Establishment of an evaluation index system of home care quality for caregivers of children aged 3 years and below with burns
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摘要:
目的 构建≤3岁烧伤患儿照护者居家护理质量评价指标体系。 方法 采用定性研究和定量研究相结合的方法，遵循指标体系构建的基本原则。2022年1—2月，通过分析文献，对宁夏医科大学总医院烧伤整形美容科6名31~51岁工作10年以上的女护士和15名（女11名、男4名）28~54岁接受过护理人员的专业性培训的住院烧伤患儿照护者进行半结构式访谈，以马斯洛需要层次论为理论指导，初步拟定≤3岁烧伤患儿照护者居家护理质量评价指标体系。2022年3—6月，运用德尔菲法对符合入选标准的在宁夏回族自治区内的综合医院、专科医院和高校就职的15名相关领域专家开展函询（统计其一般资料），确立评价指标体系并采用层次分析法确定各级指标权重。计算函询表有效回收比，判断专家积极程度；计算所有指标的权威系数均值，判断专家权威程度；计算所有指标的重要性赋值均值与满分比均值，判断专家意见集中程度；计算所有指标的肯德尔和谐系数均值和变异系数均值，判断专家意见协调程度。对各轮函询中一级指标和总二级指标及总三级指标的肯德尔和谐系数行 χ 2检验。 结果 初步拟定的≤3岁烧伤患儿照护者居家护理质量评价指标体系包含5个一级指标、13个二级指标、55个三级指标。15名专家以女性居多，年龄32~56岁，全部为本科及以上学历、中级及以上职称，工作年限14~31年。第1、2轮函询表有效回收比分别为1（15/15）、0.93（14/15）。第1、2轮函询所有指标的权威系数均值分别为0.87、0.90。所有指标重要性赋值均值、满分比均值在第1轮函询中分别为4.25、0.68，在第2轮函询中分别为4.39、0.70。第1、2轮函询中所有指标的肯德尔和谐系数均值分别为0.50和0.62，所有指标的变异系数均值分别为0.15和0.14。第1、2轮函询中5个一级指标（生理需要、安全需要、爱与归属的需要、尊重的需要、自我实现的需要）和总二级指标及总三级指标的肯德尔和谐系数检验，结果均具有统计学意义（ χ 2值分别为22.18、20.36、23.42、25.81、21.44、124.73、524.05及24.27、19.85、22.39、27.52、20.83、102.38、503.27， P<0.05）。最终确立的≤3岁烧伤患儿照护者居家护理质量评价指标体系包括5个一级指标、13个二级指标、56个三级指标。一级指标生理需要、安全需要、爱与归属的需要、尊重的需要、自我实现的需要的权重分别为0.343、0.371、0.091、0.076、0.127，二级指标的权重为0.024~0.192，三级指标的权重为0.001~0.089。 结论 基于马斯洛需要层次论构建的≤3岁烧伤患儿照护者居家护理质量评价指标体系具有较好的科学性、可靠性，可以为该年龄段烧伤患儿居家护理提供参考。 Abstract:Objective To establish an evaluation index system of home care quality for caregivers of children aged ≤3 years with burns. Methods The combined approach of qualitative and quantitative research was used, and the fundamental principles of constructing an index system was followed. From January to February 2022, through literature analysis, conducting a semi-structured interview on 6 female nurses aged 31 to 51 years who worked for more than 10 years in the Department of Burns, Plastic Surgery, and Aesthetic Medicine of General Hospital of Ningxia Medical University, as well as 15 caregivers (11 females and 4 males) of hospitalized children with burns aged 28 to 54 years who received professional training from nursing staff, a preliminary evaluation index system of home care quality for caregivers of children ≤3 years old with burns was established using Maslow's hierarchy of needs as theoretical guidance. From March to June 2022, the Delphi method was applied to conduct inquiry by correspondence with 15 experts in relevant fields who met the inclusion criteria and were employed in general hospitals, specialized hospitals, and universities in the Ningxia Hui Autonomous