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Article(id=1324078078011519220, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506048, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1748966400000, receivedDateStr=2025-06-04, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614413978, onlineDateStr=2026-11-02, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614413978, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614413978, creator=13701087609, updateTime=1793614413978, updator=13701087609, issue=Issue{id=1324078037817504735, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614404396, creator='13701087609', updateTime=1793614474144, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078330420527919, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078330420527920, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078037817504735, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=507, endPage=512, ext={EN=ArticleExt(id=1324078078372229365, articleId=1324078078011519220, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Construction of an evaluation index system for fall management capability in elderly care institutions based on the 4R crisis management theory, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To construct an evaluation index system for fall management capability in elderly care institutions and evaluate its applicability, aiming to provide a reference for assessing and improving fall management in such settings.

Methods

Guided by the 4R crisis management theory, a preliminary evaluation index system was constructed through qualitative research, literature research, Delphi expert consultation, and analytic hierarchy process(AHP). Subsequently, a survey was conducted in six elderly care institutions in Guangdong to evaluate the applicability of the index system.

Results

Two rounds of expert consultations were conducted, with questionnaire response rates of 83.3% and 92.0%, and the expert authority coefficients were 0.892 and 0.896. Kendall W values ranged from 0.175 to 0.237 in the first round, and from 0.217 to 0.339 in the second round (P<0.001). The final index system consisted of four first-level indicators, including reduction, readiness,response, and recovery management capabilities, as well as 13 second-level indicators and 41 third-level indicators. Fourteen managers from the six institutions participated in the study and considered the system comprehensive and practical.

Conclusion

The constructed evaluation index system for fall management capability in elderly care institutions is comprehensive, scientific and practical, providing a valuable reference for relevant health authorities and elderly care institution managers to periodically assess fall management capability.

, authors=Ru-xue YI1, Yan-ping ZOU2, Na-na WANG3, Zi-wei XU1, Xin-yu CHEN4, Ping ZHANG1, authorsList=Ru-xue YI, Yan-ping ZOU, Na-na WANG, Zi-wei XU, Xin-yu CHEN, Ping ZHANG, authorCompany=null, correspAuthors=Ping ZHANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324078078846185718, articleId=1324078078011519220, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=基于4R危机管理理论的养老机构跌倒管理能力评价指标体系的构建研究, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

构建养老机构跌倒管理能力评价指标体系并进行适用性评价，为评价和提升养老机构跌倒管理能力提供参考。

方法

以4R危机管理理论为框架，通过质性研究、文献研究法、德尔菲专家函询法、层次分析法构建养老机构跌倒管理能力评价指标体系，随后在广东地区6家养老机构进行实地调研，以验证指标体系的适用性。

结果

共进行了二轮专家函询，问卷回收率分别为83.3%和92.0%；专家权威系数分别为0.892和0.896；专家协调系数波动在0.175～0.237和0.217～0.339（P<0.001）。最终构建的指标体系包括缩减管理能力、预备管理能力、反应管理能力、恢复管理能力4项一级指标、13项二级指标和41项三级指标。6家养老机构的14名管理者参与了调研并认为指标体系具有全面性和实用性。

结论

本研究构建的养老机构跌倒管理能力评价指标体系内容全面，具有科学性和实用性，可为相关卫生部门及养老机构管理者评价养老机构跌倒管理能力提供参考。

, authors=易茹雪1, 邹艳平2, 王娜娜3, 徐子为1, 陈心钰4, 张萍1, authorsList=易茹雪, 邹艳平, 王娜娜, 徐子为, 陈心钰, 张萍, authorCompany=null, correspAuthors=张萍, authorNote=

易茹雪（1999—），女，硕士在读，研究方向：老年护理

, correspAuthorsNote=
张萍，E-mail:
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易茹雪（1999—），女，硕士在读，研究方向：老年护理

