enveloping quality indicators of home care nursing practice for older adults : Defining items and their standardization based upon the best practice

本研究的目的是明确老年人家庭护理的最佳实践，并在最佳实践的基础上制定和标准化质量指标。首先，我们选择了16个家庭护理领域的质量指标。这16个领域通常被实践或被认为在不久的将来变得重要。每名研究人员都负责制定质量指标。制定指标所依赖的基本资源是过去关于目标领域的文献和专家从业人员拥有的实用知识。第二，利用开发的质量指标对日本家庭护理护士的护理质量进行了全国性调查。调查问卷向全国5322个家庭护理站的10644名护士发出，3068名护士(29.7%)进行了回复。反馈显示，所有16个领域的平均70%以上的质量指标在护士的日常工作中得到了实践。在所有领域，护士都对QI表示肯定。结果表明，QI量表普遍适用于当今日本的家庭护理。我们已经根据调查结果确定了质量指标。然后，我们检查了家庭支持和压疮护理方面的质量指标的有效性。我们回顾了60张护理图表，并检查了护理图表中实际报告了多少质量指标内容。在家庭支持方面，存在一些效度较低的质量指标。压疮护理领域的大多数质量指标显示出较高的效度。结果表明，在评估实际护理质量时，不能仅依靠护士对质量指标的反应。

The purpose of this study was to define the best practice of home care nursing for older adults and to develop and standardize quality indicators based upon the best practice.First we selected the 16 areas of home care nursing in which we developed the quality indicators. The 16 areas were commonly practiced or considered to become important in near future. Each researcher was responsible in developing the quality indicators. The basic resources to rely on in developing the indicators were past literature on the target area and practical knowledge owned by the expert practitioners. As a result, 483 quality indicators were developed.Second, we conducted a national survey on the quality of care provided by the home care nurses in Japan, using the developed quality indicators. The questionnaires were sent out to the 10,644 nurses working at 5,322 home nursing stations nation-wide, and 3,068 (29.7%) nurses responded. The response showed that on average over 70% of quality indicators from all 16 areas were practiced in the nurses' daily works. In all areas, the nurses were affirmative of the QIs. The results suggested that the QIs were generally applicable to today's home care nursing in Japan. We have finalized the quality indicators based upon the survey results.Then we have examined the validity of quality indicators in the areas of family support and pressure ulcer care. We have reviewed 60 nursing charts and examined how much contents of quality indicators were actually reported in nursing charts. In the area of family support, there were some quality indicators with low validity. Most quality indicators in the area of pressure ulcer care showed relatively high validity. The results suggested that the nurses' response to the quality indicators alone cannot be relied upon in estimating the actual quality of care.