垂直管理模式下工作量绩效在PICU的应用效果

目的探讨垂直管理模式下,基于德尔菲法的工作量绩效在儿科重症监护病房(PICU)中的实施效果。方法根据文献检索与访谈调查结果,应用德尔菲法编制PICU护理工作量统计表,实施以工作量为基础的PICU护理绩效薪酬分配。实施前后对护士工作积极性、护理质量得分、工作满意度进行比较。结果经2轮德尔菲法咨询后,PICU护理工作量统计表包含7个一级指标(每日医嘱与药品管理、病区管理、每日患儿危重程度、出入环节、基础护理操作、重症专科护理操作、专科护理照护)、62个2级指标。实施以工作量为基础的PICU护理绩效薪酬分配后护士工作积极性、护理质量得分、护士工作满意度均较实施前提高,具有统计学意义(P0.05,P0.01)。结论实施以工作量为基础的PICU护理绩效薪酬分配,可保证护理绩效薪酬分配公平透明,实现多劳多得、优绩优酬。     

基于资源相对价值比率的内科系统护理项目及绩效值的构建

目的构建内科系统护理项目及其绩效值,客观公平地体现护士的劳动价值。方法基于资源相对价值比率,采用文献分析法、德尔菲法专家咨询法,构建以工作量为基础的内科系统护理项目及绩效值。结果构建内科系统护理项目88项(护理诊疗35项,护理操作44项,医护协作9项)及其相对价值比率点值、合适度评分及绩效值。结论构建的内科系统护理项目及绩效值可用于内科系统护理绩效考核,以体现护理人员的劳动价值。     

慢性阻塞性肺疾病患者远程康复使用意愿量表的编制及信效度检验

目的 编制慢性阻塞性肺疾病（COPD）患者远程康复使用意愿量表,为评估COPD患者远程康复使用意愿提供测评工具。方法 以整合技术与采纳模型及健康信念模型为理论依据,结合文献回顾和德尔菲专家函询形成量表的初始条目。便利选取COPD患者156例进行问卷调查,对量表进行项目分析和信效度检验。结果 2轮专家函询的积极系数均为100%;专家权威系数分别为0.872、0.888;Kendall′s协调系数分别为0.114、0.113（均P＜0.05）;变异系数为0.08~0.23、0.05~0.22。正式量表共计26个条目,探索性因子分析提取7个公因子,累计方差贡献率为84.84%;条目水平的内容效度指数0.800~1.000,量表水平的内容效度指数为0.913;量表总的Cronbach′s α系数为0.963;分半信度为0.884。结论 慢性阻塞性肺疾病患者远程康复使用意愿量表具有良好的信效度,可作为COPD患者远程康复使用意愿的评估工具。     

居家养老环境风险评估体系的构建

目的 构建居家养老环境风险评估指标体系,为开展老年人居家环境风险评估提供测评工具.方法 采用文献研究法、焦点小组讨论法、德尔菲专家咨询法筛选评估指标,运用层次分析法确定指标权重,建立老年人居家养老环境风险评估体系.结果 2轮专家咨询问卷有效回收率分别为92.31％、86.11％,权威系数分别为0.878、0.892;Ⅰ级指标协调系数分别为0.276、0.291;最终构建的居家养老环境风险评估指标体系包括Ⅰ级指标9个和Ⅱ级指标43个,并确定各级指标权重.结论 居家养老环境风险评估体系被专家认可,评估指标体系的内容全面、权重合理,但需进一步在社区开展实证研究.     

Determining clinically meaningful thresholds for innovative burn care products to reduce autograft: A US burn surgeon Delphi panel

Reducing the amount of donor skin needed for definitive wound closure can improve outcomes in patients with severe burns. This Delphi Consensus Panel (DCP) aimed to achieve expert consensus on the percentage reduction in donor skin for autograft that constitutes a clinically meaningful benefit. A two-round DCP of fifteen US burn surgeons was conducted via a web-based survey platform. Fourteen panelists (93.3%) completed both rounds. In Round 2, consensus, defined as ≥70% agreement, was achieved for five of the seven consensus statements. All panelists agreed that a clinically meaningful reduction in the amount of donor skin required would facilitate wound management and decrease donor site morbidity experienced by patients. Furthermore, based on three treatment scenarios, consensus was achieved for a clinically meaningful reduction in the amount of donor skin required for autograft for the adult population in deep partial-thickness and full-thickness burns. Findings from this DCP indicate that an innovative cellular and/or tissue product that would reduce the needed amount of donor skin, by the identified thresholds, has the potential to improve the outcomes for patients with severe burn injuries in a meaningful way.     

