医药, 2020, 39(6):615-617.
	Wu XY, Guo J, Bai Y. Clinical application and implementation of structured medical record system of traditional Chinese medicine nursing scheme[J]. China Ind Econ, 2020, 39(6):615-617.
[5]	谢雅红, 陈晓洁, 祝亚男. 乳腺癌中医护理方案效果评价体系的构建[J]. 中华护理杂志, 2019, 54(1):70-75.
	Xie YH, Chen XJ, Zhu YN. Development of an evaluation index system of traditional Chinese medicine nursing project for breast cancer[J]. Chin J Nurs, 2019, 54(1):70-75.
[6]	Donabedian A. Evaluating the quality of medical care[J]. Milbank Q, 2005, 83(4):691-729. DOI PMID
[7]	孙朋霞, 李树亚, 华小雪, 等. 急危重症患者院间转运护理质量评价指标的构建[J]. 中华护理杂志, 2023, 58(15):1831-1837. DOI URL
	Sun PX, Li SY, Hua XX, et al. Construction of a nursing quality evaluation index system for inter-hospital transfer of emergency critically ill patients[J]. Chin J Nurs, 2023, 58(15):1831-1837. DOI URL
[8]	卢芳燕, 董丽, 刘元, 等. 儿童肝移植围手术期护理质量评价指标体系的构建[J]. 中华护理杂志, 2022, 57(6):666-673. DOI URL
	Lu FY, Dong L, Liu Y, et al. Establishment of quality evaluation indicator system for perioperative nursing in pediatric liver transplantation[J]. Chin J Nurs, 2022, 57(6):666-673. DOI URL
[9]	国家中医药管理局. 国家中医药管理局关于印发中医医院中医护理工作指南(试行)的通知[EB/OL]. (2010-07-28)[2023-08-07]. http://www.natcm.gov.cn.
	State Administration of Traditional Chinese Medicine. Notice on printing and distributing the guidelines for Chinese medicine nursing in Chinese medicine hospitals[EB/OL]. (2010-07-28)[2023-08-07]. http://www.natcm.gov.cn.
[10]	Denadai R, Lo LJ. Adapting Donabedian’s structure-process-outcome triad for quality improvement activities in surgical cleft-craniofacial care[J]. J Plast Reconstr Aesthet Surg, 2021, 74(1):223-243.
[11]	Kang L, Wang MH, Wu SJ. Construction of nursing-sensitive quality indicator system for cardiac rehabilitation of patients undergoing percutaneous coronary intervention based on structure-process-outcome model[J]. BMC Nurs, 2023, 22(1):457. DOI PMID
[12]	Kobayashi H, Takemura Y, Kanda K. Patient perception of nursing service quality;an applied model of Donabedian’s structure-process-outcome approach theory[J]. Scand J Caring Sci, 2011, 25(3):419-425. DOI PMID
[13]	国家卫生健康委. 国家卫生健康委关于印发全国护理事业发展规划(2021—2025年)的通知[EB/OL]. (2022-05-07)[2023-09-05]. http://www.nhc.gov.cn.
	National Health Commission. Notice of the National Health Commission on printing and distributing the national nursing development plan(2021-2025)[EB/OL]. (2022-05-07)[2023-09-05]. http://www.nhc.gov.cn.
[14]	周姣媚, 张素秋, 习亚炜. 中医护理方案的应用与思考[J]. 中国护理管理, 2016, 16(2):145-148.
	Zhou JM, Zhang SQ, Xi YW. The application and thinking of Traditional Chinese Medicine nursing program[J]. Chin Nurs Manag, 2016, 16(2):145-148.
[15]	陈媛儿, 冯莺. 腰椎间盘突出症患者中医辨证施护的研究进展[J]. 中华护理杂志, 2017, 52(5):604-607.
	Chen YE, Feng Y. Research progress on nursing with syndrome differentiation for lumber disc herniation[J]. Chin J Nurs, 2017, 52(5):604-607.
[16]	魏冕, 叶然, 徐桂华, 等. 44773名中医院护士辨证施护培训需求的现状调查[J]. 中华护理杂志, 2021, 56(8):1216-1221. DOI
	Wei M, Ye R, Xu GH, et al. Status investigation on the training demand of syndrome differentiation and nursing of 44773 Traditional Chinese Medicine hospital nurses[J]. Chin J Nurs, 2021, 56(8):1216-1221.
[17]	赵雪, 戴国华, 管慧, 等. 中医临床疗效评价指标的选择与应用[J]. 中华中医药杂志, 2022, 37(4):1863-1867.
	Zhao X, Dai GH, Guan H, et al. Selection and application of clinical efficacy evaluation indexes of Traditional Chinese Medicine[J]. China J Tradit Chin Med Pharm, 2022, 37(4):1863-1867.