護理品質指標之建構

The Development of Nursing Quality Indicators

本研究目的旨在建構「護理品質指標」，採焦點團體座談法和德爾菲專家預測法(Delphi technique)，以科學性的方法彙整專家們的意見，以取得共同的看法。首先彙集國內外有關醫療指標相關之文獻以及參考國內外曾進行之護理品質指標項目編製成問卷初稿。邀請七位護理專家進行座談，並對護理品質指標提供意見，依專家之意見製成問卷，每題以1～10分計。Delphi專家群以滾雪球方式由座談會的專家推薦共50人，以匿名方式經過三回合的Delphi專家問卷調查，達成各指標項目之共識。最後指標項目為29項，其中結構面包括：護理人力配置、執業資格、設備及環境安全和工作手冊與作業規範等10項；過程面包括：護理過程的執行、照護態度、意外事件防範和感染管制等11項；結果面包括：跌倒、壓瘡、給藥錯誤、院內感染、異常事件等的發生率以及病患滿意度等8項。以上指標是護理品質的核心內涵，未來可進一步進行指標定義和資料收集與分析，對將來的護理評鑑和護理專業的發展會有很大助益。

The purpose of this study was to develop standardized indicators for measuring the quality of nursing care in acute-care hospitals based on the scientific methods and expert opinions. The research methods employed in this study were focus group discussion and Delphi technique. International as well as domestic literatures, regarding nursing-quality indicators, were first reviewed to draft the preliminary questionnaires. In the next phase 7 nursing experts were invited to attend focus group discussions and to formulate the final questionnaires, scoring 1 to 10 for each item. Finally, in the Delphi study, 50 experts were recommended by aforementioned experts, through 3 successive questionnaire inquiries anonymously to reach a consensus on indicators of nursing-quality. The results of the study provided 29 indicators of nursing-quality. The structural indicators have 10 items: nursing-manpower allocation, qualification of practice, safety of equipments and environments, safety guide, and operational manual, etc. The process indicators have 11 items containing the implementation and process of nursing, attitude of caring, incident prevention, and infection control, etc. The outcome indicators consist of 8 items such as patient falls, pressure ulcers, medication errors, nosocomial infections, adverse events, and patient satisfaction, etc. The study developed core indictors of nursing quality, though more studies are needed to refine the definition of indicators, expand collection and analysis of data on quality of nursing care, in order to promote the future nursing evaluation and professionalism.