Priorities for content for a short-course on postoperative care relevant for low- and middle-income countries: an e-Delphi process with training facilitators

Most surgical and anaesthetic mortality and morbidity occurs postoperatively, disproportionately affecting low- and middle-income countries. Various short courses have been developed to improve patient outcomes in low- and middle-income countries, but none specifically to address postoperative care and complications. We aimed to identify key features of a proposed short-course addressing this topic using a Delphi process with low- and middle-income country anaesthesia providers trained as short-course facilitators. An initial questionnaire was co-developed from literature review and exploratory workshops to include 108 potential course features. Features included content; teaching method; appropriate participants; and appropriate faculty. Over three Delphi rounds (panellists numbered 86, 64 and 35 in successive cycles), panellists indicated which features they considered most important. Responses were analysed by geographical regions: Africa, the Americas, south-east Asia and Western Pacific. Ultimately, panellists identified 60, 40 and 54 core features for the proposed course in each region, respectively. There were high levels of consensus within regions on what constituted core course content, but not between regions. All panellists preferred the small group workshop teaching method irrespective of region. All regions considered anaesthetists to be key facilitators, while all agreed that both anaesthetists and operating theatre nurses were key participants. The African and Americas regional panels recommended more multidisciplinary healthcare professionals for participant roles. Faculty from high-income countries were not considered high priority. Our study highlights variability between geographical regions as to which course features were perceived as most locally relevant, supporting regional adaptation of short-course design rather than a one-size-fits-all model.     

机械通气系统效能评估指标的建立

目的 应用Delphi法筛选机械通气系统效能评估指标.方法 根据研究主题遴选25名从事危重症治疗和护理工作的咨询专家,采用Delphi法进行两轮咨询.结果 两轮咨询问卷回收率分别为100%和96%;专家权威系数均为0.89;专家意见的协调系数分别为0.47和0.49,差异有统计学意义(均P＜0.01);两轮咨询后,最终...     

“双师型”临床护理带教教师培训方案的构建

目的构建"双师型"临床护理带教教师培训方案。方法采用文献法和半结构化访谈法初步拟定"双师型"临床护理带教教师培训方案,运用Delphi法对38名专家进行2轮函询对各指标进行评价筛选。结果 2轮函询有效问卷回收率分别为88.89%、95.00%;专家的权威系数为0.83;肯德尔协调系数分别为0.204、0.300(均P0.01)。最终构建的培训方案包括教学能力培训、临床护理能力培训、评判性思维能力培训、科研能力培训、专业发展能力培训、人际沟通能力培训、法律与伦理实践能力培训7个一级指标及其所属的31个二级指标和106个三级指标,确定了培训学时、方法及评价方式。结论该培训方案获得专家的认可,能够为各院校对"双师型"临床护理带教教师培训提供参考。     

Falls prevention activities among community-dwelling elderly in the Netherlands: A Delphi study

IntroductionThis study aimed to provide an overview of the current falls prevention activities in community-dwelling elderly with an increased risk of falling in the Netherlands. Therefore, we determined: a) how health professionals detect community-dwelling elderly with an increased risk of falling; b) which falls prevention activities are used by health professionals and why; c) how elderly can be stimulated to participate in falls prevention programs; and d) how to finance falls prevention.MethodsA two-round online Delphi study among health experts was conducted. The panel of experts (n = 125) consisted of community physiotherapists, community nurses, general practitioners, occupational therapists and geriatricians, from all over the Netherlands. The median and Inter Quartile Deviation (IQD) were reported for the questions with 5-point Likert scales, ranging from ‘least’ (1) to ‘most’ (5).ResultsRespectively 68% (n = 85/125) and 58% (n = 72/125) of the panel completely filled in the first and second round questionnaires. According to the panel, regular detection of fall risk of community-dwelling elderly with an increased risk of falling hardly takes place (median = 2 [hardly]; IQD = 1). Furthermore, these elderly are reluctant to participate in annual detection of fall risk (median = 3 [reluctant]; IQD = 1). According to 73% (n = 37/51) of the panel, 0–40% of the elderly with an increased risk of falling are referred to exercise programs. In general, the panel indicated that structural follow-up is often lacking. Namely, after one month (n = 21/43; 49%), three months (n = 24/42; 57%), and six months (n = 27/45; 60%) follow-up is never or hardly ever offered. Participation of elderly in falls prevention programs could be stimulated by a combination of measures. Should a combination of national health education, healthcare counseling, and removal of financial barriers be applied, 41–80% of the elderly is assumed to participate in falls prevention programs (n = 47/64; 73%). None of the panel members indicated full financing of falls prevention by the elderly. A number of individuals are considered key in falls prevention activities, such as the general practitioner, physiotherapist, and informal caregiver.ConclusionThis Delphi study showed clear directions for improving falls prevention activities and how to increase participation rates.