杨毅　杨小莹　于梅

[摘要] 目的 探讨基于Donabedian理论构建的临床压力性损伤护理质量评价体系。 方法 采用德尔菲法对26名专家进行两轮咨询，初步构建临床压力性损伤护理质量评价体系。 结果 两轮专家咨询的问卷有效率分别92.30%和100.00%；变异系数分别为0.121～0.163和0.073～0.184；判断依据Ca为0.839、熟悉程度Cs为0.847、权威程度Cr为0.843。Kendall协调系数分别为0.541、0.743，专家意见协调性较高（P < 0.05）。结构-过程-结果三个维度的临床压力性损伤护理质量评价体系包括一级指标3项，二级指标15项，三级指标32项。 结论 专家咨询的积极系数、变异系数、权威系数等结果提示专家咨询代表性和可信度高，本研究构建的临床压力性损伤护理质量评价体系有利于临床压力性损伤护理质量的持续改进。

[关键词] Donabedian理论；压力性损伤；护理质量评价

[中图分类号] R473.71 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0137-04

Establishment of evaluation for the quality of clinical pressure sore nursing based on Donabedian theory

YANG Yi1 YANG Xiaoying2 YU Mei2

1.Nursing Department， Civil Aviation General Hospital， Beijing 100123， China；2.Department of Spine， the 309th Hospital of Chinese People's Liberation Army， Beijing 100123， China

[Abstract] Objective To explore the evaluation for the quality of clinical pressure sore nursing based on Donabedian theory. Methods Delphi method was adopted in this study. Through 2-round of consultation， the general evaluation for the quality of clinical pressure sore nursing was built up by 26 experts. Results The effective rates for the experts′ questionnaire consultation in 2 rounds were 92.30% and 100.00% respectively； the variation coefficient in first round was between 0.121-0.163 and in second round was between 0.073-0.184； the determination coefficient was 0.839， the familiar coefficient was 0.847 and the degree of authority coefficient was 0.843. The Kendall coefficients were 0.541 and 0.743， and it showed that the experts had an high agreement with the system. The structure-process-outcome system includes 3 primary indicators， 15 secondary indicators and 32 tertiary indicators. Conclusion High representativeness and dependability is proved by the results of experts' consultation such as active coefficient， variation coefficient and authority coefficient. The clinical pressure sore nursing evaluation system in this study is conductive to continuous improvement of clinical pressure sore nursing.

[Key words] Donabedian Theory； Pressure Sore； Evaluation System of Nursing Quality

美國学者Donabedian[1]首次提出通过测量结构-过程-结果三个维度的质量指标，对医疗服务质量进行评价，该理论指出，护理敏感性质量指标包括结构、过程和结果。就Donabedian的“结构-过程-结果”模式[3-4]而言，现阶段护理服务的质量评价指标往往集中于“结果”层面，而缺少对“结构”和“过程”两大重要维度的评价[5]。压力性损伤一直是临床护理和管理的重点和难点，其效果是衡量护理指标的主要内容之一[6]。有研究显示，住院患者压力性损伤发生率为3%～12%[7]，不仅表现为局部组织受损或开放性溃疡，也可能伴有疼痛[8]，影响患者生活质量和疾病转归。目前，管理缺乏集风险识别、压疮评估、标准防范、质量监控为一体的管理模式[9]。本研究运用Donabedian理论构建的临床压力性损伤护理质量评价体系，取得了良好的效果。现报道如下：

1 对象与方法

1.1 编制函询问卷

以Donabedian理论为基础，结合临床压力性损伤质量管理内容和患者需求，在参照国内外文献和10名本领域多地区资深专家焦点团体访谈基础上形成问卷初稿[10-12]。……