【作者】 刘慧；

【导师】 刘晓英；

【作者基本信息】 山西医科大学 ， 护理学， 2017， 硕士

【摘要】 目的本研究应用循证医学的方法,评鉴并综合影响老年髋部骨折患者护理质量危险因素和质量评价的证据,制定出科学、敏感、实用,且适合我国护理实际的髋部骨折护理质量敏感性指标,为国内髋部骨折患者护理质量的评价与监测提供依据。同时,增强护理人员对患者不良结局发生的警觉性,为髋部骨折患者提供基于循证的安全保障。方法1.文献研究:通过检索Pub Med、Science Direct、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方医学网等数据库,及指南网站National Guideline Clearinghouse(NGC),检索关于国内外髋部骨折护理质量评价的相关研究,根据澳大利亚JBI循证卫生保健中心制定的证据分级方法(2010版),对纳入文献的证据等级进行分级,总结髋部骨折护理质量的评价指标。2.系统评价:计算机检索Cochrane Library、Medline、EMbase、中国生物医学文献数据库(CBM)、中国期刊全文数据库CNKI、万方医学网等中英文数据库,收集影响髋部骨折患者护理结局危险因素的文献,采用纽卡斯尔-渥太华(NOS)评分对文献质量进行评价,运用Rev Man 5.3软件进行数据分析与综合。3.小组讨论法:成立专家讨论小组,分析、整理与护理过程、护理结局有关的,有护理敏感性的髋部骨折护理质量敏感性指标,并对指标的条目含义、计算公式、资料收集方式进行讨论,初步拟定髋部骨折护理质量敏感性指标。4.Delphi法:采用德尔菲专家咨询法,对初步形成的髋部骨折护理质量敏感性指标的指标条目、计算公式、收集资料方法进行评价。并运用专家积极系数、权威系数、变异系数和协调系数等指标,对咨询结果进行统计分析。结果1.检索获得涉及髋部骨折护理质量评价的研究24篇,包括3份指南、19篇文献、2份专家共识,归纳总结出涉及髋部骨折护理质量评价的过程指标、结局指标。尚未发现针对髋部骨折护理质量评价的指标体系。为进一步构建髋部骨折护理质量敏感性指标提供证据支持和理论参考。2.通过系统地检索文献与评价文献质量,最后纳入了50篇文献进行Meta-分析,包括25篇队列研究和25篇病例对照研究,分析出影响患者护理结局的危险因素;3.综合汇总所收集的证据,构建出包含急诊停滞率、压疮风险评估率等20项髋部骨折护理质量敏感怔指标,并确定了指标内涵、计算公式、分子分母释义、资料收集方法。2轮专家函询的积极系数分别为80%和100%(>70%),专家权威系数均为0.83(>0.7);2轮专家函询后各项指标重要性的变异系数为0.05~0.22,计算公式合理性的变异系数为0.06~0.17,在收集资料方法可操作性系数为0.04~0.21,均小于0.3。结论本研究运用循证思维,通过系统、科学地评价分析,对证据进行筛选整理,构建了一套包含20项指标的髋部骨折护理质量敏感性指标体系,确立了各指标的内涵、计算方法及资料收集方法。为临床护理人员提高护理质量、护理管理者评价护理质量提供证据支持,有利于降低髋部骨折患者的死亡率和致残率。但该指标体系有待于进一步临床试点应用。更多还原

【Abstract】 Objective:The research applied the method of evidence-based medicine,to find out the evidence that affect the quality of care and quality assessment of patients with hip fractures.To formulate a scientific,practical,sensitive quality index of hip fracture,providing the basis for the evaluation and monitoring of the quality of care for patients with hip fracture.At the same time,enhancing the nursing awareness for the adverse outcome of patients that to provide safety guarantee for patients with hip fracture.Methods:1.Literature research: We searched literature published Medline,Science Direct,Chinese biomedical literature database(CBM),CNKI,Wanfang database,and guide web site National Guideline Clearinghouse(NGC),to seek literature about the hip fracture nursing quality evaluation.According to the classification method of Australia JBI based evidence center health care card set(2010),classified the level of evidence of literature,and summarized the evaluation indicators of nursing quality of hip fracture.2.System evaluation: We searched literature published Medline,Library searched Cochrane,EMbase,Chinese biomedical literature database(CBM),CNKI and Wanfang database,to find out the factors that influence the nursing outcomes of hip fracture patients,and use Rev Man 5.3 software to quantitatively analysis data.3.Group discussion: The group of experts analyzed and sorted out the nursing quality concerning nursing process,nursing outcomes and nursing sensitivity indexes of hip fracture.To discuss the items meaning,calculation formula and the method of collecting information.Studying out sensitivity index system of nursing quality of hip fracture.4.Delphi: The Delphi expert consultation method was used to evaluate the indexes,the calculation formula and the method of data collection,and to establish the nursing quality sensitivity index of hip fracture.Using expert positive coefficient,authority coefficient,variation coefficient and the coordination coefficient,statistical analysis of the consultation results.Result1.Through searching literature found out 24 studies,including 3 guidelines,19 literature,2expert consensus.Summarize the process and outcomes indexes,relating to the quality evaluation of nursing of hip fracture.Has not yet found the index system of nursing quality evaluation of hip fracture.For further construction of hip fracture nursing quality sensitivity index to provide evidence support and theoretical reference.2.Through searching literature and evaluating the quality of literature,50 articles were included in the Meta-analysis,including 25 cohort studies and 25 case-control studies.We analyze risk factors which can influence the patients’ nursing outcomes;3.A comprehensive summary of the evidence collected,building the 20 items hip fractures nursing quality sensitive indicators,including index connotation,calculation formula,the numerator and denominator of interpretation,data collection method.The positive coefficient of consultation were 80% and 100%(> 70%),the expert authority coefficient was 0.83(> 0.7).After 2 rounds of expert consultation the coefficient of variation of the importance of each indicator is 0.05~0.22,calculating the variation coefficient formula of rationality is 0.06~0.17,in the data collection method effectiveness coefficient is0.04~0.21(< 0.3).Conclusion In this study,using evidence-based theory,sorted evidences through the scientific evaluation system analysis.The construction of nursing quality sensitivity of an index system including 20 items of hip fracture,established the connotation of each index,calculation method and data collection method.Providing the evidence for clinical nursing staff and improving the quality of nursing,to reduce hip fracture patients mortality and disability rate.But the index system needs to be further clinical trial application.更多还原