【摘要】目的根据血液透析中心特性构建适合评价血液透析中心护理服务质量的模型，调查患者对血液透析中心护理服务质量的评价，分析其影响因素并提出建议。方法选取2019 年5 月～8 月在贵州省3 所综合医院血液透析中心治疗的540 名患者为调查对象，采用自行构建的护理服务质量评价量表进行调查，采用多重线性回归分析其影响因素。结果血液透析患者对护理服务质量在有形性、可靠性、响应性、移情性、安全性、透明性、有效性7个维度的感知差异评价均为负值，且差异有统计学意义(t值分别为- 21.742，- 24.973, - 34.006, - 34.583, - 15.415, - 19.542, - 34.289；P值分别为＜0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001)。多重线性回归分析显示患者月收入5000 元以上 (β=0.644，95%CI：0.476～0.614，P＜0.001)、年龄在61～75 岁(β= 0.508，95%CI：0.338～0.471，P＜0.001)和公费医疗(β=-0.145，95%CI：-0.269～-0.036，P=0.011)是影响血液透析中心护理服务质量总感知差异评分的主要因素。结论患者总体感知血液透析中心护理服务质量水平较低，且受多因素影响，因此应根据不同患者需求从各方面针对性地改进，切实提高血液透析中心服务质量。
【Abstract】Objective According to the working characteristics in hemodialysis centers, a model for evaluating nursing quality in hemodialysis centers was established. Nursing quality estimated by the patients was conducted, the influencing factors for nursing quality were analyzed, and the measures to improve nursing quality were then suggested. Methods A total of 540 patients treated in the hemodialysis centers in the three general hospitals in Guizhou province from May to August 2019 were recruited as the subjects for investigation. The self-designed nursing quality evaluation scale was used for the investigation. Multivariate linear regression was used to analyze the influencing factors. Results The perception difference score of nursing quality in the seven dimensions of tangibility, reliability, responsiveness, empathy, safety, transparency and effectiveness showed negative values (t=-21.742, -24.973, -34.006, -34.583, -15.415, -19.542 and -34.289 respectively; P<0.001). Multivariate linear regression found that monthly income >5000 yuan (β=0.644, P<0.001), 61~75 years old (β=0.508, P<0.001) and public medical service (β= -0.145, P=0.011) were the influencing factors for the overall perception difference score of nursing quality in the hemodialysis centers. Conclusion The overall perception of nursing quality in the hemodialysis centers by MHD patients was negative, and was
affected by many factors. Therefore, improvement of nursing quality in the hemodialysis centers must be consistent with the various needs from different kinds of MHD patients.
[1]上海慢性肾脏病早发现及规范化诊治与示范项目专家组.慢性肾脏病筛查诊断及防治指南[J].中国实用内科杂志, 2017, 37(1):28-34
[2]Ene-Iordache B, Perico N, Bikbov B, et al.Chronic kidney diseaseand cardiovascular risk in six regions of the world (ISN-KDDC)a cross-sectional study[J].Lancet Glob Health, 2016, 4(5):e307-e319
[3]赵德龙.维持性血液透析患者流行病学调查及生存预后相关性分析[M].北京:中国人民解放军医学院, 2016.
