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Article(id=1322168620428407057, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168387082502716, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.06.014, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1745510400000, receivedDateStr=2025-04-25, revisedDate=1770566400000, revisedDateStr=2026-02-09, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159163815, onlineDateStr=2026-10-28, pubDate=1774368000000, pubDateStr=2026-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159163815, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159163815, creator=13701087609, updateTime=1793159163815, updator=13701087609, issue=Issue{id=1322168387082502716, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='6', pageStart='881', pageEnd='1056', issueExtLink='null', onlineDate='null', pubDate='1774368000000', pubDateStr='2026-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159108180, creator='13701087609', updateTime=1793159108180, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=982, endPage=992, ext={EN=ArticleExt(id=1322168620663288082, articleId=1322168620428407057, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Development of the perioperative missed nursing care scale and its reliability and validity test, columnId=1220689492655129450, journalTitle=Chinese Nursing Research, columnName=Scale Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To develop the perioperative missed nursing care scale and to test its reliability and validity.

Methods

The initial version of the perioperative missed nursing care scale was developed through literature review and qualitative interviews.The scale was revised by Delphi expert consultations and a pre-survey.A total of 754 operating room nurses from 22 provinces,autonomous regions,and municipalities in China were selected as survey subjects.The reliability and validity of the scale were tested.

Results

The questionnaire response rates for the two rounds of expert consultations were 100.0% and 94.4%,respectively.The expert authority coefficients were 0.911 and 0.935,respectively.Kendall's W coefficients for subscale A were 0.279 and 0.295(both P<0.001).Kendall's W coefficients for subscale B were 0.220 and 0.185(both P<0.001).Exploratory factor analysis extracted four common factors each for both subscale A and subscale B,with cumulative variance contribution rates of 76.41% and 75.71%,respectively.Confirmatory factor analysis results showed that all fit indices were within acceptable ranges.For subscale A,the average variance extracted values for the four dimensions ranged from 0.430 to 0.529,and composite reliability values ranged from 0.880 to 0.966.For subscale B,the average variance extracted values for the four dimensions ranged from 0.519 to 0.700,and composite reliability values ranged from 0.873 to 0.972.The item-level content validity index (I-CVI) for the perioperative missed nursing care scale ranged from 0.857 to 1.000.The scale-level content validity index(S-CVI) was 0.914.The overall Cronbach's α coefficient for the scale was 0.967.The Cronbach's α coefficients for the dimensions of subscale A ranged from 0.885 to 0.965.The Cronbach's α coefficients for the dimensions of subscale B ranged from 0.866 to 0.972.The overall split-half reliability was 0.924 for subscale A and 0.898 for subscale B.

Conclusions

The perioperative missed nursing care scale demonstrates scientific rigor and practical utility.It could be used to assess missed nursing care items and their causes in the perioperative period.

, authors=Yajing FU1, Ting HUANG2, Pei KUANG3, authorsList=Yajing FU, Ting HUANG, Pei KUANG, authorCompany=null, correspAuthors=Ting HUANG, authorNote=null, correspAuthorsNote=
HUANG Ting, E-mail:
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目的

编制围术期护理缺失量表并进行信效度检验。

方法

通过文献回顾、质性访谈形成围术期护理缺失量表初稿，通过德尔菲专家函询、预调查对量表进行修订。选取我国22个省、自治区、直辖市的754名手术室护士作为调查对象对量表进行信效度检验。

结果

2轮专家函询问卷回收率分别为100.0%及94.4%。专家权威系数分别为0.911和0.935。分量表A的肯德尔协调系数分别为0.279和0.295（均P<0.001），分量表B的肯德尔协调系数分别为0.220和0.185（均P<0.001）。探索性因子分析中，围术期护理缺失量表分量表A和分量表B均提取4个公因子，累积方差贡献率分别为76.41%和75.71%。验证性因子分析结果显示各拟合指标均在正常范围。分量表A的4个维度平均方差提取量为0.430~0.529，组合信度为0.880~0.966；分量表B的4个维度平均方差提取量为0.519~0.700，组合信度为0.873~0.972。围术期护理缺失量表条目水平的内容效度指数为0.857~1.000，量表水平内容效度指数为0.914。量表总体的Cronbach's α系数为0.967，分量表A各维度的Cronbach's α系数为0.885~0.965，分量表B各维度的Cronbach's α系数为0.866~0.972。分量表A总体折半信度为0.924，分量表B总体折半信度为0.898。

结论

围术期护理缺失量表具有一定的科学性和实用性，可用于评估围术期的护理缺失项目及原因。

, authors=付亚静1, 黄婷2, *, *, 况培3, authorsList=付亚静, 黄婷, 况培, authorCompany=null, correspAuthors=黄婷, authorNote=

