基于结构—过程—结果模型的多视角下口腔门诊护理质量认知的质性研究

doi:10.7518/hxkq.2025.2024277

华西口腔医学杂志 ›› 2025, Vol. 43 ›› Issue (2): 227-235.doi: 10.7518/hxkq.2025.2024277

基于结构—过程—结果模型的多视角下口腔门诊护理质量认知的质性研究

马永红(), 刘帆(), 杨春霞, 杨金容, 许力升, 谢静颖, 王敬钧, 韦靖怡

口腔疾病防治全国重点实验室国家口腔医学中心国家口腔疾病临床医学研究中心四川大学华西口腔医院，成都 610041

收稿日期:2024-07-31 修回日期:2024-12-12 出版日期:2025-04-01 发布日期:2025-03-25
通讯作者: 刘帆 E-mail:1437541368@qq.com;liufan@scu.edu.cn
作者简介:马永红，护师，硕士，E-mail： 1437541368@qq.com
基金资助:
四川大学华西口腔医院软科学研究项目(RD-01-2024-01)

Perceived quality of dental outpatient care from multiple perspectives based on Structure-Process-Outcome model

Ma Yonghong(), Liu Fan(), Yang Chunxia, Yang Jinrong, Xu Lisheng, Xie Jingying, Wang Jingjun, Wei Jingyi

State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2024-07-31 Revised:2024-12-12 Online:2025-04-01 Published:2025-03-25
Contact: Liu Fan E-mail:1437541368@qq.com;liufan@scu.edu.cn
Supported by:
Soft Science Research Project of West China Hospital of Stomatology, Sichuan University(RD-01-202401)

摘要/Abstract

摘要：

目的探究管理者、医生、护士以及患者多视角下口腔门诊护理质量的认知，提出符合临床实际的护理质量评价指标，为构建科学、系统、全面的口腔门诊护理质量评价体系提供参考。方法于2024年1—4月采用多阶段抽样方法，在全国具有区域代表性的5家三级甲等口腔专科医院中选取7名管理者、11名医生、11名门诊护士及10名患者，共39名访谈对象进行半结构化深度访谈。采用Colaizzi七步法对访谈资料进行分析和归纳，并基于结构-过程-结果（SPO）三维质量评价模型提炼主题。结果研究从结构、过程及结果3个质量维度提取了5个主要主题，15个次要主题。析出的结构质量相关主题：消毒隔离规范、仪器设备和耗材管理、护理人力配比和护士学历架构、应急能力；过程质量相关主题：诊前风险评估、患者分诊与引导、沟通与态度、健康宣教、人文关怀、延续性护理、专科护理操作、四手操作；结果质量相关主题：满意度、不良事件管理与分析、有效投诉和纠纷。结论在口腔门诊护理质量评价内容中结构质量是基础，过程质量是核心，结果质量是重点。规范消毒隔离、仪器设备以及耗材管理，配置合理的护理人力和岗位能力，落实优质护理服务，提升医护配合质量和满意度是确保口腔门诊护理质量的必要保证。

关键词: 口腔门诊, 护理质量, 指标, 质量评价, 结构-过程-结果, 质性研究

Abstract:

Objective This study aimed to investigate the perception of dental outpatient care quality from multiple perspectives of administrators, physicians, nurses, and patients and propose nursing care quality evaluation indices that are consistent with the clinical reality to provide reference for the construction of a scientific, systematic, and comprehensive dental outpatient care quality evaluation system. Methods A total of 39 interviewees, including 7 administrators, 11 doctors, 11 nurses, and 10 patients, were selected for semi-structured in-depth interviews in five regionally representative tertiary-level A stomatological specialty hospitals nationwide during January-April 2024 by using a multistage sampling method. Colaizzi 7-step analysis was used to analyze and summarize the interview data. Themes were extracted on the basis of the Structure-Process-Outcome (SPO) three-dimensional quality assessment model. Results Five main themes and 15 secondary themes were extracted from three quality dimensions: structure, process, and result. The related topics of structural quality were as follows: disinfection and isolation norms, equipment and consumable management, nursing manpower ratio and nurse education structure, and emergency capability. The related topics of process quality were as follows: pre-diagnosis risk assessment, patient triage and guidance, communication and attitude, health education, humanistic care, continuous care, specialty operation, and four-hand operation. The related topics of result quality were as follows: satisfaction, adverse event management and analysis, effective complaints and disputes. Conclusion Structure quality is the foundation, process quality is the core, and result quality is the key in the evaluation of the quality of oral outpatient care. The standardization of disinfection and isolation, equipment and consumable management, allocation of reasonable nursing manpower and post capacity, implementation of high-quality nursing services, and improvement of the quality and satisfaction of medical cooperation are necessary guarantees to ensure the quality of oral outpatient care.