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易茹雪（1999—），女，硕士在读，研究方向：老年护理

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Nursing Older People, 2019, 31(1): 36-38., articleTitle=Simulation-based training to teach nurses skills in falls assessment and prevention, refAbstract=null), Reference(id=1324078088576971090, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, doi=null, pmid=null, pmcid=null, year=2024, volume=57, issue=null, pageStart=45, pageEnd=50, url=null, language=null, rfNumber=[22], rfOrder=33, authorNames=Xu DJ, Wang YQ, Zhu SS, journalName=Geriatric Nursing, refType=null, unstructuredReference=Xu DJ, Wang YQ, Zhu SS, et al. Relationship between fear of falling and quality of Life in nursing home residents: The role of activity restriction[J]. Geriatric Nursing, 2024, 57: 45-50., articleTitle=Relationship between fear of falling and quality of Life in nursing home residents: The role of activity restriction, refAbstract=null)], funds=[Fund(id=1324078084110037296, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, awardId=GD23X SH30, language=CN, fundingSource=广东省哲学社会科学规划 2023 年度学科共建项目(GD23X SH30), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324078079081066743, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, xref=1., ext=[AuthorCompanyExt(id=1324078079089455352, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, companyId=1324078079081066743, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Southern Medical University, Guangdong, Guangzhou 510515, China), AuthorCompanyExt(id=1324078079097843961, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, companyId=1324078079081066743, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南方医科大学护理学院，广东 广州510515)]), AuthorCompany(id=1324078079181730042, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, xref=2., ext=[AuthorCompanyExt(id=1324078079190118651, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, companyId=1324078079181730042, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南方医科大学南方医院器官捐献服务管理中心)]), AuthorCompany(id=1324078079269810428, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, xref=3., ext=[AuthorCompanyExt(id=1324078079278199037, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, companyId=1324078079269810428, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.广州市老人院护理部)]), AuthorCompany(id=1324078079362085118, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, xref=4., ext=[AuthorCompanyExt(id=1324078079370473727, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, companyId=1324078079362085118, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.越秀区东山福利院)])], figs=[ArticleFig(id=1324078083422171432, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, language=EN, label=Table 1, caption=

General information of consulted experts

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项目分类第一轮（n=25）第二轮（n=23）
人数百分比（%）人数百分比（%）
性别男312.0313.0
女2288.02087.0
年龄（岁）30~40520.0417.4
41~501456.01356.5
>50624.0626.1
工作年限（年）5~15624.0521.7
16~25832.0834.8
>251144.01043.5
地域东北416.0417.4
华东832.0626.1
华南832.0834.8
华中14.014.3
西南416.0417.4
学历本科312.0313.1
硕士832.0730.4
博士1456.01356.5
职称正高1040.01043.5
副高1456.01252.2
中级14.014.3
专业领域老年护理1040.01043.5
护理管理728.0626.1
养老服务312.0313.0
健康管理520.0417.4
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函询专家一般资料

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项目分类第一轮（n=25）第二轮（n=23）
人数百分比（%）人数百分比（%）
性别男312.0313.0
女2288.02087.0
年龄（岁）30~40520.0417.4
41~501456.01356.5
>50624.0626.1
工作年限（年）5~15624.0521.7
16~25832.0834.8
>251144.01043.5
地域东北416.0417.4
华东832.0626.1
华南832.0834.8
华中14.014.3
西南416.0417.4
学历本科312.0313.1
硕士832.0730.4
博士1456.01356.5
职称正高1040.01043.5
副高1456.01252.2
中级14.014.3
专业领域老年护理1040.01043.5
护理管理728.0626.1
养老服务312.0313.0
健康管理520.0417.4
), ArticleFig(id=1324078083581554986, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, language=EN, label=Table 2, caption=

Coordination level of expert opinions

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项目第一轮第二轮
χ2值W值P值χ2值W值P值
一级指标17.7600.237<0.00123.3680.339<0.001
二级指标65.9200.203<0.00163.4290.230<0.001
三级指标206.8550.176<0.001202.3940.215<0.001
总体指标284.8890.175<0.001289.3950.217<0.001
), ArticleFig(id=1324078083665441067, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, language=CN, label=表2, caption=

专家意见协调程度

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项目第一轮第二轮
χ2值W值P值χ2值W值P值
一级指标17.7600.237<0.00123.3680.339<0.001
二级指标65.9200.203<0.00163.4290.230<0.001
三级指标206.8550.176<0.001202.3940.215<0.001
总体指标284.8890.175<0.001289.3950.217<0.001
), ArticleFig(id=1324078083740938540, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, language=EN, label=Table 3, caption=