付亚静，主管护师，硕士研究生

, correspAuthorsNote=
黄婷，E-mail:
HUANG Ting, E-mail:
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refAbstract=null), Reference(id=1322530252711113183, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, doi=null, pmid=null, pmcid=null, year=2015, volume=71, issue=3, pageStart=632, pageEnd=641, url=null, language=null, rfNumber=40, rfOrder=39, authorNames=TUBBS-COOLEY H L, PICKLER R H, MARK B A, journalName=Journal of Advanced Nursing, refType=null, unstructuredReference=TUBBS-COOLEY H L,PICKLER R H,MARK B A,et al.A research protocol for testing relationships between nurse workload,missed nursing care and neonatal outcomes:the neonatal nursing care quality study[J].Journal of Advanced Nursing,2015,71(3):632-641., articleTitle=A research protocol for testing relationships between nurse workload,missed nursing care and neonatal outcomes:the neonatal nursing care quality study, refAbstract=null), Reference(id=1322530252786610656, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, doi=null, pmid=null, pmcid=null, year=2016, volume=25, issue=7, pageStart=535, pageEnd=543, url=null, language=null, rfNumber=41, rfOrder=40, authorNames=LAKE E T, GERMACK H D, VISCARDI M K, journalName=BMJ Quality & Safety, refType=null, unstructuredReference=LAKE E T,GERMACK H D,VISCARDI M K.Missed nursing care is linked to patient satisfaction:a cross-sectional study of US hospitals[J].BMJ Quality & Safety,2016,25(7):535-543., articleTitle=Missed nursing care is linked to patient satisfaction:a cross-sectional study of US hospitals, refAbstract=null), Reference(id=1322530252878885345, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, doi=null, pmid=null, pmcid=null, year=2010, volume=58, issue=5, pageStart=233, pageEnd=241, url=null, language=null, rfNumber=42, rfOrder=41, authorNames=KALISCH B J, LEE K H, journalName=Nursing Outlook, refType=null, unstructuredReference=KALISCH B J,LEE K H.The impact of teamwork on missed nursing care[J].Nursing Outlook,2010,58(5):233-241., articleTitle=The impact of teamwork on missed nursing care, refAbstract=null), Reference(id=1322530252958577122, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, doi=null, pmid=null, pmcid=null, year=2015, volume=52, issue=6, pageStart=1121, pageEnd=1137, url=null, language=null, rfNumber=43, rfOrder=42, authorNames=JONES T L, HAMILTON P, MURRY N, journalName=International Journal of Nursing Studies, refType=null, unstructuredReference=JONES T L,HAMILTON P,MURRY N.Unfinished nursing care,missed care,and implicitly rationed care:state of the science review[J].International Journal of Nursing Studies,2015,52(6):1121-1137., articleTitle=Unfinished nursing care,missed care,and implicitly rationed care:state of the science review, refAbstract=null), Reference(id=1322530253038268899, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, doi=null, pmid=null, pmcid=null, year=2006, volume=21, issue=4, pageStart=306, pageEnd=315, url=null, language=null, rfNumber=44, rfOrder=43, authorNames=KALISCH B J, journalName=Journal of Nursing Care Quality, refType=null, unstructuredReference=KALISCH B J.Missed nursing care:a qualitative study[J].Journal of Nursing Care Quality,2006,21(4):306-315., articleTitle=Missed nursing care:a qualitative study, refAbstract=null), Reference(id=1322530253117960676, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, doi=null, pmid=null, pmcid=null, year=2023, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=45, rfOrder=44, authorNames=高静, journalName=null, refType=null, unstructuredReference=高静.新生儿科护理缺失量表的编制[D].济南:山东中医药大学,2023., articleTitle=新生儿科护理缺失量表的编制, refAbstract=null), Reference(id=1322530253222818277, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, doi=null, pmid=null, pmcid=null, year=2021, volume=36, 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tableContent=null), ArticleFig(id=1322530247329821102, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, language=CN, label=图1, caption=围术期护理缺失量表分量表A验证性因子分析模型, figureFileSmall=eXNeXBBO+XhRzkK/K+XBNw==, figureFileBig=0HuD2xpILe1l3Yi+RAC3tQ==, tableContent=null), ArticleFig(id=1322530247577285039, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, language=EN, label=Figure 2, caption=Confirmatory factor analysis model diagram for subscale B of the perioperative missed nursing care scale, figureFileSmall=WD+J8Z7Fv+9JD1FaWiGZCg==, figureFileBig=owlkcThCWCNw9DxreReedg==, tableContent=null), ArticleFig(id=1322530247652782512, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, language=CN, label=图2, caption=围术期护理缺失量表分量表B验证性因子分析模型, figureFileSmall=WD+J8Z7Fv+9JD1FaWiGZCg==, figureFileBig=owlkcThCWCNw9DxreReedg==, tableContent=null), ArticleFig(id=1322530247711502769, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, language=EN, label=Table 1, caption=

General information of nurses（n=754）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类项目分析及探索因子分析（n=434）验证性因子分析（n=320）
性别男77（17.7）51（15.9）
女357（82.3）269（84.1）
年龄≤25岁34（7.8）30（9.4）
>25~35岁245（56.5）153（47.8）
>35~45岁102（23.5）103（32.2）
>45~50岁26（6.0）23（7.2）
>50岁27（6.2）11（3.4）
学历中专0（0.0）1（0.3）
专科28（6.5）25（7.8）
本科396（91.2）277（86.6）
研究生10（2.3）17（5.3）
职称护士29（6.7）40（12.5）
护师120（27.6）82（25.6）
主管护师269（62.0）176（55.0）
副主任护师15（3.5）21（6.6）
主任护师1（0.2）1（0.3）
婚否已婚326（75.1）248（77.5）
未婚108（24.9）72（22.5）
所在医院等级三级医院385（88.7）295（92.2）
二级医院47（10.8）22（6.9）
一级医院2（0.5）3（0.9）
手术室工作时长≤3年42（9.7）48（15.0）
>3~5年32（7.4）26（8.1）
>5~<11年158（36.4）78（24.4）
≥11年202（46.5）168（52.5）
是否为手术室专科护士是143（32.9）150（46.9）
否291（67.1）170（53.1）
白班时平均每周工作时间≤40 h126（29.0）106（33.1）
>40 h308（71.0）214（66.9）
过去3个月累计加班时间≤20 h126（29.0）77（24.1）
>20~50 h108（24.9）68（21.3）
>50 h51（11.8）72（22.5）
没有累计加班时间40（9.2）32（10.0）
不确定109（25.1）71（22.2）
你认为所在护理单元是否人员充足一直觉得人员充足51（11.8）52（16.3）
约80%的时间觉得人员充足211（48.6）134（41.9）
约60%的时间觉得人员充足111（25.6）82（25.6）
约30%的时间觉得人员充足42（9.7）30（9.4）
<30%的时间觉得人员充足19（4.4）22（6.9）
), ArticleFig(id=1322530247971549618, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, language=CN, label=表1, caption=

护士一般资料（n=754）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类项目分析及探索因子分析（n=434）验证性因子分析（n=320）
性别男77（17.7）51（15.9）
女357（82.3）269（84.1）
年龄≤25岁34（7.8）30（9.4）
>25~35岁245（56.5）153（47.8）
>35~45岁102（23.5）103（32.2）
>45~50岁26（6.0）23（7.2）
>50岁27（6.2）11（3.4）
学历中专0（0.0）1（0.3）
专科28（6.5）25（7.8）
本科396（91.2）277（86.6）
研究生10（2.3）17（5.3）
职称护士29（6.7）40（12.5）
护师120（27.6）82（25.6）
主管护师269（62.0）176（55.0）
副主任护师15（3.5）21（6.6）
主任护师1（0.2）1（0.3）
婚否已婚326（75.1）248（77.5）
未婚108（24.9）72（22.5）
所在医院等级三级医院385（88.7）295（92.2）
二级医院47（10.8）22（6.9）
一级医院2（0.5）3（0.9）
手术室工作时长≤3年42（9.7）48（15.0）
>3~5年32（7.4）26（8.1）
>5~<11年158（36.4）78（24.4）
≥11年202（46.5）168（52.5）
是否为手术室专科护士是143（32.9）150（46.9）
否291（67.1）170（53.1）
白班时平均每周工作时间≤40 h126（29.0）106（33.1）
>40 h308（71.0）214（66.9）
过去3个月累计加班时间≤20 h126（29.0）77（24.1）
>20~50 h108（24.9）68（21.3）
>50 h51（11.8）72（22.5）
没有累计加班时间40（9.2）32（10.0）
不确定109（25.1）71（22.2）
你认为所在护理单元是否人员充足一直觉得人员充足51（11.8）52（16.3）
约80%的时间觉得人员充足211（48.6）134（41.9）
约60%的时间觉得人员充足111（25.6）82（25.6）
约30%的时间觉得人员充足42（9.7）30（9.4）
<30%的时间觉得人员充足19（4.4）22（6.9）
), ArticleFig(id=1322530248038658483, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, language=EN, label=Table 2, caption=

