重症心力衰竭患者信息化护理路径的构建及管理研究

doi:10.3761/j.issn.2096-7446.2024.05.013

摘要/Abstract

摘要： 目的通过德尔菲法构建重症心力衰竭患者护理路径,并实现护理路径的信息化。方法在文献回顾基础上,初步构建重症心力衰竭患者护理路径,形成专家函询问卷。遴选49名专家进行2轮德尔菲函询。结果 2轮专家咨询问卷有效回收率均为100%,权威系数为0.92,两轮函询护理条目变异系数分别为0.071和0.003、肯德尔系数分别为0.188和0.939,专家意见趋于一致,形成重症心力衰竭患者的护理路径。将护理路径嵌入医院信息系统中,各表单及系统综合联动,信息化辅助临床工作。结论重症心力衰竭患者信息化护理路径具有科学性、可靠性,可将常规路径与各模块相结合,为改善护理质量提供保障。

关键词: 心力衰竭, 危重病, 临床路径, 德尔菲技术

Abstract: Objective To develop the nursing pathway for severe heart failure patients by Delphi method,and realize the intelligence of the pathway. Methods The preliminary nursing pathway was developed based on literature review and the expert consultation questionnaire was formed. 49 experts were selected for two-round consultations. Results The response rate of the two rounds were both 100.0%. The authoritative coefficient was 0.92. The coefficients of variation in the two rounds of consultation were 0.071 and 0.003,and the coordination coefficients were 0.188 and 0.939,respectively. Experts had the consistent opinions to form the nursing pathway for severe heart failure patients. Nursing pathway was embedded in HIS system,all forms and systems were integrated and linked,and it can assist clinical work intelligently. Conclusion The intelligent nursing pathway for patients with severe heart failure is scientific and reliable. It creates a model combining conventional path and each module,which provides a guarantee for the improvement of nursing quality.

Key words: Heart Failure, Critical Illness, Critical Pathways, Delphi Technique

吴筱筱, 李茹, 季诗明, 杨洋, 武杰, 张辰. 重症心力衰竭患者信息化护理路径的构建及管理研究[J]. 中华急危重症护理杂志, 2024, 5(5): 455-460.

WU Xiaoxiao, LI Ru, JI Shiming, YANG Yang, WU Jie, ZHANG Chen. Construction and management of intelligent nursing pathway for patients with severe heart failure[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(5): 455-460.