Evaluation index system for fall management capability in elderly care institutions based on the 4R crisis management theory

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指标原始权重指标组合权重指标组合权重
A缩减管理能力0.406A-1跌倒管理团队0.056A-1-1跌倒管理团队构成0.037
A-1-2跌倒管理团队职责0.019
A-2跌倒管理制度0.036A-2-1跌倒管理制度建设0.027
A-2-2跌倒管理制度更新0.009
A-3 跌倒管理培训0.056A-3-1跌倒管理培训内容0.027
A-3-2跌倒管理培训频次0.011
A-3-3跌倒管理培训考核0.017
A-4跌倒风险评估0.090A-4-1跌倒风险评估内容0.044
A-4-2跌倒风险评估频次0.028
A-4-3跌倒风险评估结果告知0.018
A-5跌倒预防干预0.113A-5-1跌倒健康教育0.037
A-5-2 疾病和用药管理0.016
A-5-3 躯体功能锻炼0.024
A-5-4 安全照护服务0.024
A-5-5跌倒预防工作评价0.012
A-6安全环境建设0.055A-6-1跌倒防护环境建设0.017
A-6-2跌倒应急环境建设0.011
A-6-3环境安全维护0.027
B预备管理能力0.208B-1跌倒应急预案制定与演练0.156B-1-1跌倒应急预案制定0.069
B-1-2跌倒应急预案演练0.044
B-1-3跌倒应急演练考核0.026
B-1-4 跌倒应急演练总结0.017
B-2跌倒应急资源保障0.052B-2-1跌倒急救物品配备0.027
B-2-2跌倒急救物品维护0.009
B-2-3跌倒转诊协作机制0.016
C反应管理能力0.288C-1跌倒信息报告0.035C-1-1跌倒事件上报0.026
C-1-2跌倒事件通知相关第三方0.009
C-2跌倒事件应对0.161C-2-1跌倒应急评估0.050
C-2-2跌倒应急处理0.079
C-2-3跌倒后监测0.032
C-3跌倒转诊与记录0.092C-3-1跌倒转诊指征0.029
C-3-2跌倒转诊时限0.006
C-3-3跌倒安全转诊0.029
C-3-4跌倒事件记录0.019
C-3-5跌倒记录保存0.009
D恢复管理能力0.098D-1跌倒事后总结与改进0.024D-1-1跌倒事后分析0.013
D-1-2跌倒风险再评估0.007
D-1-3应急预案检查完善0.004
D-2跌倒康复管理0.074D-2-1跌倒后躯体功能康复0.040
D-2-2康复辅助器具配备0.012
D-2-3跌倒后心理干预0.022
), ArticleFig(id=1324078083812241709, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, language=CN, label=表3, caption=

基于4R危机管理理论的养老机构跌倒管理能力评价指标体系

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指标原始权重指标组合权重指标组合权重
A缩减管理能力0.406A-1跌倒管理团队0.056A-1-1跌倒管理团队构成0.037
A-1-2跌倒管理团队职责0.019
A-2跌倒管理制度0.036A-2-1跌倒管理制度建设0.027
A-2-2跌倒管理制度更新0.009
A-3 跌倒管理培训0.056A-3-1跌倒管理培训内容0.027
A-3-2跌倒管理培训频次0.011
A-3-3跌倒管理培训考核0.017
A-4跌倒风险评估0.090A-4-1跌倒风险评估内容0.044
A-4-2跌倒风险评估频次0.028
A-4-3跌倒风险评估结果告知0.018
A-5跌倒预防干预0.113A-5-1跌倒健康教育0.037
A-5-2 疾病和用药管理0.016
A-5-3 躯体功能锻炼0.024
A-5-4 安全照护服务0.024
A-5-5跌倒预防工作评价0.012
A-6安全环境建设0.055A-6-1跌倒防护环境建设0.017
A-6-2跌倒应急环境建设0.011
A-6-3环境安全维护0.027
B预备管理能力0.208B-1跌倒应急预案制定与演练0.156B-1-1跌倒应急预案制定0.069
B-1-2跌倒应急预案演练0.044
B-1-3跌倒应急演练考核0.026
B-1-4 跌倒应急演练总结0.017
B-2跌倒应急资源保障0.052B-2-1跌倒急救物品配备0.027
B-2-2跌倒急救物品维护0.009
B-2-3跌倒转诊协作机制0.016
C反应管理能力0.288C-1跌倒信息报告0.035C-1-1跌倒事件上报0.026
C-1-2跌倒事件通知相关第三方0.009
C-2跌倒事件应对0.161C-2-1跌倒应急评估0.050
C-2-2跌倒应急处理0.079
C-2-3跌倒后监测0.032
C-3跌倒转诊与记录0.092C-3-1跌倒转诊指征0.029
C-3-2跌倒转诊时限0.006
C-3-3跌倒安全转诊0.029
C-3-4跌倒事件记录0.019
C-3-5跌倒记录保存0.009
D恢复管理能力0.098D-1跌倒事后总结与改进0.024D-1-1跌倒事后分析0.013
D-1-2跌倒风险再评估0.007
D-1-3应急预案检查完善0.004
D-2跌倒康复管理0.074D-2-1跌倒后躯体功能康复0.040
D-2-2康复辅助器具配备0.012
D-2-3跌倒后心理干预0.022
), ArticleFig(id=1324078083917099310, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, language=EN, label=Table 4, caption=