Factor loadings for subscale A of the perioperative missed nursing care scale

, figureFileSmall=null, figureFileBig=null, tableContent=
编号条目术中配合及病人管理术前评估沟通与规范化安全核查与护理文书
A1检查病人手术知情同意书与手术内容是否一致0.643
A2手术安全核查单各条目填写准确无漏项，签名完整且与实际相符0.811
A3手术清点单各条目填写准确无漏项，签名完整且与实际相符0.778
A4输液/输血核查单填写完整且正确0.824
A5其他各项护理记录单填写完整且正确（各个环节手术病人交接单、收费单等其他护理记录单）0.758
A6病人进入手术间之前经过2种以上的方式进行身份识别0.677
A7三方核查逐项准确完成0.682
A8安全核查期间，参与核查人员一切活动暂停0.519
A9参与核查人员均具备核查资质0.600
A10术前访视完成0.646
A11提前完成病人皮肤及静脉状况评估0.692
A12提前完成病人手术体位耐受性与肢体功能评估0.725
A13提前确认病人实验室检查结果0.726
A14提前了解病人术前病史（慢性病史、药物史、过敏史等）0.737
A15提前识别病人体内可植入装置/活动性假牙并告知病人勿携带金属物品、饰品进入手术间0.648
A16提前告知病人去除指甲油及有色唇膏0.733
A17关注病人术前心理状况0.784
A18确认病人术前对手术没有疑虑0.752
A19术前及时满足病人如厕需求0.614
A20遵医嘱术中正确使用药物（抗生素、止血药等）0.653
A21术中输血、给药双人核查0.706
A22提前调试仪器设备至功能状态0.660
A23手术用物准备齐全（仪器设备、器械敷料、一次性用物、高值耗材），并且提前熟悉手术配合流程、术中用物使用方法0.647
A24必要时粘贴电刀负极板0.670
A25密切关注手术进程（观察到病人病情变化、手术医生台上用物供给需求）0.719
A26巡回护士频繁出入手术间0.597
A27手术配合具备主动性0.633
A28手术器械台面整理规范并及时清理器械表面血迹0.624
A29器械护士使用正确的方式传递手术器械并正确称呼手术器械0.691
A30手术护士知晓术中用物（纱布、缝针、器械、病理组织）去向0.753
A31术后及时收取手术费用0.656
A32交接班时关键信息传达正确0.713
A33术前、关闭体腔前、关闭体腔后、皮肤缝合后的清点均完成0.770
A34手术器械等手术用物在清点时均由双人唱点其数量及检查完整性0.703
A35术中手术用物增减均由巡回护士完成并及时记录0.704
A36标本固定正确（包含标本名称填写、标本液量及是否渗漏、标本放置是否存在混淆）0.688
A37手术标本固定后上锁管理0.601
A38病人相关用物（衣物、影像资料、牵引器具等）术后随病人带回病房0.628
A39术后手术用物妥善处理和归还（手术器械、仪器设备、体位装置等），无遗失0.636
A40处理（污染）手术用物时机正确0.669
A41手术护士与麻醉后监测治疗室（PACU）护士完成双人交接，交接内容完整0.648
A42手术室护士能够规范摆放不同病人、不同专科手术体位，保障病人安全0.650
A43手术室护士提前评估病人并按时进行预防性压力性损伤或术中难免压力性损伤上报0.652
A44术前在骨隆突处预防性进行皮肤保护0.625
A45预防皮肤裸露并直接接触硬质物品（金属、管道、输液管路等）0.682
A46术前与手术医生沟通手术方式、手术体位、手术用物准备情况0.598
A47术前与手术医生沟通术前及术中用药情况0.625
A48术前与手术医生沟通病人备血及献血状况0.620
A49术中洗手护士就术中变化及手术需求与巡回护士沟通0.606
A50未与麻醉医生沟通丢弃仍需使用的麻醉用物0.612
A51术后及时与病人转归科室沟通（病人皮肤、病情等一般状况）0.634
A52手卫生及外科手消毒规范完成且时机准确0.621
A53晨间、接台手术、术后物体表面擦拭规范完成且时机正确0.670
A54规范并严格遵守手术间自净时间0.695
A55规范应对特殊感染手术（医务人员感染防护，手术间物体表明、地面、医院感染监测，术后器械辅料处理）0.660
A56将使用过的术中无菌单直接丢弃于手术间地面，未按规范处置0.676
A57手术成员开始铺单前等待皮肤消毒剂干燥0.669
), ArticleFig(id=1322530248109961652, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, language=CN, label=表2, caption=