Region (with their general information being recorded), and the evaluation index system was established and the weights of indicators at all levels were determined by the analytic hierarchy process. The effective recovery ratio of the inquiry form was calculated to determine the level of enthusiasm of experts, the average authority coefficient of all indicators was calculated to determine the level of expert authority, the average importance assignment and full score ratio of all indicators were calculated to determine the concentration of expert opinions, and the average Kendall's harmony coefficients and mean coefficient of variation for all indicators were calculated to determine the degree of coordination of expert opinions. The Kendall's harmony coefficients for the first level indicators, the total second level indicators, and the total third level indicators in each round of correspondence inquiry were statistically analyzed with chi-square test. Results The preliminary evaluation index system of home care quality for caregivers of children ≤3 years old with burns included 5 first level indicators, 13 second level indicators, and 55 third level indicators. The majority of the 15 experts were women, aged 32-56 years, all with a bachelor's degree or above education background, intermediate or above professional titles, and worked for 14-31 years. The effective recovery ratios of the first and second rounds of inquiry forms were 1 (15/15) and 0.93 (14/15), respectively. The average authority coefficients of all indicators in the first and second rounds of correspondence inquiries were 0.87 and 0.90, respectively. The average importance assignment and average full score ratio of all indicators were 4.25 and 0.68 respectively in the first round of inquiry, and 4.39 and 0.70 respectively in the second round of inquiry. In the first and second rounds of inquiries, the average Kendall's harmony coefficients for all indicators were 0.50 and 0.62, respectively, and the average coefficients of variation for all indicators were 0.15 and 0.14, respectively. The Kendall's harmony coefficients of the five first level indicators (physiological needs, safety needs, needs for love and belonging, needs for respect, and needs for self-realization), the total second level indicators, and the total third level indicators in the first and second rounds of correspondence inquiries were statistically significant (with χ 2 values of 22.18, 20.36, 23.42, 25.81, 21.44, 124.73, 524.05 and 24.27, 19.85, 22.39, 27.52, 20.83, 