参考文献

[1] 马丽媛,王增武,樊静,等. 《中国心血管健康与疾病报告2021》概要[J]. 中国介入心脏病学杂志,2022,30(7):481-496.
Ma LY,Wang ZW,Fan J,et al.Summary of China cardiovascular health and disease report 2021[J]. Chin J Interv Cardiol,2022,30(7):481-496.
[2] Hao G,Wang X,Chen Z,et al.Prevalence of heart failure and left ventricular dysfunction in China:the China Hypertension Survey,2012-2015[J]. Eur J Heart Fail,2019,21(11):1329-1337.
[3] 国家心血管病医疗质量控制中心专家委员会心力衰竭专家工作组. 2020中国心力衰竭医疗质量控制报告[J]. 中国循环杂志,2021,36(3):221-238.
Working Group on Heart Failure National Center for Cardio-vascular Quality Improvement(NCCQI). 2020 clinical performance and quality measures for heart failure in China[J]. Chin Circ J,2021,36(3):221-238.
[4] 王艺萍,王甲甲,张晓勤,等. 老年危重症患者心衰发病特征及相关危险因素分析[J]. 西安交通大学学报(医学版),2016,37(1):148-151.
Wang YP,Wang JJ,Zhang XQ,et al.Characteristics and risk factors for heart failure in elderly patients in intensive care unit[J]. J Xi'an Jiaotong Univ Med Sci,2016,37(1):148-151.
[5] 余研,詹晓娟,丁雅霜,等. 不同肠内营养时机对重症心衰呼吸支持患者血清BNP、营养状态、T细胞亚群的影响及安全性探讨[J]. 中国急救复苏与灾害医学杂志,2021,16(8):874-879.
Yu Y,Zhan XJ,Ding YS,et al.The effect of different enteral nutrition timing on serum BNP,nutri-tional status,T cell subsets and safety in patients with severe heart fail-ure and respiratory support[J]. China J Emerg Resusc Disaster Med,2021,16(8):874-879.
[6] 陈妞,陈莹,郭瑾,等. 人工智能在危重症护理中的应用现状及挑战[J]. 中华急危重症护理杂志,2022(3):276-279.
Chen N,Chen Y,Guo J,et al.The application and challenge of artificial intelligence in critical care[J]. Chin J Emerg Crit Care Nurs,2022(3):276-279.
[7] 袁剑云,英立平. 临床路径实施手册[M]. 北京:北京医科大学出版社,2002.
Yuan JY,Ying LP.Nursing pathway implementation manual[M]. Beijing:Beijing Medical University Press,2002.
[8] Martin GP,Kocman D,Stephens T,et al.Pathways to professionalism? Quality improvement,care pathways,and the interplay of standardisation and clinical autonomy[J]. Sociol Health Illn,2017,39(8):1314-1329.
[9] 潘卫宇,谢煜,李佳佳,等. 基于病种分值付费的高龄股骨颈骨折患者临床护理路径的构建研究[J]. 中华护理杂志,2022,57(20):2437-2444.
Pan WY,Xie Y,Li JJ,et al.Construction of clinical nursing pathway for femoral neck fracture in the elderly based on Diagnosis Intervention Packet[J]. Chin J Nurs,2022,57(20):2437-2444.
[10] Ciałkowska M,Adamowski T,Piotrowski P,et al.What is the Delphi method? Strengths and shortcomings[J]. Psychiatr Pol,2008,42(1):5-15.
[11] Hasson F,Keeney S,McKenna H. Research guidelines for the Delphi survey technique[J]. J Adv Nurs,2000,32(4):1008-1015.
[12] 李晓萍,沈翠珍. 德尔菲法在护理研究中的应用现状[J]. 中华现代护理杂志,2012,18(22):2605-2607.
Li XP,Shen CZ.Application status of Delphi method in nursing research[J]. Chin J Mod Nurs,2012,18(22):2605-2607.
[13] Drumm S,Bradley C,Moriarty F.‘More of an art than a science'? The development,design and mechanics of the Delphi Technique[J]. Res Social Adm Pharm,2022,18(1):2230-2236.
[14] 顾芸韵,朱佳华,周菊花. 基于Delphi构建急诊护理路径在急性心肌梗死患者中的应用[J]. 齐鲁护理杂志,2023,29(3):102-105.
Gu YY,Zhu JH,Zhou JH.Application of emergency nursing path based on Delphi in patients with acute myocardial infarction[J]. J Qilu Nurs,2023,29(3):102-105.
[15] Powell C.The Delphi technique:myths and realities[J]. J Adv Nurs,2003,41(4):376-382.
[16] Lawal AK,Rotter T,Kinsman L,et al.What is a clinical path-way? Refinement of an operational definition to identify clin-ical pathway studies for a Cochrane systematic review[J]. BMC Med,2016,14:35.
[17] Asmirajanti M,Hamid AYS,Hariyati RTS.Nursing care activities based on documentation[J]. BMC Nurs,2019,18(Suppl 1):32.
[18] Rotter T,Kinsman L,James E,et al.The effects of clinical pathways on professional practice,patient outcomes,length of stay,and hospital costs:Cochrane systematic review and meta-analysis[J]. Eval Health Prof,2012,35(1):3-27.
[19] 朱晖晖. 基于心衰单元理念构建急性心力衰竭中西医结合临床护理路径的研究[D]. 杭州:浙江中医药大学,2017.
Zhu HH.The study on traditional Chinese combined with western medicine clinical nursing pathway for acute heart failure based on the concept of heart failure unit building[D]. Hangzhou:Zhejiang Chinese Medical University,2017.
[20] Bao H,Yang FJ,Su SF,et al.Evaluating the effect of clinical care pathways on quality of cancer care:analysis of breast,colon and rectal cancer pathways[J]. J Cancer Res Clin Oncol,2016,142(5):1079-1089.
[21] Panella M,Marchisio S,Di Stanislao F.Reducing clinical variations with clinical pathways:do pathways work?[J]. Int J Qual Health Care,2003,15(6):509-521.
[22] 张正华,高居中. 实施临床路径的意义和方法[J]. 中华医院管理杂志,2002,18(9):513-515.
Zhang ZH,Gao JZ.Significance and means of implementing clinical pathways[J]. Chin J Hosp Adm,2002,18(9):513-515.
[23] Hawley S,Yu J,Bogetic N,et al.Digitization of measurement-based care pathways in mental health through REDCap and electronic health record integration:development and usability study[J]. J Med Internet Res,2021,23(5):e25656.