围术期护理缺失量表分量表A因子载荷

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编号条目术中配合及病人管理术前评估沟通与规范化安全核查与护理文书
A1检查病人手术知情同意书与手术内容是否一致0.643
A2手术安全核查单各条目填写准确无漏项，签名完整且与实际相符0.811
A3手术清点单各条目填写准确无漏项，签名完整且与实际相符0.778
A4输液/输血核查单填写完整且正确0.824
A5其他各项护理记录单填写完整且正确（各个环节手术病人交接单、收费单等其他护理记录单）0.758
A6病人进入手术间之前经过2种以上的方式进行身份识别0.677
A7三方核查逐项准确完成0.682
A8安全核查期间，参与核查人员一切活动暂停0.519
A9参与核查人员均具备核查资质0.600
A10术前访视完成0.646
A11提前完成病人皮肤及静脉状况评估0.692
A12提前完成病人手术体位耐受性与肢体功能评估0.725
A13提前确认病人实验室检查结果0.726
A14提前了解病人术前病史（慢性病史、药物史、过敏史等）0.737
A15提前识别病人体内可植入装置/活动性假牙并告知病人勿携带金属物品、饰品进入手术间0.648
A16提前告知病人去除指甲油及有色唇膏0.733
A17关注病人术前心理状况0.784
A18确认病人术前对手术没有疑虑0.752
A19术前及时满足病人如厕需求0.614
A20遵医嘱术中正确使用药物（抗生素、止血药等）0.653
A21术中输血、给药双人核查0.706
A22提前调试仪器设备至功能状态0.660
A23手术用物准备齐全（仪器设备、器械敷料、一次性用物、高值耗材），并且提前熟悉手术配合流程、术中用物使用方法0.647
A24必要时粘贴电刀负极板0.670
A25密切关注手术进程（观察到病人病情变化、手术医生台上用物供给需求）0.719
A26巡回护士频繁出入手术间0.597
A27手术配合具备主动性0.633
A28手术器械台面整理规范并及时清理器械表面血迹0.624
A29器械护士使用正确的方式传递手术器械并正确称呼手术器械0.691
A30手术护士知晓术中用物（纱布、缝针、器械、病理组织）去向0.753
A31术后及时收取手术费用0.656
A32交接班时关键信息传达正确0.713
A33术前、关闭体腔前、关闭体腔后、皮肤缝合后的清点均完成0.770
A34手术器械等手术用物在清点时均由双人唱点其数量及检查完整性0.703
A35术中手术用物增减均由巡回护士完成并及时记录0.704
A36标本固定正确（包含标本名称填写、标本液量及是否渗漏、标本放置是否存在混淆）0.688
A37手术标本固定后上锁管理0.601
A38病人相关用物（衣物、影像资料、牵引器具等）术后随病人带回病房0.628
A39术后手术用物妥善处理和归还（手术器械、仪器设备、体位装置等），无遗失0.636
A40处理（污染）手术用物时机正确0.669
A41手术护士与麻醉后监测治疗室（PACU）护士完成双人交接，交接内容完整0.648
A42手术室护士能够规范摆放不同病人、不同专科手术体位，保障病人安全0.650
A43手术室护士提前评估病人并按时进行预防性压力性损伤或术中难免压力性损伤上报0.652
A44术前在骨隆突处预防性进行皮肤保护0.625
A45预防皮肤裸露并直接接触硬质物品（金属、管道、输液管路等）0.682
A46术前与手术医生沟通手术方式、手术体位、手术用物准备情况0.598
A47术前与手术医生沟通术前及术中用药情况0.625
A48术前与手术医生沟通病人备血及献血状况0.620
A49术中洗手护士就术中变化及手术需求与巡回护士沟通0.606
A50未与麻醉医生沟通丢弃仍需使用的麻醉用物0.612
A51术后及时与病人转归科室沟通（病人皮肤、病情等一般状况）0.634
A52手卫生及外科手消毒规范完成且时机准确0.621
A53晨间、接台手术、术后物体表面擦拭规范完成且时机正确0.670
A54规范并严格遵守手术间自净时间0.695
A55规范应对特殊感染手术（医务人员感染防护，手术间物体表明、地面、医院感染监测，术后器械辅料处理）0.660
A56将使用过的术中无菌单直接丢弃于手术间地面，未按规范处置0.676
A57手术成员开始铺单前等待皮肤消毒剂干燥0.669
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Factor loadings for subscale B of the perioperative missed nursing care scale

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编号条目人员决策沟通劳动力/环境及物质资源不可预测情形
B1工作内容难度大，专业知识覆盖面广0.591
B2缺乏外科团队成员支持0.684
B3缺乏领导者支持0.707
B4医院空间资源有限0.755
B5医院客观资源（仪器设备、器械）数量有限0.720
B6手术用物、仪器设备定期检修处于备用状态0.736
B7术中用药不能使用（未开具医嘱、药物过期等）0.597
B8医院开展某项技术或业务数量较少0.671
B9外科团队成员的疑问在手术前未得到解决0.604
B10手术安排或病人病情变化，手术团队成员第一时间信息共享0.574
B11护理人员外科团队沟通缺乏或沟通失败0.646
B12护理人员与手术科室护士沟通缺乏或沟通失败0.726
B13手术室护理人员之间缺乏有效或预见性沟通0.668
B14与辅助岗位人员沟通紧张（护理助理、保洁人员）0.669
B15与其他部门沟通紧张（输血科、放射科、病理科等）0.716
B16外科团队成员之间的传达中断0.724
B17外科团队成员之间不必要的对话0.762
B18手术突发情况下，外科团队成员出现情绪化沟通0.594
B19交接班不清0.607
B20手术室护士专业知识掌握不足0.752
B21手术专业组内无知识更新0.780
B22缺乏完善的教学管理体系0.792
B23教学信息部分接收或未接收0.772
B24领导者能力缺失，缺乏合理的工作安排及人力资源调度管理0.733
B25缺乏完善且书面化的手术室管理制度、合理的工作流程0.747
B26缺乏责任心，无主动配合意识0.799
B27惯性思维0.755
B28缺乏预见性思维0.757
B29缺乏批判思维0.749
B30因经验不足导致的紧张0.726
B31工作外的突发事件导致注意力不集中0.736
B32工作时的经验主义与教条主义，未遵循循证互利原则0.753
B33外科团队成员之间能力不均衡，无法协调配合工作或导致手术中断0.743
B34外科团队成员之间缺乏信任、不适应0.750
B35因外科团队成员不遵守规范或者突发状况导致手术中断0.740
B36出现手术量突然增加等工作量增大的情形0.736
B37手术时间意外延长0.774
B38出现紧急情况，例如病人病情突然恶化0.709
), ArticleFig(id=1322530248395174326, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168620428407057, language=CN, label=表3, caption=

