Donabedian环节模型设计急诊脑出血护理质量评价指标构建与初步实践效果探究

doi:10.20223/j.cnki.1000-8535.2025.10.005

摘要/Abstract

摘要： 目的基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系,并应用于临床,为急诊脑出血患者护理质量管理、监测与评价提供客观、科学的参考依据。方法通过文献查阅、筛查与评价,提取可行性资料,基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系的框架,并采用德尔菲法完成两轮专家函询,确定最终的指标体系。选择2021年1月—2024年1月本院收治的230例急诊脑出血患者为研究对象,将2021年1月—2022年6月作为干预前监测节点,该阶段的165例患者为传统组,实施常规的护理质量管理;将2022年7月—2024年1月作为干预后监测节点,该阶段的165例患者为观察组,实施以急诊脑出血患者护理质量评价指标进行护理质量监测管理。结果两轮函询中专家积极系数分别为95%和100%,意见提出率分别为56.25%和35.54%;两轮函询专家权威系数为0.945、0.893;第1轮函询中各项指标变异系数（CV）均值为0~0.136,Kendall’s W协调系数为0.065;第2轮函询中变异系数（CV）均值为0~0.110,Kendall’s W协调系数为0.186。最终形成的急诊脑出血患者护理质量评价体系共涵盖一级指标3个、二级指标11个、三级指标55个。观察组入院-用药时间合格率、吞咽障碍患者动态评估率、气道管理合格率、早期被动/主动活动落实率高于传统组,差异具有统计学意义（χ²=14.850、12.261、8.183、37.420,P<0.05）,观察组患者满意度明显高于传统组（χ²=14.049,P<0.001）。结论本研究构建的急诊脑出血患者护理质量评价体系具有一定的科学性、可靠性和实用性,可作为临床实现护理质量持续改进的重要评价工具。

关键词: Donabedian环节模型, 脑出血, 护理质量, 评价体系

Abstract: Objective Based on the Donabedian model,the nursing quality evaluation system of emergency cerebral hemorrhage patients was constructed,and applied to clinical practice,providing an objective and scientific reference basis for realizing the nursing quality management,monitoring and evaluation of emergency cerebral hemorrhage patients．Methods Through literature review,screening and evaluation,the feasibility data was extracted,and the framework of the nursing quality evaluation system for patients with emergency cerebral hemorrhage was constructed based on the Donabedian model,and the Delphi method was adopted to complete two rounds of expert letter inquiry to determine the final index system．The study selected 230 patients with acute cerebral hemorrhage admitted to our hospital from January 2021 to January 2024 as the research subjects．The period from January 2021 to June 2022 was used as the pre-intervention monitoring period,during which 165 patients were in the traditional group,receiving routine nursing quality management．The period from July 2022 to January 2024 was used as the post-intervention monitoring period,during which 165 patients were in the observation group,implementing nursing quality monitoring and management based on evaluation indicators for the care of patients with acute cerebral hemorrhage．Results In the two rounds of letter inquiry,the positive coefficient of experts was 95% and 100%,respectively,and the rate of suggestions was 56.25% and 35.54%,respectively;the authority coefficient of experts in the two rounds of letter inquiry was 0.945 and 0.893．In the first round the mean value of coefficient of variation（CV）of each index was 0~0.136,and the coordination coefficient of Kendall’s W was 0.065;in the second round the mean value of variation coefficient（CV）was 0-0.110,and the coordination coefficient of Kendall's W was 0.186．The final nursing quality evaluation system for emergency cerebral hemorrhage patients covers 11 first-level indicators,11 second-level indicators and 55 third-level indicators．The results showed that the pass rate of admission-medication time,dynamic assessment rate of dysphagia patients,airway management rate,and early passive / active activity implementation rate of the observation group were statistically significant different from those in the traditional group（χ²=14.850,12.261,8.183,37.420,P<0.05）,and the patient satisfaction in the observation group was significantly higher than that in the traditional group（χ²=14.049,P<0.001）．Conclusions The nursing quality evaluation system for emergency cerebral hemorrhage patients constructed in this study is scientific,reliable and practical,and can be used as an important evaluation tool to achieve continuous improvement of nursing quality in clinical practice．

Key words: Donabedian model, cerebral hemorrhage, quality of care, evaluation system

何妮妮, 蒋静, 王银娥, 苏兴珊. Donabedian环节模型设计急诊脑出血护理质量评价指标构建与初步实践效果探究[J]. 广州医药, 2025, 56(10): 1353-1362.

HE Nini, JIANG Jing, WANG Yin’e, SU Xingshan. Donabedian model based evaluation index construction of emergency cerebral hemorrhage care quality and the preliminary practice effect[J]. Guangzhou Medical Journal, 2025, 56(10): 1353-1362.

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