Abstract:

Objective　To construct a localized, scientific, and reliable quality evaluation index system for ophthalmic outpatient care, and to provide a standardized tool for quality control of ophthalmic outpatient care. Method Using the literature evidence-based approach, relevant literature on ophthalmic outpatient nursing quality indicators was retrieved from databases such as China National Knowledge Infrastructure, Wanfang, PubMed, EmBase, and CINAHL. The search period was from the establishment of the database until August 2023, and 11 relevant articles were ultimately selected. Based on the Structure Process Outcome (SPO) indicator system framework, develop specific interview content items. Using purposive sampling method, interviews were conducted with ophthalmic nursing managers and clinical nurses from five tertiary hospitals in Guangdong Province. Colaizzi analysis method was used to summarize and organize the interview content. Based on literature evidence and interview results, a preliminary indicator system for the quality of ophthalmic outpatient nursing was constructed, including 3 primary indicators, 9 secondary indicators, and 41 tertiary indicators. Create an expert inquiry questionnaire and use the Delphi method to conduct two rounds of expert inquiries via email from December 2023 to May 2024. Based on the results of the first round of inquiry, a second round of inquiry questionnaire will be formed through discussion. Using the recovery rate to indicate the level of expert engagement; The authority coefficient represents the level of expert authority, which is equal to (familiarity+judgment basis)/2; The Kendall harmony coefficient represents the coordination situation among experts. Using Analytic Hierarchy Process (AHP), construct a judgment matrix, calculate the weights, weight ranking, and combination weights of each indicator, and obtain the consistency coefficient (CR value). When the CR value is ≤ 0.100, the judgment matrix has consistency. Results　This study included 17 ophthalmic nursing experts, including 9 with 15 to 30 years of work experience and 8 with over 30 years of work experience; Among them, 7 experts have less than 10 years of experience in outpatient work, 9 experts have 10 to 20 years of working experience, and 1 expert has 20 years or more of working experience; 5 candidates hold senior professional titles, and 12 candidates hold deputy senior titles or below; The distribution areas of expert work units are 10 in South China, 1 in North China, 2 in East China, 1 in Central China, and 3 in Southwest China. In the first round, a total of 18 inquiry questionnaires were distributed and 17 were collected. In the second round, a total of 17 inquiry questionnaires were distributed and 17 were collected. The positive coefficients for the two rounds of expert inquiry were 0.944 and 1.000, the authoritative coefficients were 0.885 and 0.977, and the Kendall harmony coefficients were 0.221 and 0.239, respectively (both P<0.001). In the first round of inquiry, 10 experts proposed 74 revision suggestions. In the second round of inquiry, 9 experts proposed 14 revision suggestions. The final system of ophthalmic outpatient nursing quality indicators includes 3 primary indicators, 8 secondary indicators, and 36 tertiary indicators. Conclusion　The quality evaluation index system of ophthalmic outpatient care constructed in this study has specialized characteristics on the basis of ensuring the scientificity and reliability of the research results, which is in line with the characteristics of clinical practice and nursing management of ophthalmology outpatient clinics, and can provide a reference for the scientific, refined, and standardized management of ophthalmic clinical nursing quality.

Key words:

Ophthalmology, Outpatient, Quality of care, Index system, Delphi method

摘要：

目的　构建本土化、科学可靠的眼科门诊护理质量指标体系，为控制眼科门诊护理质量提供标准化工具。方法　通过文献循证方法，从中国知网、万方、PubMed、EmBase、CINAHL等数据库中检索眼科门诊护理质量指标相关文献，检索时限为建库至2023年8月，最终纳入文献11篇。基于结构-过程-结果（SPO）指标体系框架，拟定具体的访谈内容条目。采用目的抽样法，访谈广东省5所三级甲等医院眼科护理管理者及临床护士，采用Colaizzi分析法对访谈内容进行归纳整理。基于文献循证及访谈结果，初步构建眼科门诊护理质量指标体系，包括一级指标3项，二级指标9项，三级指标41项。制作专家函询问卷。采用德尔菲法，通过电子邮件方式于2023年12月至2024年5月进行2轮专家函询。基于第1轮函询结果，经讨论后形成第2轮函询问卷。采用回收率表示专家积极程度；权威系数表示专家权威程度，权威系数=（熟悉程度+判断依据）/2；肯德尔和谐系数表示专家协调情况。应用层次分析法（AHP），构建判断矩阵，计算各指标权重、权重排序与组合权重，得出一致性系数（CR值），当CR值≤0.100时，判断矩阵具有一致性。结果　本研究共纳入17名眼科护理专家，工作年限：≥15～<30年9名，≥30年8名；门诊工作年限：<10年7名，≥10～<20年9名，≥20年1名；职称：正高级5名，副高级及以下12名；地域：华南10名，华北1名，华东2名，华中1名，西南3名。第1轮共发放18份函询问卷，回收17份。第2轮共发放17份函询问卷，回收17份。2轮专家函询积极系数分别为0.944、1.000，权威系数分别为0.885、0.977，肯德尔和谐系数分别为0.221、0.239（均P<0.001）。第1轮函询，10名专家提出74条修改意见。第2轮函询，9名专家提出14条修改意见。最终形成包含3个一级指标、8个二级指标、36个三级指标的眼科门诊护理质量指标体系。结论　本研究构建的眼科门诊护理质量指标体系在保证研究结果科学性和可靠性基础上，具有专科特色。符合眼科门诊专科临床实践与护理管理特点，可为眼科临床护理质量的科学化、精细化、规范化管理提供参考依据。

关键词:

眼科, 门诊, 护理质量, 指标体系, 德尔菲法