102.38, 503.27, respectively, P<0.05). The final evaluation index system of home care quality for caregivers of children ≤3 years old with burns included 5 first level indicators, 13 second level indicators, and 56 third level indicators. The weights of the first level indicators for physiological needs, safety needs, needs for love and belonging, needs for respect, and needs for self-realization were 0.343, 0.371, 0.091, 0.076, and 0.127, respectively. The weights of the second level indicators were 0.024 to 0.192, and the weights of the third level indicators were 0.001 to 0.089. Conclusions The evaluation index system of home care quality for caregivers of children ≤3 years old with burns established on the basis of Maslow's hierarchy of needs theory is scientific and reliable, and can serve as a reference for home care of children with burns in this age group. -
Key words:
- Burns /
- Home nursing /
- Caregivers /
- Evaluation index /
- Maslow's hierarchy of needs theory
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表1 15名专家对3岁及以下烧伤患儿照护者居家护理质量评价指标体系的2轮函询意见协调程度
表1. The degree of coordination of 15 experts' opinions in two rounds of correspondence inquiries on the evaluation index system of home care quality for caregivers of children aged 3 years and below with burns
类别 第1轮函询 第2轮函询 指标个数 肯德尔和谐系数 χ 2值 P值 指标个数 肯德尔和谐系数 χ 2值 P值 生理需要 4 0.46 22.18 <0.001 4 0.53 24.27 <0.001 安全需要 3 0.40 20.36 <0.001 3 0.48 19.85 <0.001 爱与归属的需要 2 0.38 23.42 <0.001 2 0.50 22.39 <0.001 尊重的需要 2 0.35 25.81 <0.001 2 0.48 27.52 <0.001 自我实现的需要 2 0.42 21.44 <0.001 2 0.53 20.83 <0.001 总二级指标 13 0.37 124.73 <0.001 13 0.42 102.38 <0.001 总三级指标 61 0.40 524.05 <0.001 56 0.55 503.27 <0.001 
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表2 15名专家对确立的3岁及以下烧伤患儿照护者居家护理质量评价指标体系的重要性赋值和权重赋值
表2. Importance assignment and weight assignment of the evaluation index system for home care quality of caregivers of children aged 3 years and below with burns by 15 experts
各级指标 重要性赋值（分， 变异系数 权重 生理需要 4.56±0.23 0.05 0.343 营养 4.52±0.25 0.06 0.093 居家期间患儿体重和身长符合正常成长标准 4.65±0.23 0.05 0.011 观察患儿食欲情况（据食、厌食），寻找食欲不佳的原因 4.57±0.28 0.06 0.019 为患儿选择种类多、营养丰富、搭配合理的食物，按需及时添加辅食 4.31±0.35 0.08 0.014 帮助患儿规律、按时、少量及多次进食，注意饮水或奶制品的温度 4.06±0.27 0.07 0.029 对进食障碍患儿遵医嘱给予其他途径营养支持，营养不足时及时带患儿就医 4.45±0.24 0.05 0.017 穿着 4.13±0.15 0.04 0.050 给患儿穿棉质、柔软、透气和不掉色的衣服 4.21±0.18 0.04 0.007 给瘢痕患儿穿的衣服宽松、易穿脱、便于活动 4.20±0.21 0.05 0.005 为会阴部有创面的患儿及时更换尿不湿 4.26±0.16 0.04 0.016 注意对患儿身体暴露有瘢痕部位采取防晒措施 4.32±0.23 0.05 0.021 疼痛 4.26±0.32 0.08 0.080 识别患儿出现疼痛的部位 4.37±0.25 0.06 0.027 明确导致患儿出现疼痛的原因 4.28±0.18 