围术期护理缺失量表分量表B因子载荷

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编号条目人员决策沟通劳动力/环境及物质资源不可预测情形
B1工作内容难度大，专业知识覆盖面广0.591
B2缺乏外科团队成员支持0.684
B3缺乏领导者支持0.707
B4医院空间资源有限0.755
B5医院客观资源（仪器设备、器械）数量有限0.720
B6手术用物、仪器设备定期检修处于备用状态0.736
B7术中用药不能使用（未开具医嘱、药物过期等）0.597
B8医院开展某项技术或业务数量较少0.671
B9外科团队成员的疑问在手术前未得到解决0.604
B10手术安排或病人病情变化，手术团队成员第一时间信息共享0.574
B11护理人员外科团队沟通缺乏或沟通失败0.646
B12护理人员与手术科室护士沟通缺乏或沟通失败0.726
B13手术室护理人员之间缺乏有效或预见性沟通0.668
B14与辅助岗位人员沟通紧张（护理助理、保洁人员）0.669
B15与其他部门沟通紧张（输血科、放射科、病理科等）0.716
B16外科团队成员之间的传达中断0.724
B17外科团队成员之间不必要的对话0.762
B18手术突发情况下，外科团队成员出现情绪化沟通0.594
B19交接班不清0.607
B20手术室护士专业知识掌握不足0.752
B21手术专业组内无知识更新0.780
B22缺乏完善的教学管理体系0.792
B23教学信息部分接收或未接收0.772
B24领导者能力缺失，缺乏合理的工作安排及人力资源调度管理0.733
B25缺乏完善且书面化的手术室管理制度、合理的工作流程0.747
B26缺乏责任心，无主动配合意识0.799
B27惯性思维0.755
B28缺乏预见性思维0.757
B29缺乏批判思维0.749
B30因经验不足导致的紧张0.726
B31工作外的突发事件导致注意力不集中0.736
B32工作时的经验主义与教条主义，未遵循循证互利原则0.753
B33外科团队成员之间能力不均衡，无法协调配合工作或导致手术中断0.743
B34外科团队成员之间缺乏信任、不适应0.750
B35因外科团队成员不遵守规范或者突发状况导致手术中断0.740
B36出现手术量突然增加等工作量增大的情形0.736
B37手术时间意外延长0.774
B38出现紧急情况，例如病人病情突然恶化0.709
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围术期护理缺失量表的编制及信效度检验
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付亚静 1 , 黄婷 2, *, * , 况培 3
护理研究 | 量表研究 2026,40(6): 982-992
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护理研究 |量表研究 2026 , 40 (6) : 982 -992
围术期护理缺失量表的编制及信效度检验
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付亚静1, 黄婷2, *, * , 况培3
作者信息
  • 1武汉大学护理学院，湖北 430000
  • 2武汉大学人民医院
  • 3湖北省妇幼保健院
通讯作者:
黄婷，E-mail:
HUANG Ting, E-mail:
作者简介:

付亚静，主管护师，硕士研究生

Development of the perioperative missed nursing care scale and its reliability and validity test
Yajing FU1, Ting HUANG2 , Pei KUANG3
Affiliations
  • 1School of Nursing, Wuhan University, Hubei 430000 China
  • 2Renmin Hospital of Wuhan University
  • 3Maternal and Child Health Hospital of Hubei Province
    • Corresponding Author:
    HUANG Ting, E-mail:
出版时间: 2026-03-25 doi: 10.12102/j.issn.1009-6493.2026.06.014
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摘要
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目的

编制围术期护理缺失量表并进行信效度检验。

方法

通过文献回顾、质性访谈形成围术期护理缺失量表初稿，通过德尔菲专家函询、预调查对量表进行修订。选取我国22个省、自治区、直辖市的754名手术室护士作为调查对象对量表进行信效度检验。

结果

2轮专家函询问卷回收率分别为100.0%及94.4%。专家权威系数分别为0.911和0.935。分量表A的肯德尔协调系数分别为0.279和0.295（均P<0.001），分量表B的肯德尔协调系数分别为0.220和0.185（均P<0.001）。探索性因子分析中，围术期护理缺失量表分量表A和分量表B均提取4个公因子，累积方差贡献率分别为76.41%和75.71%。验证性因子分析结果显示各拟合指标均在正常范围。分量表A的4个维度平均方差提取量为0.430~0.529，组合信度为0.880~0.966；分量表B的4个维度平均方差提取量为0.519~0.700，组合信度为0.873~0.972。围术期护理缺失量表条目水平的内容效度指数为0.857~1.000，量表水平内容效度指数为0.914。量表总体的Cronbach's α系数为0.967，分量表A各维度的Cronbach's α系数为0.885~0.965，分量表B各维度的Cronbach's α系数为0.866~0.972。分量表A总体折半信度为0.924，分量表B总体折半信度为0.898。

结论

围术期护理缺失量表具有一定的科学性和实用性，可用于评估围术期的护理缺失项目及原因。

围术期护理  /  护理缺失  /  手术室  /  量表构建  /  效度  /  信度
Objective

To develop the perioperative missed nursing care scale and to test its reliability and validity.

Methods

The initial version of the perioperative missed nursing care scale was developed through literature review and qualitative interviews.The scale was revised by Delphi expert consultations and a pre-survey.A total of 754 operating room nurses from 22 provinces,autonomous regions,and municipalities in China were selected as survey subjects.The reliability and validity of the scale were tested.

Results

The questionnaire response rates for the two rounds of expert consultations were 100.0% and 94.4%,respectively.The expert authority coefficients were 0.911 and 0.935,respectively.Kendall's W coefficients for subscale A were 0.279 and 0.295(both P<0.001).Kendall's W coefficients for subscale B were 0.220 and 0.185(both P<0.001).Exploratory factor analysis extracted four common factors each for both subscale A and subscale B,with cumulative variance contribution rates of 76.41% and 75.71%,respectively.Confirmatory factor analysis results showed that all fit indices were within acceptable ranges.For subscale A,the average variance extracted values for the four dimensions ranged from 0.430 to 0.529,and composite reliability values ranged from 0.880 to 0.966.For subscale B,the average variance extracted values for the four dimensions ranged from 0.519 to 0.700,and composite reliability values ranged from 0.873 to 0.972.The item-level content validity index (I-CVI) for the perioperative missed nursing care scale ranged from 0.857 to 1.000.The scale-level content validity index(S-CVI) was 0.914.The overall Cronbach's α coefficient for the scale was 0.967.The Cronbach's α coefficients for the dimensions of subscale A ranged from 0.885 to 0.965.The Cronbach's α coefficients for the dimensions of subscale B ranged from 0.866 to 0.972.The overall split-half reliability was 0.924 for subscale A and 0.898 for subscale B.

