Construction of a sensitive quality indicator system for ambulatory chemotherapy nursing based on the structure-process-outcome model_West China Medical Journal

Authors：

LI Shuo ¹ , JIN Xiaoyan ² ,  GAO Fengli ¹

1. Department of Nursing, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, P. R. China;
2. Peking University Health Science Center-Macao Polytechnic University Nursing Academy, Macao Polytechnic University, Macao 999078, P. R. China;

Corresponding author：

GAO Fengli, Email: gfla00059@btch.edu.cn

Keywords：

Ambulatory chemotherapy; sensitive quality indicator for nursing; Delphi method

DOI：

10.7507/1002-0179.202406011

Video：

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Objective To construct a sensitive indicator system for the quality of ambulatory chemotherapy nursing, and provide reference basis for the evaluation and scientific management of ambulatory chemotherapy nursing quality. Method Based on Donabedian’s three-dimensional quality structure model of “structure process result”, through literature review, a preliminary quality indicator system for ambulatory chemotherapy nursing was formulated. The Delphi method was used for two rounds of expert inquiry to determine the sensitive treatment indicator system for ambulatory chemotherapy nursing. The weight of the indicators was calculated using the hierarchical analysis method. Result Fifteen expert inquiry questionnaires were distributed through two rounds of inquiry, and the response rates of the two rounds of expert inquiry questionnaires were all 100%, with expert positivity coefficients of 100% and authority coefficients of 0.90 and 0.94, respectively. The second round of expert inquiry questionnaires Kendall’s coefficient of concordance were between 0.573 and 0.769 (P<0.01). The final constructed quality sensitive indicator system for ambulatory chemotherapy nursing included 3 primary indicators, 8 secondary indicators, and 27 tertiary indicators. The overall Cronbach’s α coefficient for the second round of inquiry questionnaires was 0.853, while the Cronbach’s α coefficients for structural indicators, process indicators, and outcome indicators were 0.879, 0.921, and 0.857, respectively. Conclusions The sensitive indicator system for nursing quality in ambulatory chemotherapy wards constructed has high systematicity, sensitivity, and scientificity, and the weight distribution is reasonable. This indicator system can provide a reference basis for objective evaluation and standardized management of nursing quality in ambulatory chemotherapy.

Citation： LI Shuo, JIN Xiaoyan, GAO Fengli. Construction of a sensitive quality indicator system for ambulatory chemotherapy nursing based on the structure-process-outcome model. West China Medical Journal, 2025, 40(2): 261-268. doi: 10.7507/1002-0179.202406011 Copy

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2.	苏亚平, 李瑞玲, 王园园, 等. 老年髋关节置换病人护理敏感质量指标体系的构建. 护理研究, 2023, 37(24): 4378-4385.
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7.	张雨晨, 戴燕, 宋应寒. 日间手术护理质量敏感指标体系的构建. 华西医学, 2021, 36(2): 220-224.
8.	周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具 AGREE Ⅱ及各领域分值的补充解释及思考. 护理学报, 2018, 25(18): 56-58.
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12.	余茴香, 刘樱, 胡保红, 等. 基于三维质量模式构建围术期癌症病人营养护理质量评价指标体系. 护理研究, 2022, 36(3): 386-392.
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15.	关勋强, 李瑞兴, 刘运成. 医学研究生教育评价研究与实践. 北京: 军事医学科学出版社, 2001: 80-84.
16.	张先庚, 刘珊, 刘林峰, 等. 基于德尔菲法构建初级医养结合老年护理人才岗位胜任力评价指标体系. 解放军护理杂志, 2022, 39(3): 24-27.
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20.	兰岚, 杨丹, 刘君, 等. 急性心肌梗死护理质量敏感性指标的研究进展. 护理研究, 2022, 36(5): 880-883.
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26.	朱红, 刘争, 王垭, 等. 基于三维质量评价模式构建住院患者非计划拔管风险管理质量评价体系. 护理学报, 2022, 29(1): 7-12.
27.	潘世琴, 罗明琴, 赵生秀, 等. 基于层次分析法构建青海省三级医院护理质量评价指标体系. 护理管理杂志, 2023, 23(12): 951-955.
28.	连洁, 高汉, 杨雪, 等. 门诊化疗一体化管理模式的建立. 中国卫生标准管理, 2023, 14(15): 44-48.

