急性呼吸窘迫综合征患者俯卧位通气护理质量评价指标的构建

doi:10.3761/j.issn.0254-1769.2021.07.003

摘要/Abstract

摘要：

目的构建急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）患者俯卧位通气护理质量评价指标,为评价ARDS患者俯卧位通气护理质量提供依据。方法基于三维质量结构模型,通过文献分析、半结构式访谈初步拟订ARDS患者俯卧位通气护理质量评价指标,于2020年9月—11月采用德尔菲法对35名专家进行2轮咨询确立ARDS患者俯卧位通气护理质量评价指标。结果 2轮咨询问卷回收率均为100%,专家权威系数为0.85、0.89,肯德尔和谐系数为0.155、0.122。最终形成的ARDS患者俯卧位通气护理质量评价指标包含3项一级指标、8项二级指标、41项三级指标。结论构建的ARDS患者俯卧位通气护理质量评价指标具有较高可靠性和科学性,可作为评价ARDS患者俯卧位通气护理质量的依据。

关键词: 急性呼吸窘迫综合征, 俯卧位, 机械通气, 质量指标, 卫生保健, 德尔菲法, 护理管理研究

Abstract:

Objective The establishment of an evaluation index for the quality of prone ventilation care for patients with acute respiratory distress syndrome （ARDS） is to provide a basis for evaluating the quality of prone ventilation care for patients with ARDS. Methods Based on the three-dimensional quality structure model,through literature analysis and semi-structured interviews,a preliminary drafting of an ARDS patient prone position ventilation nursing quality evaluation index was established. From September to November 2020,the Delphi method was used to conduct 2 rounds of consultation inquiries to 35 experts to establish the evaluation index of the ARDS patient’s prone position ventilation nursing quality. Results The recovery rates of the 2 rounds of questionnaires were 100%;the expert authority coefficients were 0.85 and 0.89;the Kendall harmony coefficients were 0.155 and 0.122,respectively. The final evaluation index of prone ventilation nursing quality for ARDS patients includes 3 first-level indicators,8 second-level indicators,and 41 third-level indicators. Conclusion The constructed evaluation index of prone ventilation nursing quality for ARDS patients is highly reliable and practical,and can be used as a basis for evaluating the prone ventilation nursing quality of ARDS patients.

Key words: Acute Respiratory Distress Syndrome, Prone Position, Mechanical Ventilation, Quality Indicators, Health Care, Delphi Method, Nursing Administration Research

于奕,李暘,李姗姗,张凤,韩文兰,刘会会,单信芝. 急性呼吸窘迫综合征患者俯卧位通气护理质量评价指标的构建[J]. 中华护理杂志, 2021, 56(7): 977-982.

YU Yi,LI Yang,LI Shanshan,ZHANG Feng,HAN Wenlan,LIU Huihui,SHAN Xinzhi. Construction of the evaluation index of prone position ventilation nursing quality for patients with acute respiratory distress syndrome[J]. Chinese Journal of Nursing, 2021, 56(7): 977-982.