Conclusions

The perioperative missed nursing care scale demonstrates scientific rigor and practical utility.It could be used to assess missed nursing care items and their causes in the perioperative period.

perioperative care  /  missed nursing care  /  operating room  /  scale development  /  validity  /  reliability
付亚静, 黄婷, 况培. 围术期护理缺失量表的编制及信效度检验. 护理研究, 2026 , 40 (6) : 982 -992 . DOI: 10.12102/j.issn.1009-6493.2026.06.014
Yajing FU, Ting HUANG, Pei KUANG. Development of the perioperative missed nursing care scale and its reliability and validity test[J]. Chinese Nursing Research, 2026 , 40 (6) : 982 -992 . DOI: 10.12102/j.issn.1009-6493.2026.06.014
正文
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病人安全问题一直是全球关注的焦点问题，对于提供高质量和基础医疗服务至关重要[1]。医疗服务过程中产生的不良事件可能会导致病人的不良后果，包括住院时间延长、永久性或严重的健康损害、死亡等[2]。护理工作是现代医疗服务的重要组成部分，对全面推进全球健康事业发展、积极应对人口老龄化具有重要意义[3]。护理缺失作为评估病人安全和护理安全的重要指标[4]，指错过、遗漏（部分或全部）或延迟对病人进行所需的护理[5]。现有研究表明，不同国家的护理缺失发生状况存在差异[6]。Jones等[7]针对欧洲国家的研究结果显示，55%~98%的护士每班至少有一项预期护理任务未完成。Ausserhofer等[8]对欧洲12个国家的数据进行分析发现，平均每13项护理活动中有3.6项护理任务未完成。美国一项研究结果显示，其护理缺失发生率为10%~27%[9]。而我国数据表明，95.1%的重症监护室（ICU）护士在护理工作中发生过护理缺失[10]。随着全球科技的不断发展，医疗器械和设备不断更新，内镜及腹腔镜被广泛应用于外科手术[11-12]以及人类对遗传学、分子生物学、基因工程等的研究深度加深[13-14]，外科手术适用范围逐渐扩大，且安全性、有效性、可靠性逐渐增高[15]。一项关于我国医院心血管手术数量的统计数据显示，2023年我国共有771所医院开展心血管手术，数量高达341 804台[16]。手术室作为集多种仪器设备、专业背景人员、密集医疗资源为一体的专业科室，其工作流程与其他临床科室存在不同[17]，手术室护士不仅工作强度较大，而且会面临各种突发的紧急情况，需要与不同专业背景的人员沟通，其工作压力极大[18]。减少手术室护理缺失、提升手术室护理质量是确保病人手术安全的关键[4]。2021年，Kalisch等[19]进行了围术期护理缺失工具的开发与验证，但该工具仅聚焦围术期的术前与术后部分，未涉及术中配合内容，鉴于此，本研究进行手术室围术期全程护理缺失量表的编制，以期完善手术室护理缺失相关知识体系，并为手术室的护理缺失提供有效的评估工具，以提高手术室护理质量。本研究已通过武汉大学人民医院临床研究伦理委员会审批（编号：WDRY2024-K290）。
1　研究方法
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1.1　构建量表初稿
1.1.1　确定理论框架
基于Donabedian描述的结构-过程-结果理论[20]，Kalisch等[5]使用概念分析方法定义了护理缺失并提出护理缺失模型（missed nursing care model），该模型分为5个部分：1）护理环境中促进或抑制护理实践的前因；2）护理过程的要素；3）内部认知和决策过程；4）按计划提供的护理和延迟或遗漏的护理；5）病人结局。在手术室护理缺失的结构性前因条件下，护理缺失项目或可作为过程中介[21]造成病人各种不良结局。本研究基于护理缺失理论结合文献回顾与质性访谈结果拟定量表维度，严格遵守Kalisch编制的护理缺失量表结构，除一般资料外，将量表主体分为2个分量表，其中，分量表A为围术期护理缺失项目，分量表B为围术期护理缺失原因。
1.1.2　形成条目池
1.1.2.1　文献回顾
以“护理缺失”“未完成护理”“护理隐性配给”等作为中文关键词，以“missed nursing care”“unfinished nursing care”“rationed care”“implicit ration care”“undone care”“omitted care”等作为英文关键词，分别检索万方数据、中国知网（CNKI）、PubMed、Web of Science等数据库，检索时间为建库至2025年1月31日。
1.1.2.2　质性访谈
基于目的抽样方法和信息饱和原则，从我国5个省招募22名在职手术室护士进行半结构化访谈。纳入标准：1）在职手术室护士，且当年连续脱离岗位时间<3个月；2）符合《手术室护理实践指南2024版》中提出的N2层级及以上标准。为了保证访谈效果，本研究采用方便抽样法在武汉大学人民医院对5名手术室护士进行预访谈，经过3次修订形成正式访谈提纲：1）您从事手术室护理工作多久了？是手术室专科护士吗？2）目前您主要从事的是哪个专科的手术配合工作，该专科有什么工作特点？3）您之前听说过护理缺失吗，您是否认为护理缺失是严重的不良事件？4）您认为该如何划分洗手/巡回护士的工作内容？5）从您每个部分的工作内容出发，您可以列举几个关于手术室护士可能出现的护理缺失状况并分析其可能出现的原因吗？正式访谈前获得被访谈者的知情同意，要求其根据临床工作大致划分工作流程，以便为量表维度划分提供参考，并详细描述可能存在的缺失项目及原因。访谈过程中使用录音设备对访谈内容进行记录并通过Colaizzi 7步分析法[21]对访谈资料进行分析、总结。结合文献检索结果形成分量表A和分量表B的初稿。
1.2　专家函询
1.2.1　遴选函询专家
纳入标准：1）从事护理教育、临床护理及护理管理工作；2）护理相关工作年限≥8年；3）本科及以上学历；4）中级及以上职称。排除标准：函询无回复或者中途退出。
1.2.2　制定专家函询表
专家函询表主要包括5个部分：1）本研究领域相关知识、研究目的、研究方法；2）函询表填写方法及具体要求；3）量表内容：包含2个分量表内容，要求专家采用Likert 5级评分法对一级条目及二级条目的重要性进行评分；4）专家基本情况：包括职称、学历、从事相关领域年限、联系方式等；5）专家权威程度：包含专家对该研究内容的熟悉程度及专家判断依据。
1.3　预调查
