Construction of the evaluation index system for nursing quality management in outpatient dental clinics based on the structure-process-outcome model

doi:10.7518/hxkq.2025.2025017

Abstract

Abstract:

Objective This study aimed to construct an evaluation index system for nursing quality management in outpatient dental clinics based on the structure-process-outcome model and provide an objective standard for the evaluation of nursing quality in outpatient dental clinics. Methods Through literature review, multi-subject interviews, and expert meetings, the first draft of the evaluation index for nursing quality management in outpatient dental clinics was formulated. The Delphi method was adopted to select and invite 15 experts in the fields of hospital infection management, nursing management, and specialized oral care from across the country to modify the first draft. Results The positive coefficients of the experts in the two rounds of consultation were 86.7% and 92.3%, respectively. The total authority coefficients of the experts were 0.791 and 0.717, respectively. The mean scores of the importance and feasibility of the third-level indices in the two rounds of consultation were all ≥4.333; the coefficients of variation were all ≤0.150; and the Kendall’s coordination coefficients were 0.308 and 0.184 respectively, with P<0.05 for all. These results indicated that the experts were motivated to participate in this study. They recognized the importance and feasibility of the overall items in this index system, and their opinions were relatively consistent. Finally, an evaluation index system, which included 3 first-level indices, 7 second-level indices, 22 third-level indices, and 69 index connotations, for nursing quality management in outpatient dental clinics was determined. The weights of the three first-level indicators were all 0.333. Patient satisfaction (0.076, outcome dimension), hand hygiene (0.061, outcome dimension), chair care ratio (0.057, structural dimension), and turnover rate (0.057, structural dimension) were the top tertiary indicators in terms of portfolio weight. Conclusion The construction method of the evaluation index system for nursing quality management in outpatient dental clinics is scientific and reliable. It can provide a reference for the evaluation of the management level of nursing quality in outpatient dental clinics and promote the continuous improvement of nursing quality in outpatient dental clinics.

Key words: structure-process-outcome model, outpatient dental clinic, nursing management, index system

CLC Number:

R473.78

Wei Jingyi, Liu Fan, Yang Chunxia, Wang Jingjun, Ma Yonghong, Yang Jinrong, Xie Jingying, Xu Lisheng. Construction of the evaluation index system for nursing quality management in outpatient dental clinics based on the structure-process-outcome model[J]. West China Journal of Stomatology, 2025, 43(6): 860-870.

Figures/Tables 4

Tab 1

Tab 2

Tab 3

Evaluation indicators for nursing quality management in outpatient dental clinics based on the SPO model and expert ratings