1. 汤磊雯, 叶志弘, 潘红英. 护理质量敏感指标体系的构建与实施. 中华护理杂志, 2013, 48(9): 801-803.
2. 苏亚平, 李瑞玲, 王园园, 等. 老年髋关节置换病人护理敏感质量指标体系的构建. 护理研究, 2023, 37(24): 4378-4385.
3. 李黎, 郭骊莉. 专科护理敏感质量指标对于改善肝癌介入术后尿潴留患者的应用价值. 介入放射学杂志, 2022, 31(6): 613-615.
4. 李梦奇, 孙蓓, 汪洋, 等. 日间化学治疗模式下医护人员对静脉治疗护士主导的血管通路共享决策认知与体验的质性研究. 华西医学, 2024, 39(2): 234-239.
5. 汪洋, 孙蓓, 李梦奇, 等. 基于瑞士奶酪模型的护理管理模式在日间病房化学治疗患者安全用药中的应用. 华西医学, 2024, 39(2): 229-233.
6. 孙蓓, 汪洋, 孙英明, 等. 按病种分值付费背景下乳腺癌日间化疗患者经济毒性预警模型的构建. 华西医学, 2023, 38(2): 226-232.
7. 张雨晨, 戴燕, 宋应寒. 日间手术护理质量敏感指标体系的构建. 华西医学, 2021, 36(2): 220-224.
8. 周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具 AGREE Ⅱ及各领域分值的补充解释及思考. 护理学报, 2018, 25(18): 56-58.
9. 李晨雄, 王丹, 莫陶欣, 等. 国内日间化疗工作开展现况调查研究. 中国医院管理, 2022, 42(2): 47-49.
10. Powell C. The Delphi technique: myths and realities. J Adv Nurs, 2003, 41(4): 376-382.
11. 伍琳, 孙艳杰. 德尔菲法简介及在护理学中的应用现状. 护理研究, 2015, 29(29): 3599-3601.
12. 余茴香, 刘樱, 胡保红, 等. 基于三维质量模式构建围术期癌症病人营养护理质量评价指标体系. 护理研究, 2022, 36(3): 386-392.
13. Kaymaz ÇK, Birinci S, Kızılkan Y. Sustainable development goals assessment of Erzurum province with SWOT-AHP analysis. Environ Dev Sustain, 2022, 24(3): 2986-3012.
14. 黄天雯, 张伟玲, 刘圆圆, 等. 基于敏感指标的骨科专科护理质量标准的构建. 护理研究, 2022, 36(4): 580-586.
15. 关勋强, 李瑞兴, 刘运成. 医学研究生教育评价研究与实践. 北京: 军事医学科学出版社, 2001: 80-84.
16. 张先庚, 刘珊, 刘林峰, 等. 基于德尔菲法构建初级医养结合老年护理人才岗位胜任力评价指标体系. 解放军护理杂志, 2022, 39(3): 24-27.
17. Prip A, Møller KA, Nielsen DL, et al. The patient-healthcare professional relationship and communication in the oncology outpatient setting: a systematic review. Cancer Nurs, 2018, 41(5): E11-E22.
18. Arbour C, Tremblay M, Ogez D, et al. Feasibility and acceptability of hypnosis-derived communication administered by trained nurses to improve patient well-being during outpatient chemotherapy: a pilot-controlled trial. Support Care Cancer, 2022, 30(1): 765-773.
19. 林梦, 马晶晶, 陈秋蓉, 等. 血液肿瘤患儿专科护理质量敏感指标体系的构建. 中华现代护理杂志, 2022, 28(6): 782-787.
20. 兰岚, 杨丹, 刘君, 等. 急性心肌梗死护理质量敏感性指标的研究进展. 护理研究, 2022, 36(5): 880-883.
21. Singh K, Kober KM, Paul SM, et al. Gastrointestinal symptoms are associated with trajectories of chemotherapy-induced nausea. Support Care Cancer, 2020, 28(5): 2205-2215.
22. Sonneborn-Papakostopoulos M, Dubois C, Mathies V, et al. Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: a cross-sectional study. Med Oncol, 2021, 38(2): 20.
23. Saragiotto L, Leandro-Merhi VA, Aquino JLB, et al. Gastrointestinal changes during nutritional follow-up of cancer patients undergoing outpatient chemotherapy. Arq Gastroenterol, 2020, 57(4): 354-360.
24. Huang YL, Bryce AH, Culbertson T, et al. Alternative outpatient chemotherapy scheduling method to improve patient service quality and nurse satisfaction. J Oncol Pract, 2018, 14(2): e82-e91.
25. Krzyzanowska MK, Julian JA, Gu CS, et al. Remote, proactive, telephone based management of toxicity in outpatients during adjuvant or neoadjuvant chemotherapy for early stage breast cancer: pragmatic, cluster randomised trial. BMJ, 2021, 375: e066588.
26. 朱红, 刘争, 王垭, 等. 基于三维质量评价模式构建住院患者非计划拔管风险管理质量评价体系. 护理学报, 2022, 29(1): 7-12.
27. 潘世琴, 罗明琴, 赵生秀, 等. 基于层次分析法构建青海省三级医院护理质量评价指标体系. 护理管理杂志, 2023, 23(12): 951-955.
28. 连洁, 高汉, 杨雪, 等. 门诊化疗一体化管理模式的建立. 中国卫生标准管理, 2023, 14(15): 44-48.

West China Medical Journal

Construction of a sensitive quality indicator system for ambulatory chemotherapy nursing based on the structure-process-outcome model

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