0.04 0.010 判断患儿疼痛时的严重程度 4.15±0.21 0.05 0.028 患儿疼痛原因明确时给予非药物镇痛或遵医嘱用药，未明确原因时及时带患儿就医 4.17±0.23 0.06 0.014 肢体功能 4.38±0.32 0.07 0.119 通过功能训练预防患儿创面愈合后出现瘢痕增生、挛缩或畸形 4.65±0.37 0.08 0.009 根据烧伤部位进行肢体功能训练，用患儿喜爱的玩具激发训练兴趣 4.26±0.25 0.06 0.007 患儿因面部瘢痕存在张口困难时，用玩具式开口训练器帮助其练习开口 4.28±0.21 0.05 0.027 协助患儿做分开手指、伸指、屈指、抓握、腕关节旋转、双手高举训练 4.32±0.36 0.08 0.025 协助患儿做仰头、低头、旋转、伸颈训练 4.22±0.17 0.04 0.008 协助患儿做关节屈曲、外展、旋转训练 4.26±0.13 0.03 0.005 功能训练时循序渐进，动作轻柔，以患儿能接受的力量和时长为主 4.52±0.24 0.05 0.025 患儿出现关节脱位等异常时，及时带去医院就诊 4.59±0.10 0.02 0.010 安全需要 4.64±0.17 0.04 0.371 居家安全 4.53±0.25 0.06 0.155 居家环境整洁舒适，定期清扫、整理 4.48±0.18 0.04 0.030 保障居家用水、用电、生活场景（主要是客厅、厨房）的安全，消除不安全因素 4.75±0.26 0.05 0.032 患儿居家或室外活动时，注意为其预留出相对足够的周围空间 4.63±0.31 0.07 0.066 患儿日常活动（爬、走、跑、进餐、睡眠）时，有专人陪伴 4.48±0.29 0.06 0.026 创面处理 4.63±0.20 0.04 0.024 正确包扎、保护患儿创面 4.62±0.27 0.06 0.002 处理患儿创面前注意清洁双手，用清洁棉签或纱布护理皮肤残余创面 4.45±0.24 0.05 0.003 用清洁棉签为患儿涂抹能够预防瘢痕和促进创面愈合的药物 4.53±0.26 0.06 0.003 遵医嘱给患儿正确穿戴局部弹力套 4.26±0.19 0.04 0.002 帮助患儿睡觉时保持正确卧位，抬高伤侧肢体 4.42±0.21 0.05 0.005 帮助患儿卧位时保护创面之外的皮肤完好、无受压 4.31±0.22 0.05 0.002 患儿因创面瘙痒抓挠时，为其穿戴手保护套，防止抓伤 4.28±0.20 0.05 0.001 观察患儿创面愈合状况，接受医护人员的定期随访，必要时带患儿按期门诊复查 4.72±0.34 0.07 0.002 居家意外伤害 4.65±0.38 0.08 0.192 预防患儿发生二次烧伤事件 4.72±0.28 0.06 0.064 预防患儿居家时发生跌伤、碰伤、刀割伤和触电伤 4.58±0.31 0.07 0.089 预防患儿居家时发生其他意外伤害事件（如宠物抓伤及咬伤、高处摔落伤） 4.53±0.32 0.07 0.035 为患儿购买意外伤害保险 4.29±0.16 0.04 0.002 爱与归属的需要 4.73±0.28 0.06 0.091 有害健康行为 4.65±0.20 0.04 0.050 观察患儿睡眠质量（时长、醒来的次数、有无惊醒、喃喃自语） 4.29±0.15 0.03 0.011 识别患儿有无不良情绪行为（哭闹不止、易受惊吓、不笑不语） 4.23±0.25 0.06 0.011 预防患儿“自伤”或“伤他” 4.38±0.17 0.04 0.020 教育患儿应对紧急情况的方法，如拨打紧急电话、寻求周围人的帮助和自救方法 4.25±0.16 0.04 0.006 健康照护 4.63±0.25 0.05 0.040 态度积极，愿意主动陪伴，全心全意照护患儿 4.33±0.17 0.04 0.012 主动塑造与患儿的亲密关系 4.42±0.26 0.06 0.004 维持与亲属及家庭成员的良好关系，保持家庭和谐 4.57±0.29 0.06 0.003 安抚患儿不良情绪，避免不良行为 4.36±0.21 0.05 0.011 留守儿童的照护者积极寻求来自家庭、社区和社会福利机构的帮助 4.06±0.15 0.04 0.008 尊重的需要 4.28±0.27 0.06 0.076 内部尊重 4.38±0.13 0.03 0.046 家庭核心成员对患儿持接纳态度并关心患儿 4.49±0.26 0.06 0.022 引导家庭内年长儿或低龄儿接纳和爱护患儿 4.37±0.20 0.05 0.023 外部尊重 4.52±0.38 0.08 0.030 帮助患儿回归温暖家庭，密切接触的亲朋好友适时为患儿提供帮助和关爱 4.73±0.22 0.05 0.017 帮助患儿回归社会，带领患儿多接触同龄小朋友，与小伙伴一起玩耍和学习 4.39±0.16 0.04 0.012 自我实现的需要 4.53±0.27 0.06 0.127 外观形象 4.13±0.21 0.05 0.076 患儿烧伤所处部位的瘢痕程度较轻，对日常活动不造成影响 4.26±0.18 0.04 0.039 患儿身体正常暴露部位无瘢痕形成或仅色素沉着，患儿外观变化在可接受范围内 4.83±0.26 0.05 0.015 周围人正确认识患儿经历的烧伤事件，接纳患儿外观形象发生的改变 4.27±0.22 0.05 0.021 成长发育 4.15±0.16 0.04 0.051 采取积极的成长教育方式，给患儿创造良好的成长环境，注重童年的健康成长 4.52±0.75 0.17 0.012 引导患儿通过观察和模仿来探索周围环境，激发患儿内在驱动力 4.61±0.33 0.07 0.021 尝试挖掘患儿潜能，引导患儿树立积极、乐观、坚韧的生活态度 4.64±0.27 0.06 0.017 注：变异系数=重要性赋值的标准量÷均值
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