[4]Webster AC, Nagler EV, Morton RL, et al.Chronic kidney disease[J].Lancet, 2017, 389(10075):1238-1252
[5]Parasuraman A, Zeithaml VA, Berry LL.SERVQUAL: A Multiple-Item Scale for Measuring Consumer Perceptions of Service Quality[J].Journal of Retailing, 1988, 64(1):12-40
[6] Kidney Disease:Improving Global Outcomes (KDIGO)CKD Work Group.KDIGO 2012 Clinical Prac-tice Guideline for the valuation and Management of Chronic Kidney Disease[J].Kidney inter, 2013, 3:1-150
[7]喻姣花, 柯卉, 李芬.基于模型的护患双方感知护理服务质量调查分析[J].护理学杂志, 2014, 29(05):34-38
[8]Bahadori M, Raadabadi M, Heidari Jamebozorgi M, et al.Measuring the Quality of Provided Services for Patients With Chronic Kidney Disease[J].Nephro Urol Mon, 2014, 6(5):e201810-
[9]王梦娜, 甘秀妮, 盛晓敏, 等.基于服务质量差距模型构建腹部手术患者护理服务质量评价指标体系的研究[J].中国实用护理杂志, 2016, 32(18):1416-1421
[10]Cerri S.Assessing the quality of higher education services using a modified SERVQUAL scale[J].Annales Universitatis Apulensis: Series Oeconomica, 2012, 14(2):665-669
[11]Darke Peter R, Ashworth Laurence, Main Kelly J.Great expectations and broken promises: misleading claims,product failure,expectancy disconfirmation and consumer distrust[J].Academy of Marketing Science, 2010, 38(3):347-362
[12]Prabhakar Gantasala V, Ram Padmakumar.SERVQUAL and Customer Satisfaction: the mediating influence of communication in the privatized telecom sector[J].International Journal of Academic Research in Business and Social Sciences, 2013, 3(3):139-147
[13]戴靖华, 张沁莲, 徐建萍.基于服务质量差距模型的急诊护理服务质量现状调查分析[J].中华现代护理杂志, 2015, 21(21):2485-2489
[14]Aman Bakhtiar, Abbas Faisal.Patient' s perceptions about the service quality of public hospitals located at District Kohat[J].The Journal of the Pakistan Medical Association, 2016, 66(1):72-75
[15]刘艳峰.模型在外科护理服务质量评价中的应用研究[J].护理研究, 2015, 29(6):2258-2260
[16]汪文新, 江舜杰, 田怀古.医疗服务质量对医患关系的影响研究-基于患者角度[J].卫生经济研究, 2018, 4(4):26-30
[17]郭惠子, 纪代红, 赵巧玉.评价法在护理服务质量评测中的应用现状[J].中华现代护理杂志, 2015, 21(21):2481-2484
[18]喻姣花, 柯卉, 李芬.护患双方感知护理服务质量的研究[J].护理研究, 2014, 8(6):659-662
[19]焦盼盼, 李新辉, 胡文风.应用量表评价肝胆外科护理服务质量现状及影响因素分析[J].中国实用护理杂志, 2013, 29(34):63-65
[20]陶化青, 高艳华, 孔青.住院患者护理服务质量现状及影响因素[J].解放军医院管理杂志, 2016, 23(6):557-560
[21]王江蓉, 张拓红.中国成年居民社会资本相关因素与健康自评的关系[J].北京大学学报医学版, 2012, 44(3):392-396
[22]Uzun O.Patient satisfaction with nursing care at a university hospital in Turkey[J].J Nurs Care Qual, 2001, 16(1):24-33
[23]Lumby J, England K.Patient satisfaction with nursingcare in a colorectal surgical population [J)[J].Int J Nurs Pract, 2000, 6(3):140-145
[24]Zhang L, Wang F, Wang L, et al.Prevalence of chronic kidney disease in China: across-sectional survey[J].The Lancet, 2012, 379(9818):815-822
[25]Tozawa M, Iseki K, Iseki C, et al.Blood pressure predicts risk of developing end-stage renal disease in men and women[J].Hypertension, 2003, 41(6):1341-1345
[26]应志野, 李春漾, 曾筱茜, 等.物联网在慢性肾病管理中的应用[J].华西医学, 2019, 34(7):827-831
[27]黄月阳, 石运莹, 陈懿, 等.慢性肾脏病随访患者健康素养现状及影响因素分析[J].华西医学, 2019, 34(07):777-782
[28]王珍珍, 王绪保, 丁亚莉, 等.在白内障手术护理质量中的应用[J].中华现代护理杂志, 2017, 23(02):230-233
[29]Zarei A, Arab M, Froushani AR, et al.Service quality of private hospitals:the Iranian patients′perspective[J].BMC Health Serv Res, 2012, (12):31.
[30]张春瑜, 王燕森, 张何明.医护人员满意度影响因素分析[J].卫生经济研究, 2017, (6):61-63
[31]林文强, 林琦, 张金, 等.医院自主的门诊处方审核干预系统的建立[J].中国医院药学杂志, 2016, 36(11):943-946
