以质量求发展，以服务铸品牌

护理学报 ›› 2019, Vol. 26 ›› Issue (10): 26-31.doi: 10.16460/j.issn1008-9969.2019.10.026

• 循证护理 • 上一篇    下一篇

基于循证构建住院患者肠内营养护理质量评价指标体系

詹昱新a, 杨中善b, 李素云c, 喻姣花a, 米元元d, 黄海燕d, 史雯嘉e, 陈剑苹f   

  1. 华中科技大学同济医学院附属协和医院 a.护理部; b.神经外科; c.外科; d.重症医学科; e.小儿外科; f.神经内科,湖北 武汉 430022
  • 收稿日期:2019-03-03 发布日期:2020-07-17
  • 作者简介:詹昱新（1982-）,女,湖北武汉人,本科学历,主管护师,护士长。
  • 基金资助:
    2017湖北省技术创新专项（2017ADC077）; 2017湖北省卫生计生委面上项目（WJ2017M102）

Construction of Evidence-based Evaluation Index System for Nursing Quality of Enteral Nutrition for Hospitalized Patients

ZHAN Yu-xina, YANG Zhong-shanb, LI Su-yunc, YU Jiao-huaa, MI Yuan-yuand, HUANG Hai-yand, SHI Wen-jiae, CHEN Jian-pingf   

  1. a. Dept. of Nursing Administration; b. Dept. of Neurosurgery; c. Dept. of Surgery; d. Dept. of Critical Care Medicine; e. Dept.of Pediatric Surgery; f. Dept.of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022,China
  • Received:2019-03-03 Published:2020-07-17

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摘要： 目的 构建肠内营养护理质量评价指标体系,为提高临床护士执行力提供理论依据,以提高肠内营养护理质量。方法 基于循证方法学结合本院临床数据分析,应用德尔菲法对20名专家进行2轮函询,确定各指标内容及及重要性,结合层次分析法确定各指标权重。结果 经过2轮专家函询后,得到聚焦于过程质量指标下的一级指标1项即肠内营养规范符合率;4项二级指标即营养风险护理评估落实率、肠内营养护理评估落实率、肠内营养溶液配制落实率和肠内营养输注护理落实率;每项二级指标下级包括依次为3项、2项、3项、13项,共21项三级指标。结论 肠内营养护理质量评价指标体系具有科学性、有效性和可行性,可有效指导护士行为,评价肠内营养护理质量。

关键词: 肠内营养, 护理质量, 评价指标, 德尔菲法, 循证护理

Abstract: Objective To construct an evaluation index system for nursing quality of enteral nutrition for hospitalized patients and to provide theoretical basis for improving the executive ability of clinical nurses and ultimately improving the quality of enteral nutrition care. Methods With evidence-based methodology and combined with the clinical data of the hospital, Delphi method was used to conduct two rounds of enquiries in 20 experts to determine the content and importance of each index, and the weight of each index was determined by analytic hierarchy process(AHP). Results After two rounds of expert consultation, one first-level indicator of the compliance rate of enteral nutrition was formed. There were four second-level indicators including implementation rate of nutrition risk nursing evaluation, implementation rate of enteral nutrition nursing evaluation, implementation rate of enteral nutrition solution and implementation rate of enteral nutrition infusion and there were 3, 2, 3 and 13 third-level items in each second-level indicator respectively. Conclusion The evaluation index system for nursing quality of enteral nutrition for hospitalized patients is scientific and feasible and it can effectively evaluate the quality of enteral nutrition nursing.

Key words: enteral nutrition, nursing quality, evaluation index, Delphi method, evidence-based nursing

中图分类号: 