图/表 1

参考文献 15

[1]	Villar J, Sulemanji D, Kacmarek RM. The acute respiratory distress syndrome:incidence and mortality,has it changed?[J]. Curr Opin Crit Care, 2014, 20(1):3-9. DOI PMID
[2]	Fan E, Del Sorbo L, Goligher EC, et al. An official American thoracic society/European society of intensive care medicine/society of critical care medicine clinical practice guideline:mechanical ventilation in adult patients with acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2017, 195(9):1253-1263. DOI URL
[3]	岳伟岗, 张莹, 蒋由飞, 等. 俯卧位通气对急性呼吸窘迫综合征患者的影响[J]. 中国呼吸与危重监护杂志, 2019, 18(6):532-536.
	Yue WG, Zhang Y, Jiang YF, et al. Effect of prone position ventilation on patients with acute respiratory distress syndrome[J]. Chin J Respir Crit Care Med, 2019, 18(6):532-536.
[4]	岳伟岗, 张莹, 蒋由飞, 等. 俯卧位通气治疗急性呼吸窘迫综合征患者临床不良事件的Meta分析[J]. 解放军护理杂志, 2018, 5(20):36-41,73.
	Yue WG, Zhang Y, Jiang YF, et al. Clinical adverse events of prone position in ventilated patients with acute respiratory distress syndrome:a meta-analysis[J]. Nurs J Chin PLA, 2018, 5(20):36-41,73.
[5]	郎子佳, 王立平. ICU病人俯卧位通气护理敏感性指标体系的构建[J]. 护理研究, 2020, 34(15):2650-2654.
	Lang ZJ, Wang LP. Construction of index system for nursing sensitivity of prone position ventilation in ICU patients[J]. Chin Nurs Res, 2020, 34(15):2650-2654.
[6]	李尊柱, 李真, 刘桂英, 等. 基于患者安全为导向的俯卧位通气护理指标的构建[J]. 中国实用护理杂志, 2020, 36(19):1451-1456.
	Li ZZ, Li Z, Liu GY, et al. The construction of nursing index of prone position ventilation based on patient safety[J]. Chin J Pract Nurs, 2020, 36(19):1451-1456.
[7]	Jünger S, Payne SA, Brine J, et al. Guidance on Conducting and Reporting Delphi Studies(CREDES) in palliative care:recommendations based on a methodological systematic review[J]. Palliat Med, 2017, 31(8):684-706. DOI URL
[8]	崔金锐, 陈英, 徐蓉, 等. 呼吸内科护理敏感性质量指标体系的构建[J]. 中华护理杂志, 2016, 51(11):1285-1291.
	Cui JR, Chen Y, Xu R, et al. Development of a nursing-sensitive quality indicator system in respiratory medicine department[J]. Chin J Nurs, 2016, 51(11):1285-1291.
[9]	郭红艳, 谢红. 美国护理质量评价体系对我国护理质量管理的启示[J]. 中国护理管理, 2014, 14(5):459-462.
	Guo HY, Xie H. Nursing quality management system in the United States and its revelation to China[J]. Chin Nurs Manag, 2014, 14(5):459-462.
[10]	邢双双, 顾则娟, 蒋秀美, 等. 急性白血病临床护理质量评价标准的构建[J]. 中华护理杂志, 2018, 53(3):324-329.
	Xing SS, Gu ZJ, Jiang XM, et al. Construction of nursing quality evaluation index system for acute leukemia based on Structure-Process-Outcome model[J]. Chin J Nurs, 2018, 53(3):324-329.
[11]	王慧芳, 宋蕾, 修麓璐, 等. 危重患者院内转运护理质量评价指标体系的构建及应用[J]. 中华急危重症护理杂志, 2020, 1(1):31-36.
	Wang HF, Song L, Xiu LL, et al. The construction and clinical application of nursing quality evaluation index system for intrahospital transport of critically ill patients[J]. Chin J Emerg Crit Care Nurs, 2020, 1(1):31-36.
[12]	刘玲, 徐磊. 急性呼吸窘迫综合征患者俯卧位通气治疗规范化流程[J]. 中华内科杂志, 2020, 59(10):781-787.
	Liu L, Xu L. Standardized protocol of prone position ventilation in patients with acute respiratory distress syndrome[J]. Chin J Intern Med, 2020, 59(10):781-787.
[13]	Scholten EL, Beitler JR, Prisk GK, et al. Treatment of ARDS with prone positioning[J]. Chest, 2017, 151(1):215-224. DOI PMID
[14]	Munshi L, Del Sorbo L, Adhikari NKJ, et al. Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis[J]. Ann Am Thorac Soc, 2017, 14(s4):S280-S288. DOI URL
[15]	Yamagishi M, Kanda K, Takemura Y, et al. Methods developed to elucidate nursing related adverse events in Japan[J]. J Nurs Manag, 2003, 11(3):168-176. DOI URL