Managers’ perceptions on the use of the fall management capability evaluation form for elderly care institutions (n=14)

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条目非常同意同意一般不同意非常不同意
1.此评价表能够反映养老机构跌倒管理能力，具有有效性310100
2.此评价表可以区分不同养老机构跌倒管理能力，具有敏感性26600
3.此评价表指标涵盖内容具有全面性68000
4.此评价表在养老服务工作中使用具有可操作性110300
5.此评价表在养老服务工作中使用具有简便性04910
6.我愿意使用此评价表评价养老机构的跌倒管理能力29300
), ArticleFig(id=1324078084005179695, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078078011519220, language=CN, label=表4, caption=

管理者对养老机构跌倒管理能力评价表的使用感受（n=14）

, figureFileSmall=null, figureFileBig=null, tableContent=
条目非常同意同意一般不同意非常不同意
1.此评价表能够反映养老机构跌倒管理能力，具有有效性310100
2.此评价表可以区分不同养老机构跌倒管理能力，具有敏感性26600
3.此评价表指标涵盖内容具有全面性68000
4.此评价表在养老服务工作中使用具有可操作性110300
5.此评价表在养老服务工作中使用具有简便性04910
6.我愿意使用此评价表评价养老机构的跌倒管理能力29300
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基于4R危机管理理论的养老机构跌倒管理能力评价指标体系的构建研究
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易茹雪 1 , 邹艳平 2 , 王娜娜 3 , 徐子为 1 , 陈心钰 4 , 张萍 1
现代预防医学 | 健康与社会行为 2026,53(3): 507-512
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现代预防医学 |健康与社会行为 2026 , 53 (3) : 507 -512
基于4R危机管理理论的养老机构跌倒管理能力评价指标体系的构建研究
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易茹雪1, 邹艳平2, 王娜娜3, 徐子为1, 陈心钰4, 张萍1
作者信息
  • 1.南方医科大学护理学院，广东 广州510515
  • 2.南方医科大学南方医院器官捐献服务管理中心
  • 3.广州市老人院护理部
  • 4.越秀区东山福利院
通讯作者:
张萍，E-mail:
作者简介:

易茹雪（1999—），女，硕士在读，研究方向：老年护理

Construction of an evaluation index system for fall management capability in elderly care institutions based on the 4R crisis management theory
Ru-xue YI1, Yan-ping ZOU2, Na-na WANG3, Zi-wei XU1, Xin-yu CHEN4, Ping ZHANG1
Affiliations
  • School of Nursing, Southern Medical University, Guangdong, Guangzhou 510515, China
出版时间: 2026-02-10 doi: 10.20043/j.cnki.MPM.202506048
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摘要
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目的

构建养老机构跌倒管理能力评价指标体系并进行适用性评价，为评价和提升养老机构跌倒管理能力提供参考。

方法

以4R危机管理理论为框架，通过质性研究、文献研究法、德尔菲专家函询法、层次分析法构建养老机构跌倒管理能力评价指标体系，随后在广东地区6家养老机构进行实地调研，以验证指标体系的适用性。

