摘要
目的:构建血液透析患者分层分级护理评估工具,并检验其信度、效度,为临床开展科学、高效的护理管理提供标准化工具。方法:采用文献回顾、质性访谈及德尔菲法构建评估工具初稿。2025年5月—6月,采用便利抽样法选取陕西省某三级甲等综合医院血液净化中心的335例患者进行横断面调查,通过条目分析、评定者间信度检验,并与临床主观护理分级进行比较,筛选条目并形成终版工具。结果:终版评估工具包含基础评估(15个条目)和即时评估(11个条目)两部分。工具评估结果与临床主观评判护理级别具有较强一致性(加权Kappa=0.617)。交叉表分析显示,在工具判定护理级别高于主观评判的患者中,多数伴有客观临床风险指标。评定者间信度的Kendall’s W系数为0.817(P<0.001)。结论:本研究构建的评估工具具有良好的信度和效度,可为血液透析患者的精准分层分级护理提供客观、科学的评估依据,具备临床适用性。
Objective:To develop and validate a tool for hierarchical nursing grading in hemodialysis patients,thereby providing a standardized instrument for clinical nursing practice.Methods:A preliminary tool was constructed through literature review,qualitative interviews,and a Delphi expert consultation.Later 335 patients admitted to a tertiary grade A hospital hemodialysis center from May to June 2025 were conveniently selected as samples for the validation study.In order to finalize the tool,we conducted item analysis,inter-rater reliability testing,and compared the grading results obtained using the tool with the results analyzed subjectively by nurses.Results:The final tool comprised primary assessment(15 items)and instant assessment(11 items).Substantial agreement was observed between the results obtained by the tool and clinical nurses subjectively with a weighted Kappa of 0.617.Cross-tabulation analysis showed that compared with the subjective grading,patients with a higher score according to the tool often tend to have objective clinical risk indicators.Inter-rater reliability testing showed a Kendall's W of 0.817(P<0.001).Conclusion:The assessment tool demonstrates good reliability and validity,providing scientific basis for the precise stratification and graded nursing of hemodialysis patients.
作者
辛霞
叱伟华
刘小敏
苏春燕
龙卓
黄语嫣
代雯晴
高菊林
XIN Xia;CHI Weihua;LIU Xiaomin;SU Chunyan;LONG Zhuo;HUANG Yuyan;DAI Wenqing;GAO Julin(Department of Nursing,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,710061,China)
出处
《中国护理管理》
北大核心
2026年第2期161-166,共6页
Chinese Nursing Management
基金
陕西省重点研发计划项目(2025SF-YBXM-049,2025SF-YBXM-051)。