一级指标	二级指标	三级指标	指标内涵	重要性评分			可行性评分
一级指标	二级指标	三级指标	指标内涵	均数±标准差	变异系数	满分率/%	均数±标准差	变异系数	满分率/%
1结构	1-1制度职责	1-1-1规章制度	1依法执业制度；2护理质量与安全管理制度；3护理核心制度（与医疗18项核心制度相对应）；4岗位管理制度；5护士培训与考核制度；6护士绩效考核与管理制度；7人力资源紧急调配制度；8急救设备与物资管理制度；9器械设备管理制度；10优质护理服务工作制度；11医疗质量（安全）不良事件上报及管理制度；12医院感染防控制度	5.000±0.000	0.000	100.0	5.000±0.000	0.000	100.0
		1-1-2岗位职责	13门诊护理岗位职责；14特殊科室岗位职责；15各层级护理人员岗位职责	5.000±0.000	0.000	100.0	5.000±0.000	0.000	100.0
		1-1-3工作常规	16口腔内科专业护理常规；17口腔颌面外科专业护理常规；18口腔修复专业护理常规；19口腔正畸专业护理常规；20其他口腔门诊护理常规	5.000±0.000	0.000	100.0	4.917±0.289	0.059	91.7
		1-1-4操作规程	21四手操作技术；22橡皮障隔离技术；23玻璃离子水门汀调拌技术；24藻酸盐印模材料调拌技术；25磷酸锌水门汀调拌技术；26其他口腔门诊护理技术	5.000±0.000	0.000	100.0	5.000±0.000	0.000	100.0
		1-1-5应急预案	27常见急危患者处理应急预案；28医疗设备故障应急预案；29重大意外伤害事故应急预案；30其他紧急/突发/意外事件应急预案	5.000±0.000	0.000	100.0	5.000±0.000	0.000	100.0
	1-2设施设备	1-2-1环境管理	31各诊疗区域划分明确、布局合理、符合患者就诊流程要求和医院感染管理需要；32科室分区标识明显，清晰；33科室环境安静、整洁、有序	4.917±0.289	0.059	91.7	5.000±0.000	0.000	100.0
	1-2设施设备	1-2-2设施配备	34医疗设施设备配置符合国家相关要求；35为老年人、儿童、孕妇等特殊人群提供便民服务设施	4.917±0.289	0.059	91.7	4.917±0.289	0.059	91.7
	1-3人力资源	1-3-1椅护比	36椅护比符合国家/地方标准，满足医疗机构诊疗需求	4.833±0.389	0.081	83.3	4.833±0.389	0.081	83.3
		1-3-2人员构成	37门诊护士中护士学历构成（%）符合国家或地方相关质量管理标准，各医疗机构可依据相关标准参照执行	4.833±0.389	0.081	83.3	4.917±0.289	0.059	91.7
		1-3-3离职率	38动态监测	4.500±0.674	0.150	58.3	4.917±0.289	0.059	91.7
2过程	2-1业务管理	2-1-1规章制度落实	39护理人员持证上岗；40对护理人员进行核心制度培训，有记录；41对护理人员进行岗位管理制度培训，有记录；42对护理人员进行基础护理操作、急救技能、口腔专业知识技能培训与考核，有记录；43对护理人员按照绩效考核与管理制度进行绩效考核，有记录；44对护理人员进行人力资源紧急调配制度培训，有记录；45对护理人员进行急救设备与物资管理制度培训，有记录；46按流程上报医疗质量（安全）不良事件，并运用质量管理工具进行根因分析，有记录；47依据优质护理服务规范，主动帮助患者协调解决就诊相关问题，如为特殊人群安排就诊绿色通道，为患者提供便民服务等；48对工作人员进行医院感染及职业防护相关知识培训，有记录；49运用管理工具开展质量管理与持续改进	5.000±0.000	0.000	100.0	5.000±0.000	0.000	100.0
		2-1-2岗位职责落实	50对护理人员进行各岗位职责培训，有记录；51护理人员按规定落实各岗位职责	5.000±0.000	0.000	100.0	4.833±0.389	0.081	83.3
		2-1-3工作常规落实	52对护理人员进行各工作常规培训，有记录；53护理人员按规定落实各工作常规	5.000±0.000	0.000	100.0	4.833±0.389	0.081	83.3
		2-1-4操作规范落实	54对护理人员进行常用口腔操作技术培训，有记录；55护理人员按规定落实各项口腔操作技术流程	5.000±0.000	0.000	100.0	4.917±0.289	0.059	91.7
		2-1-5应急预案落实	56对护理人员进行应急事件处置培训、演练，有记录	4.917±0.289	0.059	91.7	5.000±0.000	0.000	100.0
3结果	3-1满意度	3-1-1患者满意度	57患者对护理服务满意度（%）符合国家或地方相关质量管理标准，各医疗机构可依据相关标准参照执行	4.833±0.389	0.081	83.3	4.917±0.289	0.059	91.7
		3-1-2护士满意度	58护理人员对护理服务满意度（%）符合国家或地方相关质量管理标准，各医疗机构可依据相关标准参照执行	4.833±0.389	0.081	83.3	4.917±0.289	0.059	91.7
		3-1-3医生满意度	59医生对护理服务满意度（%）符合国家或地方相关质量管理标准，各医疗机构可依据相关标准参照执行	4.750±0.622	0.131	83.3	4.917±0.289	0.059	91.7
	3-2医疗质量（安全）不良事件	3-2-1Ⅰ、Ⅱ级不良事件	60Ⅰ、Ⅱ级医疗质量（安全）不良事件上报率；61Ⅰ、Ⅱ级医疗质量（安全）不良事件及时上报率	5.000±0.000	0.000	100.0	4.750±0.452	0.095	75.0
	3-2医疗质量（安全）不良事件	3-2-2Ⅲ、Ⅳ级不良事件	62Ⅲ、Ⅳ级医疗质量（安全）不良事件上报例数	4.917±0.289	0.059	91.7	4.667±0.492	0.106	66.7
	3-3医院感染防控	3-3-1手卫生	63护理人员手卫生依从性（%）符合国家或地方相关质量管理标准，各医疗机构可依据相关标准参照执行；64护理人员手卫生正确率（%）符合国家或地方相关质量管理标准，各医疗机构可依据相关标准参照执行	5.000±0.000	0.000	100.0	4.833±0.389	0.081	83.3
		3-3-2环境卫生学监测	65空气菌落总数［Ⅰ类环境≤4 cfu/皿（30 min）；Ⅱ类环境≤4 cfu/皿（15 min）；Ⅲ、Ⅳ类环境≤4 cfu/皿（5 min）］；66物品表面菌落总数（Ⅰ、Ⅱ类环境：细菌菌落总数应≤5 cfu/cm2；Ⅲ、Ⅳ类环境：细菌菌落总数应≤10 cfu/cm2，不得检出致病性微生物）；67医护人员手部菌落总数（卫生手消毒后，细菌菌落总数应≤10 cfu/cm2，不得检出致病性微生物；外科手消毒后，细菌菌落总数应≤5 cfu/cm²，不得检出致病性微生物）；68医疗器械菌落总数（高危物品应无菌；中危物品细菌菌落总数应≤20 cfu/件；低危物品细菌菌落总数应≤200 cfu/件，均不得检出致病性微生物）；69使用中的消毒剂菌落总数（细菌含量应≤100 cfu/mL，不得检出致病性微生物）	5.000±0.000	0.000	100.0	4.667±0.651	0.140	75.0