结果

共进行了二轮专家函询，问卷回收率分别为83.3%和92.0%；专家权威系数分别为0.892和0.896；专家协调系数波动在0.175～0.237和0.217～0.339（P<0.001）。最终构建的指标体系包括缩减管理能力、预备管理能力、反应管理能力、恢复管理能力4项一级指标、13项二级指标和41项三级指标。6家养老机构的14名管理者参与了调研并认为指标体系具有全面性和实用性。

结论

本研究构建的养老机构跌倒管理能力评价指标体系内容全面，具有科学性和实用性，可为相关卫生部门及养老机构管理者评价养老机构跌倒管理能力提供参考。

养老机构  /  跌倒管理  /  4R危机管理理论  /  德尔菲法  /  指标体系
Objective

To construct an evaluation index system for fall management capability in elderly care institutions and evaluate its applicability, aiming to provide a reference for assessing and improving fall management in such settings.

Methods

Guided by the 4R crisis management theory, a preliminary evaluation index system was constructed through qualitative research, literature research, Delphi expert consultation, and analytic hierarchy process(AHP). Subsequently, a survey was conducted in six elderly care institutions in Guangdong to evaluate the applicability of the index system.

Results

Two rounds of expert consultations were conducted, with questionnaire response rates of 83.3% and 92.0%, and the expert authority coefficients were 0.892 and 0.896. Kendall W values ranged from 0.175 to 0.237 in the first round, and from 0.217 to 0.339 in the second round (P<0.001). The final index system consisted of four first-level indicators, including reduction, readiness,response, and recovery management capabilities, as well as 13 second-level indicators and 41 third-level indicators. Fourteen managers from the six institutions participated in the study and considered the system comprehensive and practical.

Conclusion

The constructed evaluation index system for fall management capability in elderly care institutions is comprehensive, scientific and practical, providing a valuable reference for relevant health authorities and elderly care institution managers to periodically assess fall management capability.