  • R151.4
[1] McClave S A, Taylor B E, Martindale R G. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition(A.S.P.E.N.)[J].JPEN J Parenter Enteral Nutr,2016,40(2):159-211.DOI:10.1097/CCM.0b013e3181a40116.
[2] 周田田,王保荣,朱小芳,等.ICU 脓毒症患者肠内营养喂养不耐受的相关因素分析[J].护理学报, 2017, 24(16):6-9. DOI:10.16460/j.issn1008-9969.2017.16.006.
[3] Agency for Healthcare Research and Quality. The AHRQ Informed Consent and Authorization Toolkit for Minimal Risk Research:Chapter 2. How to Improve Informed Consent and Authorization[EB/OL].[2018-12-01](2019-04-20).http://www.ahrq.gov/funding/policies/informedconsent/ictoolkit2.html.
[4] 杨赛,李素云,谭翠莲,等.住院病人肠内营养护理质量评价指标体系的构建[J].护理研究, 2018,32(9):1378-1381. DOI:10.12102/j.issn.1009-6493.2018.09.013.
[5] 孙琳,黄迎春,沈子琳,等.肠内营养护理质量评价指标体系的构建[J].中国护理管理,2017,17(3):341-345. DOI:10.3969/j.issn.1672-1756.2017.03.014.
[6] 李素云,柯卉,张献娜.护理人员安全实施肠内营养知信行调查[J].护理学杂志, 2017,32(18):85-88. DOI:10.3870/j.issn.1001-4152.2017.18.085.
[7] Aromataris E, Fernandez R, Godfrey C M,et al.Summarizing Systematic Reviews: Methodological Development, Conduct and Reporting of an Umbrella Review Approach[J].Int J Evid Based Healthc, 2015, 13(3):132-140.DOI:10.1177/08854122090230030701.
[8] Dicenso A, Bayley L, Haynes R B.Accessing Pre-appraised Evidence: Fine-tuning the 5S Model into a 6S Model[J]. Evid Based Nurs,2009,12(4):99-101.DOI:10.1136/ebn.12.4.99-b.
[9] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967. DOI:10.16821/j.cnki.hsjx.2015.11.002.
[10] Brouwers M C, Kho M E, Browman G P, et al.AGREE II:Advancing Guideline Development,Reporting,and Evaluation in Health Care[J].Prev Med, 2010, 51(5):421-424. DOI:https://doi.org/10.1503/cmaj.090449.
[11] The Joanna Briggs Institute Levels of Evidence and Grades of Recommend-ation Working Party.Supporting Document for the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation, the Joanna Briggs Institute[EB/OL].[2017-07-15](2018-08-30).https://www.joannabriggs.org/critical_appraisal_tools.
[12] Seres D. Nutrition Support in Critically Ill Patients:Enteral Nutrition[EB/OL].[2018-05-11](2018-08-30). https://www.uptodate.com/contents/zh-Hans/nutrition-support-in-critically-ill-patients-enteral-nutrition.
[13] 广东省药学会.肠内营养临床药学共识(第二版)[EB/OL].[2017-05-08](2018-08-30).http://guide.medlive.cn/guideline/13493. DOI:CNKI:SUN:YAXU.0.2017-05-001.
[14] Hayes K D, Hayes D D.Best Practices for Unclogging Feeding Tubes in Adults[J].Nursing,2018,48(6):66. DOI:10.1097/01.NURSE.0000532744.80506.5e.
[15] Mehta N M, Skillman H E, Irving S Y, et al.Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient:Society of Critical Care Medicine and American Society for Parenteraland Enteral Nutrition[J].JPEN J Parenter Enteral Nutr,2017,41(5):706-742.DOI:10.1177/0148607117711387.
[16] Arends J, Baracos V, Bertz H, et al.ESPEN Expert Group Recommendations for Action Against Cancer-related Malnutrition[J]. Clin Nutr,2017,36:1187-1196.DOI:10.1016/j.clnu.2017.06.017.
[17] Sioson M S, Martindale R, Abayadeera A, et al.Nutrition Therapy for Critically Ill Patients Across the Asia-pacific and Middle East Regions: A Consensus Statement[J].Clin Nutr,2017,24:156-164. DOI:10.1016/j.clnesp.2017.11.008.
[18] VanBlarcom A,McCoy M A.New Nutrition Guidelines: Promoting Enteral Nutrition via a Nutrition Bundle[J].Crit Care Nur,2018,38(3):46-52.DOI:10.4037/ccn2018617.
[19] Diamond I R, Grant R C, Feldman B M, et al.Defining Consensus:A Systematic Review Kcommends Methodologic Criteria for ReportIing of Delphi Studies[J]. J Clin Epidemiol,2014,67(4):401-409.DOI:10.1016/j.jclinepi.2013.12.002.
[20] 吴清清,朱玲玲,樊树清,等.军队医院临床护理单元绩效考评指标体系的构建[J].中华护理杂志, 2017,52(12):1495-1499. DOI:10.3761/j.issn.0254-1769.2017.12.017.
[21] 王洪梅,黄霞,张艳,等.心脏康复护理质量评价指标体系的构建[J].中华护理杂志,2018, 53(11):1323-1327.
[22] 周英凤,胡雁,朱政,等.JBI循证卫生保健模式的更新及发展[J].护理学杂志,2017,32(3):81-83. DOI:10.3870/j.issn.1001-4152.2017.03.081.
[23] 中国抗癌协会,中国抗癌协会肿瘤营养与支持治疗专业委员会,中国抗癌协会肿瘤康复与姑息治疗专业委员会等.共识、指南与标准:营养评估[EB/OL].[2016-06-30](2018-08-30).http://guide.medlive.cn/guideline/12150.DOI:10.16689/j.cnki.cn11-9349/r.2016.02.009.
[24] 赵庆华,皮红英,周玉虹.危重症患者肠内营养期间胃残余量监测情况调查[J].中华现代护理杂志, 2016, 22(20):2881-2885.DOI:10.3760/cma.j.issn.1674-2907.2016.20.015.
[25] 中华医学会神经外科学分会,中国神经外科重症管理协作组.中国神经外科重症患者消化与营养管理专家共识(2016)[J].中华医学杂志,2016,96(21):1643-1647. DOI:10.3760/cma.j.issn.0376-2491.2016.021.005.
[26] 季新强,刘志民.Delphi法及其在医学研究和决策中的应用[J].中国药物依赖性杂志,2006,15(6):422-426. DOI:10.3969/j.issn.1007-9718.2006.06.003.
[27] 王春枝,斯琴.德尔菲法中的数据统计处理方法及其应用研究[J].内蒙古财经学院学报,2011,9(4):92-96. DOI:10.3969/j.issn.1672-5344.2011.04.022.
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