选取武汉大学人民医院的30名手术室护士进行预调查。纳入标准：院内在职手术室护士且自愿参与本研究。排除标准：连续脱离岗位时间≥3个月。
1.4　正式调查
1.4.1　调查对象
采取便利抽样法，选取我国22个省、自治区、直辖市的754名手术室护士作为调查对象。纳入标准：1）在职注册护士；2）手术室护士；3）工作时间≥1年；4）自愿参与本研究。排除标准：连续脱离岗位时间≥3个月。采用面对面调查以及线上调查2种方式，分为2个阶段，第1阶段调查434名护士，数据用于项目分析及探索性因子分析；第2阶段调查320名护士，数据用于验证性因子分析。
1.4.2　调查工具
1）护士一般资料问卷：该问卷为研究者在文献检索基础上自行设计，包括性别、年龄、职称等；2）围术期护理缺失量表分量表A：采取Likert 5级评分法评分；3）围术期护理缺失量表分量表B：采取Likert 4级评分法评分。
1.5　质量控制
1）调查对象严格按照纳入与排除标准进行同质化选择；2）调查者在面对面进行问卷收集前均经过统一培训，能够使用规范化的指导语以最大程度减少对被调查者的干预，同时对填写完成的问卷进行现场核查；3）线上问卷由科室管理者统一发放并集中填写，将收集的电子问卷进行严格的质量筛选，删除无效问卷以保证问卷填写质量；4）数据采取双人录入。
1.6　量表的科学性验证
1.6.1　项目分析
基于经典测量理论[22-23]对项目进行筛选。1）频数分布法：基于条目的可回答性，即条目的通过率以及反应度筛选条目，如果回答集中于特定的选项超过80%或者某个选项无人回答则考虑删除该条目[24]；2）临界比值法：将量表总体得分由高到低排序，将前27%与后27%分别作为高分组及低分组，删除临界比值<3且P>0.05的条目[25]；3）相关性分析法：求出各条目与总分的相关系数，相关系数<0.40或P>0.05建议删除条目[26]；4）同质性检验法：从内部一致性角度对条目进行筛选，如果去除某一条目后Cronbach's α系数提高较多，说明该条目的存在有降低该维度内部一致性的作用，考虑删除[26]；5）量表维度探索法：采用主成分分析法对所有条目进行探索性因子分析（EFA），采用正交旋转（最大方差法），若条目在其所属因子上的因子载荷<0.40，或条目在≥2个因子上的因子载荷差异较小，或条目所属因子仅包含这1个条目，均考虑删除[25]。在因子分析开始前，应根据KMO（Kaiser-Meyer-Olkin）检验统计量和Bartlett's球形检验结果判断样本是否适宜进行因子分析，KMO值为0~1，越接近1，说明变量间相关性越强，样本数据越适合做因子分析[27]。
1.6.2　效度检验
1）结构效度：通过EFA对量表维度进行探索，通过验证性因子分析（confirmatory factor analysis，CFA）保留标准化因子载荷>0.50的条目，计算卡方自由度比（χ2/df）、近似误差均方根（root mean square error of approximation，RMSEA）、比较拟合指数（comparative fit index，CFI）、增值拟合指数（incremental fit index，IFI）、非范拟合指数（Tucker-Lewis index，TLI）、节俭规范拟合指数（parsimonious norms fit the index，PNFI）、节俭拟合指数（parsimonious goodness of fit index，PGFI）、均方根误差（root of mean square residual，RMR），χ2/df为1~3，RMSEA、RMR均应<0.08，IFI、TLI、CFI应>0.80，PNFI、PGFI应>0.50[28-30]。2）聚敛效度：量表各维度平均方差提取量（average variance extracted，AVE）>0.36为可接受[31]，AVE>0.50且组合信度（composite reliablity，CR）值>0.70表示效度良好[28]。3）内容效度：计算量表条目水平的内容效度指数（item-level content validity index，I-CVI）及量表水平内容效度指数（scale-content validity index，S-CVI），均>0.80，表示效度较好[28]。
1.6.3　信度检验
1）内部一致性信度（Cronbach's α系数）：分别计算量表2个分量表及各维度的Cronbach's α系数，Cronbach's α系数>0.70被认为可接受，>0.90被认为信度极好[32]；2）折半信度：将条目分为奇数条目及偶数条目，计算2个部分得分的相关系数以评估量表的分半信度[33]，分半信度<0.60被认为信度不足[34]。
1.7　统计学方法
采用SPSS 30.0和AMOS 29.0对数据进行统计分析。符合正态分布的定量资料以均数±标准差（x±s）表示，定性资料以频数及百分比（%）表示。采用问卷回收率表示专家积极程度；采用专家权威系数（Cr）表示专家权威程度，通过专家熟悉程度系数和判断依据系数计算获得；采用肯德尔协调系数表示专家意见协调程度；采用频数分布法、临界比值法、相关性分析法、同质性检验法、量表维度探索法进行项目分析；采用结构效度、聚敛效度、内容效度进行效度检验；采用内部一致性信度（Cronbach's α系数）、分半信度进行信度检验。以P<0.05为差异有统计学意义。
2　结果
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2.1　专家函询结果
共18名专家参与2轮函询，其中，主任护师2人，副主任护师7人，副教授1人，主管护师8人；博士研究生1人，硕士研究生7人，本科10人；从事护理教育2人，护理管理7人，临床护理9人；从事相关领域工作>10~20年10人，>20~30年5人，>30年3人。2轮专家函询问卷回收率分别为100.0%及94.4%，Cr分别为0.911和0.935；分量表A的肯德尔协调系数分别为0.279和0.295（均P<0.001），分量表B的肯德尔协调系数分别为0.220和0.185（均P<0.001）。经过2轮专家函询后，修改2个一级指标，删除7个二级指标。
2.2　预调查结果
30名手术室护士完成量表填写时间为（12.13±2.18）min。经研究小组深入分析，综合护士意见，删除6个条目。
2.3　正式调查
2.3.1　护士一般资料（见表1）
2.3.2　项目分析结果
1）频数分布法：本研究中，问卷调查各条目应答率均为100%且没有任何条目在某一选项上的应答率超过80%或者应答频数为0。2）临界比值法：进行高低分组后，所有条目临界比值均>3且P<0.50，故无须删除条目。3）相关性分析法：分量表B中，条目B1~条目B3、条目B5得分与总分的相关系数<0.40，故予以删除。4）同质性检验法：删除任一条目均未使量表总体的Cronbach's α系数明显提高，说明量表内部一致性佳，故无须删除条目。5）量表维度探索法：分量表A及分量表B的KMO值分别为0.978和0.977，Bartlett's球形度检验均有统计学意义（均P<0.01），说明量表适合进行因子分析。
2.3.3　效度检验
2.3.3.1　结构效度