Elderly care institutions  /  Fall management  /  4R crisis management theory  /  Delphi method  /  Index system
易茹雪, 邹艳平, 王娜娜, 徐子为, 陈心钰, 张萍. 基于4R危机管理理论的养老机构跌倒管理能力评价指标体系的构建研究. 现代预防医学, 2026 , 53 (3) : 507 -512 . DOI: 10.20043/j.cnki.MPM.202506048
Ru-xue YI, Yan-ping ZOU, Na-na WANG, Zi-wei XU, Xin-yu CHEN, Ping ZHANG. Construction of an evaluation index system for fall management capability in elderly care institutions based on the 4R crisis management theory[J]. Modern Preventive Medicine, 2026 , 53 (3) : 507 -512 . DOI: 10.20043/j.cnki.MPM.202506048
正文
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跌倒是养老机构九大服务安全问题之一，排名养老机构意外事故诉讼原因的第一位[1-3]。跌倒管理是指通过系统性的评估、干预和处理策略，以降低个体跌倒风险并减少跌倒相关性损伤的综合管理过程[4]。2022年《全球老年人跌倒预防和管理指南》指出养老机构跌倒管理具有特殊性，管理者应考虑其在照护角色、照护环境等方面的独特性[5]。目前养老机构跌倒管理处在勤观察和重经验阶段[6]，在跌倒管理制度完善、人员知识技能水平等方面仍有待提升[7-8]。
2024年中共中央国务院在《关于深化养老服务改革发展的意见》中强调，要不断完善养老服务评价体系，健全养老服务应急管理体系[9]，因此有必要开展养老机构跌倒管理能力评价以提升其跌倒管理水平。然而，现有跌倒管理评价研究多聚焦于社区及医疗机构，对养老机构关注不足；评价内容多集中于预防管理，对跌倒后处理和康复管理评价较为不足；评价维度以管理质量为主，在跌倒管理能力评价方面研究的研究尚未见报道[10-12]。
4R危机管理理论认为危机事件管理包括缩减管理（reduction）、预备管理（readiness）、反应管理（response）和恢复管理（recovery）四个阶段[13]，该理论在安全管理领域运用广泛，在评价和提升医疗护理管理能力方面具有重要价值[14-16]。因此本研究拟以4R危机管理理论为指导，构建适用于养老机构的跌倒管理能力评价指标体系，以期为相关部门及管理者评价养老机构跌倒管理能力提供参考，并进一步为提升养老机构跌倒管理能力提供方向。
1　资料与方法
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1.1　构建指标体系
1.1.1　描述性质性研究
为挖掘养老机构跌倒管理要素，研究小组采用目的抽样，对广州市2家公办及2家民营养老机构的12名老年人、13名护理员和11名管理者进行了访谈，主题围绕机构跌倒预防、处理、康复管理过程中可能存在的优势和不足展开，每名访谈对象访谈时间约为20～50min。采用定向内容分析法最终形成了跌倒缩减管理要素等4个主题及跌倒风险评估等9个亚主题。
1.1.2　文献研究法
以“养老机构”“跌倒管理”“评价”“指标体系”等为中文检索词，以“nursing home”“fall management” “indicator” 等为英文检索词。研究小组检索了Up to date、PubMed、Web of science、中国知网等数据库及相关专业协会、政府网站。最终纳入了5篇指南、3篇专家共识、6篇政策文件、1篇临床决策及1篇证据综合，整理形成了跌倒管理队伍等14个方面的51条内容。
随后，研究小组开展研讨会对质性研究和文献研究结果进行整合形成指标池，并依据指标与4R维度的相关性、重要性和可衡量性，对指标进行筛选、融合和归类。最终，初步形成了包含4个一级指标、14个二级指标、48个三级指标的评价指标体系初稿。
1.1.3　德尔菲专家函询法
依据已构建的指标体系初稿，研究小组拟定了专家函询问卷，含介绍信、指标修改意见及重要性评定、专家基本信息、权威程度（含熟悉程度与判断依据）四个部分。其次，确定函询专家遴选标准。专家纳入标准：（1）从事老年护理、健康管理等相关领域工作或研究≥5年、研究生及以上学历、副高级及以上职称；（2）从事养老服务及管理工作≥10年，本科及以上学历，中级及以上职称（高级职称占比应大于2/3）。专家排除标准：（1）函询周期内未返回问卷者；（2）未完整填写问卷者。
在正式函询前，研究小组邀请了二位老年护理、养老服务专家进行预函询，并对函询问卷的结构和表述等进行完善。正式函询通过邮件/微信方式进行，函询周期为10 d，间隔周期为14 d。每轮函询结束后，研究小组根据指标重要性均值>3.50分，变异系数<0.25且满分比>0.50[17]进行指标筛选，结合专家意见修改讨论后形成下一轮函询问卷，专家意见趋于一致时停止函询。
1.2　指标体系适用性评价