Key words: dental clinic, quality of care, indicator, quality evaluation, Structure-Process-Outcome, qualitative research

中图分类号:

R473.78

马永红, 刘帆, 杨春霞, 杨金容, 许力升, 谢静颖, 王敬钧, 韦靖怡. 基于结构—过程—结果模型的多视角下口腔门诊护理质量认知的质性研究[J]. 华西口腔医学杂志, 2025, 43(2): 227-235.

Ma Yonghong, Liu Fan, Yang Chunxia, Yang Jinrong, Xu Lisheng, Xie Jingying, Wang Jingjun, Wei Jingyi. Perceived quality of dental outpatient care from multiple perspectives based on Structure-Process-Outcome model[J]. West China Journal of Stomatology, 2025, 43(2): 227-235.

图/表 2

表 1

表 2

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项目		管理者（n=7）	门诊医生（n=11）	门诊护士（n=11）	患者（n=10）
性别	男	1	4	0	4
	女	6	7	11	6
最高学历	本科	4	0	11
	硕士	1	2	0
	博士	2	9	0
职称	中级	4	6	11
	副高	2	2	0
	正高	1	3	0
任职/就诊科室	内科	4	3	4	4
	外科	1	2	2	2
	修复	1	2	2	2
	正畸	1	4	3	2
年龄/岁		40.57±3.46	39.55±5.91	34.73±2.97	38.70±26.48
工作年限/年		16.57±3.69	12.36±6.19	13.27±3.70
门诊工作年限/年			12.55±6.95	12.55±3.05
管理工作年限/年		9.14±5.43
就诊次数					2.00±1.05

访谈对象	数量/项	访谈提纲
管理者	7	请谈谈您对口腔门诊护理质量的认识？您所在的医院是如何进行口腔门诊护理质量的评价？您作为科室的管理者，您是从哪些方面进行科室的质量管理？您认为评价口腔门诊护理质量有哪些敏感指标？您认为目前的口腔门诊护理质量评价内容存在哪些问题？基于您以上提到的问题，您对口腔门诊护理质量的评价内容有哪些修改和补充？您对构建一份完善的口腔门诊护理质量评价体系有什么建议吗？
医生	4	您认为可以从哪些方面评价口腔门诊护理的工作质量？请结合您的工作体验详细谈谈。您认为哪些与护理质量相关的内容会影响医疗诊治过程、医疗质量以及患者就诊体验？您认为评价护理质量的重要内容有哪些？您对目前实施的护理质量评价内容有什么建议或意见吗？
门诊护士	4	请您谈谈您对口腔门诊护理质量的理解？您所在的科室是如何评价口腔门诊护理质量？除了您以上提及的评价内容之外，您认为还有哪些关键环节或者因素可以评价/影响口腔门诊护理质量？请您详细谈谈。对现有的口腔门诊护理质量评价指标，您认为还有需要补充或者修改的评价内容吗？
患者	4	您认为口腔门诊应该怎么做才能更好地提高您的就诊体验？请您谈谈您在进行口腔门诊诊疗过程中护士给您提供了哪些护理服务？您对口腔门诊护士提供的护理服务有什么要求和建议吗？您认为可以从哪些方面来评价口腔门诊护理工作的好坏？

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基于结构—过程—结果模型的多视角下口腔门诊护理质量认知的质性研究

Perceived quality of dental outpatient care from multiple perspectives based on Structure-Process-Outcome model

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