Tab 3

Tab 4

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项目		人数	构成比/%
性别	男	1	6.67
	女	14	93.33
年龄/岁	≤30	0	0.00
	31～40	5	33.33
	41～50	4	26.67
	≥51	6	40.00
专业领域	医院感染管理	2	13.33
	护理管理	9	60.00
	专科口腔护理	4	26.67
学历	博士	2	13.33
	硕士	8	53.33
	本科	5	33.33
职称	正高级	7	46.67
	副高级	6	40.00
	中级	2	13.33
专业年限/年	5~7	0	0.00
	8~9	0	0.00
	≥10	15	100.00

主要主题	次要主题
构建制度与规范	消毒隔离规范
构建制度与规范	仪器设备和耗材管理
配置合理的护理人力和岗位能力	护理人力配比和护士学历架构
配置合理的护理人力和岗位能力	应急能力
实施优质护理服务	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
提升医护配合质量	专科护理操作
提升医护配合质量	四手操作
衡量护理质量水平	满意度
	不良事件管理与分析
	有效投诉和纠纷

一级指标	权重	二级指标	权重	三级指标	权重	组合权重
1结构	0.333	1-1制度职责	0.394	1-1-1规章制度	0.200	0.026
				1-1-2岗位职责	0.200	0.026
				1-1-3工作常规	0.200	0.026
				1-1-4操作规程	0.200	0.026
				1-1-5应急预案	0.200	0.026
		1-2设施设备	0.212	1-2-1环境管理	0.500	0.035
		1-2设施设备	0.212	1-2-2设施配备	0.500	0.035
		1-3人力资源	0.394	1-3-1椅护比	0.435	0.057
				1-3-2人员构成	0.130	0.017
				1-3-3离职率	0.435	0.057
2过程	0.333	2-1业务管理	1.000	2-1-1规章制度落实	0.152	0.051
				2-1-2岗位职责落实	0.391	0.130
				2-1-3工作常规落实	0.152	0.051
				2-1-4操作规范落实	0.152	0.051
				2-1-5应急预案落实	0.152	0.051
3结果	0.333	3-1满意度	0.562	3-1-1患者满意度	0.409	0.076
				3-1-2护士满意度	0.296	0.055
				3-1-3医生满意度	0.296	0.055
		3-2医疗质量（安全）不良事件	0.219	3-2-1Ⅰ、Ⅱ级不良事件	0.500	0.036
		3-2医疗质量（安全）不良事件	0.219	3-2-2Ⅲ、Ⅳ级不良事件	0.500	0.036
		3-3医院感染防控	0.219	3-3-1手卫生	0.839	0.061
		3-3医院感染防控	0.219	3-3-2环境卫生学监测	0.161	0.012