1.2.1　调研对象
研究小组目的抽样了广东地区6家养老机构作为研究对象。纳入标准：（1）为老年人提供饮食起居等综合性服务的养老机构；（2）养老机构负责人知情同意，自愿参与研究。排除标准：（1）托老所等日间照料设施；（2）纯医疗、康复性质的护理院、照护中心。
1.2.2　调研工具
（1）养老机构跌倒管理能力评价表。根据前期构建的指标体系，研究小组编制了《养老机构跌倒管理能力评价表》，并邀请二名养老服务和老年护理专家对评价表进行了审查。内容包含了4个一级维度，13个二级维度，共计41个条目。条目采用差异化的赋分方式，对于二元结构条目，赋分“1分（是）/ 0分（否）”；其余多元结构条目采用三级/五级评分法。总分采用线性加权方法计算，总分为100分，得分越高说明跌倒管理能力越好。
（2）养老机构跌倒管理能力评价表使用感受调查问卷。为了解评价指标体系的适用性，研究小组参考文献和讨论后编制了《养老机构跌倒管理能力评价表使用感受调查问卷》，问卷包含了评价表有效性、敏感性、全面性等六个方面问题，采用Likert 5级评分法进行评价。
1.2.3　调研方法
评价由研究小组与管理者共同完成。首先，研究小组通过参观养老机构环境及查阅机构跌倒管理相关文件记录进行初步评价；其次，邀请机构服务安全相关管理者填写评价表及使用感受问卷；最后，将研究小组及管理者评价结果进行比对与更正，并取评价结果平均分作为养老机构跌倒管理能力综合得分。
1.3　统计学方法
采用Excel 2019进行数据录入，SPSS 26.0、Yaahp 10.1进行统计分析。采用百分比、频数来描述研究对象一般资料。专家积极程度用问卷回收率表示；专家权威程度用专家权威系数（Cr）表示，Cr=[判断依据系数（Ca）+熟悉程度系数（Cs）]÷2；专家意见集中程度采用指标重要性赋值均数、指标重要性赋值满分比表示；专家协调程度采用变异系数、肯德尔协调系数（Kendall W）表示，采用χ2检验W值的显著性，检验水准α=0.05。采用Yaahp 10.1软件绘制层次结构图，并将第二轮函询的指标重要性均分差值转为Satty标度以计算权重，采用一致性比例（consistency ratio，CR）评估指标权重合理性，若CR值<0.1，表明各指标权重设置较为合理。
1.4　伦理原则
本研究已通过南方医科大学生物医学伦理委员会批准（审批号：南医伦审[2024]第6号）。参与访谈及调研的研究对象均知情同意并签署了知情同意书。研究中对养老机构、访谈对象及函询专家信息均进行了匿名化处理，并对相关资料进行了封存。
2　结果
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2.1　专家函询结果
2.1.1　专家基本情况
共有25名专家参与了本研究第一轮的专家函询，其中23名专家参与了第二轮的专家函询，两轮专家基本情况见表1。
2.1.2　专家积极程度和权威程度
第一轮函询发放问卷30份，回收有效问卷25份，有效回收率为83.3%，意见提出率为96.0%。第二轮专家发放问卷25份，回收有效问卷23份，有效回收率为92.0%，意见提出率为39.1%。两轮函询指标熟悉系数为0.812和0.813，判断依据程度为0.972和0.978，计算可得专家权威系数为0.892和0.896。
2.1.3　专家意见协调程度
两轮函询总体指标Kendall W值分别为0.175和0.217，整体来看各层级指标W值有所提升（P均<0.001）。见表2。
2.1.4　指标修改及权重结果
在第一轮函询中，各指标的重要性评分均值为4.52～4.96，满分比为0.52～0.96，变异系数为0.04～0.19。研究小组讨论后，共删除指标14项，修改指标16项，新增指标6项。第二轮函询后，专家意见趋于一致，各指标的重要性评分均值为4.35～5.00，满分比为0.35～1.00，变异系数为0.00～0.11。研究小组讨论后，删除指标1项，修改指标9项。
层次分析结果显示，各层级指标矩阵CR值均<0.1，最终由4个一级指标、13个二级指标及41个三级指标组成养老机构跌倒管理能力评价指标体系。见表3。
2.2　适用性评价结果
2.2.1　养老机构基本情况及跌倒管理能力评价结果
6家养老机构等级分布在三星级到五星级；包括3家公办、3家民营；床位数分布在108～700张。6家养老机构平均得分为71.7分，其中各维度平均得分为缩减管理能力28.2分，预备管理能力15.8分，反应管理能力21.7分，恢复管理能力6.0分。
2.2.2　管理者一般资料及评价表使用感受
6家养老机构的14名管理者参与了评价，管理者年龄在30～50岁占比92.9%；女性占比92.9%；管理工作年限6年及以上占比64.3%；主任及以上职务占比71.4%；学历本科及以上占比64.2%。
参与评价表填写的14名管理者中，92.8%的管理者认为评价表具有有效性；100%的管理者认为评价表内容具有全面性，71.5%的管理者认为评价表的内容条目较多，简便性有待提升。见表4。
3　讨论
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3.1　养老机构跌倒管理能力评价指标体系具有科学性和可靠性