1）EFA：模型参数估计采取主成分分析法，用最大方差进行旋转后，分量表A及分量表B分别提取6个特征值>1的公因子和4个特征值>1的公因子，比较抽取不同数量公因子的模型与理论的接近程度及旋转后各因子的可解释性，发现分量表A和分量表B均为4因素模型最佳，累积方差贡献率分别为76.41%和75.71%。分量表A以最小因子载荷系数>0.40为标准进行2轮因子旋转后共删除5个载荷系数<0.40的条目、16个归类不明确的条目，以最小因子载荷系数>0.514[35]进行第3轮正交旋转后确定分量表A共4个维度，即安全核查与护理文书、术前评估、术中配合及病人管理、沟通与规范化4个维度，共57个条目，见表2。分量表B以最小因子载荷系数>0.50[35]为标准进行因子旋转后删除5个条目，最后确定分量表B共4个维度，即劳动力/环境及物质资源、沟通、人员决策及不可预测情形，共38个条目，见表3。2）验证性因子分析：删除分量表A中2个标准化因子载荷<0.50的条目,最终确定分量表A共55个条目。分量表A的χ2/df=1.903，RMSEA=0.053，RMR=0.052，CFI=0.883，TLI=0.878，IFI=0.883，PNFI=0.750，PGFI=0.704；分量表B的χ2/df=2.848，RMSEA=0.076，RMR=0.048，CFI=0.885，TLI=0.877，IFI=0.885，PNFI=0.782，PGFI=0.679。量表条目重新编号后的验证性因子分析模型见图1、图2。
2.3.3.2　聚敛效度
分量表A的4个维度AVE为0.430~0.529，组合信度为0.880~0.966，在1个维度表现为合格，其他3个维度均表现为良好；分量表B的4个维度AVE为0.519~0.700，组合信度为0.873~0.972，各维度均表现良好。
2.3.3.3　内容效度
围术期护理缺失量表的I-CVI为0.857~1.000，S-CVI为0.914。
2.3.4　信度检验
量表总体的Cronbach's α系数为0.967，分量表A各维度的Cronbach's α系数为0.885~0.965，分量表B各维度的Cronbach's α系数为0.866~0.972。分量表A总体折半信度为0.924，各维度折半信度为0.828~0.951；分量表B总体折半信度为0.898，各维度折半信度为0.851~0.944。
3　讨论
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3.1　围术期护理缺失量表的构建具有科学性
本研究以护理缺失理论为框架，通过文献检索、半结构化访谈形成量表初稿，并经过2轮德尔菲专家函询、预调查对量表进行修订，形成过程科学、严谨。2轮德尔菲专家函询问卷回收率分别为100.0%及94.4%，表明专家积极性较高；Cr值分别为0.911及0.935，说明专家权威性较高。
探索性因子分析通过正交旋转，严格遵守量表编制程序进行条目删除，2个分量表均提取4个特征值>1的公因子，累积方差贡献率分别为76.41%及75.71%，说明量表条目较丰富，能够较全面地反映围术期的护理缺失现状及原因。验证性因子分析结果显示各拟合指标均在正常范围，说明量表的维度分布符合预期。分量表A的4个维度AVE为0.430~0.529，组合信度为0.880~0.966；分量表B的4个维度AVE为0.519~0.700，组合信度为0.873~0.972；量表I-CVI为0.857~1.000，S-CVI为0.914，说明量表具有较好的效度。
量表总体的Cronbach's α系数为0.967，分量表A各维度的Cronbach's α系数为0.885~0.965，分量表B各维度的Cronbach's α系数为0.866~0.972，说明量表具有极高的内部一致性。分量表A总体折半信度为0.924，分量表B总体折半信度为0.898，表明量表内部关联性较好。
3.2　围术期护理缺失量表编制具有实用价值
目前，关于围术期护理缺失的研究相对较少，了解手术室护理缺失项目及原因是开展关于护理缺失影响因素及干预相关研究的理论基础，因此，构建围术期护理缺失量表具有必要性。已有研究表明，医院、人员配置及缺勤次数、护士领导力、护士工作量、团队合作、病人安全文化、护士的职业倦怠及工作满意度等[9,36-39]均为护理缺失的影响因素。在前因作用下，护理缺失可发挥中介作用导致病人发生不良结局[40]。护理缺失的出现会降低护理质量及病人满意度[41]，增加病人不良事件发生率、再入院率及死亡率[39]，同时会导致护士工作满意度降低，离职率增高等结局[42-43]。2006年，Kalisch[44]首次在内科手术病房探讨护理缺失并报告了9项经常缺失的护理内容，随后世界各地的学者结合各地域医疗环境差异在ICU[10]、新生儿病房等[45]、儿科病房[46]等医疗单元编制了护理缺失工具。Kalisch等[19]编制的手术室护理缺失工具仅涉及术前及术后内容，对于术中部分未提及，而术中配合是手术室护士工作的关键环节，也是提升护理质量的中心环节。本研究构建的围术期护理缺失量表分量表A包括安全核查与护理文书、术前评估、术中配合及病人管理、沟通与规范化4个维度，共55个条目，分量表B包括劳动力/环境及物质资源、沟通、人员决策及不可预测情形4个维度，共38个条目，涵盖术前、术中、术后全流程评估内容，条目详细、全面，表述准确、简洁，具有较高的临床实用价值。
4　小结
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本研究编制的围术期护理缺失量表具有科学性及实用价值，可有效量化手术室全流程护理缺失项目及其原因，发现急需解决的问题，为后期干预以减少护理缺失的研究提供依据。但本研究仍存在一定局限性，如量表为护士自评工具，调查参与者在填写过程中可能会因主观原因对选项认知程度模糊，从而造成结果偏倚。未来建议做好被调查者及调查者的宣教工作，使得问卷调查过程更加规范化、科学化。

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2026年第40卷第6期
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doi: 10.12102/j.issn.1009-6493.2026.06.014
  • 接收时间：2025-04-25
  • 首发时间：2026-10-28
  • 出版时间：2026-03-25
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  • 收稿日期：2025-04-25
  • 修回日期：2026-02-09
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    1武汉大学护理学院，湖北 430000
    2武汉大学人民医院
    3湖北省妇幼保健院

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HUANG Ting, E-mail:
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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