本研究以4R危机管理理论为框架，通过质性研究和文献研究形成了指标体系初稿，通过德尔菲专家函询法对指标体系进行修订和完善。函询专家来自华东、华南等不同地区，平均工作年限大于20年，硕士及以上学历占比大于85%，高级职称占比大于95%，专业背景涵盖老年护理和养老服务等多领域，提示专家质量较高且具有代表性。两轮函询问卷回收率均大于80%，提示专家积极程度较高。两轮函询专家权威系数均大于0.80，说明专家权威程度较高。多数指标的变异系数在0.25以下且各层级Kendall W值第二轮较第一轮有所提升，提示专家意见波动较小。最后，各层级指标的CR值均<0.1，说明指标体系权重分配合理。综上，本研究以系统、紧密的方法学构建了评价体系，研究结果具有科学性和可靠性。
3.2　养老机构跌倒管理能力评价指标体系的内容及权重分析
一级指标中缩减管理能力权重占比最高，这突显了“跌倒管理重在预防”的理念，与4R危机管理内涵相契合，4R危机理论认为缩减管理是危机管理的核心，有效的缩减管理能降低事故发生的风险，缩减危机的发生及冲击力[13]。其下二级指标中，“跌倒风险评估”和“跌倒预防干预”权重占比较高，这与多项指南和研究推荐一致[5,18]，即跌倒风险评估和跌倒预防干预是降低养老机构老年人跌倒风险的必要举措，也是跌倒管理的重中之重。
反应管理能力指标权重位居一级指标第二位。分析其原因，养老机构跌倒快速应对能力与跌倒损伤的发展密切相关，高效的应急处理可最大限度减轻损伤后果，是保障老年人生命安全的关键环节[19]。预备管理能力关注养老机构在老年人跌倒发生前的应急准备能力，是衔接跌倒风险预防与事件应对的重要桥梁[20]。其下的二级指标中，以“跌倒应急预案制定与演练”权重较高，这与GRAINGER等学者[21]的研究结果相似，即强调通过定期演练提升养老机构工作人员应急技能和心理素质的重要性。
恢复管理能力权重占比虽为一级指标中最低，但其对老年人长期生活质量的影响不容忽视。恢复管理能力维度下以“跌倒康复管理”权重占比较高，研究显示64.0%的跌倒会导致受伤，76.60%的养老机构老年人因跌倒日常生活活动能力下降[22]，因此跌倒康复管理的高权重也突显了躯体功能康复和心理支持对于提升跌倒后老年人长期生活质量至关重要。
3.3　养老机构跌倒管理能力评价指标体系的适用性分析
评价表使用感受问卷调查结果显示，本研究所构建的指标体系具有一定的可操作性，且内容较为全面。然指标体系仍有改善空间，一是，评价表简便性有待提升，这可能与评价表内容条目较多，导致填写较为耗时有关。下一步研究小组拟通过精简指标说明、制定简化版（快速自查）和详细版（专业审查）评价表等方式以提升评价表的简便性。二是，评价表的敏感性有待提升，这可能与随着“医养结合”模式的大力推广，养老机构在服务模式和跌倒管理方法上逐渐多元化有关。对此，下一步研究小组也将通过优化选项梯度、增设“不适用”选项等方式以完善评价表，同时未来我们也将尝试根据养老机构服务类型构建更具针对性的评价方案，以不断完善多元主体协同的养老机构跌倒管理能力评价体系。
3.4　研究不足
本研究将视角放置于跌倒全过程管理能力评价与既往仅关注预防管理或跌倒结局指标评价的研究相比，评价角度更为多元，内容更为全面。然本研究仍具有一定局限性，本研究仅在6家养老机构开展了适用性评价且未进行重测信度验证，这一限制可能会影响评价结果的稳定性和可推广性，下一步本研究将进一步开展大样本、多中心的调查，以验证评价指标体系的信效度并进一步对指标体系进行完善和推广。
基金
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  • 广东省哲学社会科学规划 2023 年度学科共建项目(GD23X SH30)
文献
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参考文献 引证文献
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2026年第53卷第3期
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doi: 10.20043/j.cnki.MPM.202506048
  • 接收时间：2025-06-04
  • 首发时间：2026-11-02
  • 出版时间：2026-02-10
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  • 收稿日期：2025-06-04
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广东省哲学社会科学规划 2023 年度学科共建项目(GD23X SH30)
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    1.南方医科大学护理学院，广东 广州510515
    2.南方医科大学南方医院器官捐献服务管理中心
    3.广州市老人院护理部
    4.越秀区东山福利院

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2种不同金属材料的力学参数
科
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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