Construction and validation of the nursing quality evaluation indicator system for patients with skin flap transplantation_West China Medical Journal

Authors：

ZHOU Guoling ¹ , ZHANG Xing ² , ZHANG Siyuan ¹ , WANG Ye ¹ ,  PENG Lingli ¹

1. Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China;
2. Department of Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China;

Corresponding?author：

PENG Lingli, Email: lingli.peng@csu.edu.cn

Keywords：

Flap transplantation; nursing quality; evaluation indicator; Delphi method

DOI：

10.7507/1002-0179.202604243

Video：

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Objective To construct a nursing quality evaluation indicator system for patients with skin flap transplantation and to provide a reference for the evaluation and continuous improvement of nursing quality in patients with skin flap transplantation. Methods With the three-dimensional quality structure theory as the theoretical framework, the nursing quality evaluation indicator system for patients with skin flap transplantation and indicator weights were established through literature review, expert meeting, Delphi method, and analytic hierarchy process. From October to December 2025, clinical application was carried out in departments performing flap transplantation surgeries nationwide to verify the feasibility and practicality of the indicator system. Results Two rounds of expert consultations were conducted. The expert authority coefficients were 0.941 and 0.950, respectively. The mean importance scores of all indicators were >3.50, the variation coefficients were <0.25, and the full-score rates were >20.00%. Kendall’s coefficients of concordance were 0.122 and 0.153 (P＜0.05), respectively. The final nursing quality evaluation indicator system for patients with skin flap transplantation included 3 primary indicators, 7 secondary indicators, and 18 tertiary indicators. A total of 50 departments participated in the preliminary clinical application. The Cronbach’s α coefficient of the indicator system was 0.821, the Spearman-Brown coefficient for split-half reliability was 0.773, the average content validity index of the indicator system was 0.99, and the universal content validity index was 0.83. The satisfaction questionnaire score was 21.86±2.26. Conclusion The nursing quality evaluation indicator system for patients with skin flap transplantation is feasible and practical, reflects the disease-specific characteristics of skin flap transplantation, and can be used for nursing quality management in patients with skin flap transplantation.

Citation： ZHOU Guoling, ZHANG Xing, ZHANG Siyuan, WANG Ye, PENG Lingli. Construction and validation of the nursing quality evaluation indicator system for patients with skin flap transplantation. West China Medical Journal, 2026, 41(9): 1478-1484. doi: 10.7507/1002-0179.202604243 Copy

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2.	Yin X, Hua Q, Ye J, et al. Clinical application and developmental direction of free flaps in plastic and reconstructive surgery procedures: a bibliometric analysis[J]. Front Surg, 2025, 12: 1661571.
3.	Lalonde SP, Voshage AM. Perioperative care of free flap patients: a scoping review of current evidence[J]. Plast Reconstr Surg Glob Open, 2025, 13(10): e7174.
4.	國家衛生健康委員會. 關于開展全面提升醫療質量行動(2023-2025 年)的通知[J]. 中華人民共和國國家衛生健康委員會公報, 2023(5): 8-14.
5.	國家衛生健康委網站. 國家衛生健康委辦公廳關于印發 2024 年國家醫療質量安全改進目標的通知[J]. 中國衛生質量管理, 2024, 31(2): 34.
6.	朱小雨, 喬曉斐, 劉戀蕊, 等. 基于加速康復外科理念的圍手術期護理質量評價標準體系構建[J]. 中國護理管理, 2024, 24(8): 1192-1197.
7.	Donabedian A. Quality of care: problems of measurement. II. Some issues in evaluating the quality of nursing care[J]. Am J Public Health Nations Health, 1969, 59(10): 1833-1836.
8.	Zhang G, Zheng D, Li A, et al. Assessing the quality for integrated guidelines: systematic comparison between the AGREE Ⅱ and AGREE-HS tools[J]. BMC Med Res Methodol, 2025, 25(1): 252.
9.	周英鳳, 胡雁, 朱政, 等. JBI 循證衛生保健中心文本證據的質量評價清單[J]. 護士進修雜志, 2024, 39(10): 1075-1080.
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12.	韓娜菲, 馮華麗, 賀紅, 等. 肺癌合并慢性阻塞性肺疾病患者術后肺康復管理的證據總結[J]. 中華護理雜志, 2024, 59(1): 42-50.
13.	陳秀彥, 張遠妮, 關小倩, 等. 基于層次分析法的縣級綜合醫院醫療服務能力評價指標體系研究[J]. 現代預防醫學, 2024, 51(20): 3730-3735.
14.	Tavana M, Soltanifar M, Santos-Arteaga FJ. Analytical hierarchy process: revolution and evolution[J]. Ann Oper Res, 2023, 326(2): 879-907.
15.	Salehzadeh R, Ziaeian M. Decision making in human resource management: a systematic review of the applications of analytic hierarchy process[J]. Front Psychol, 2024, 15: 1400772.
16.	王莉, 何雪花, 陳香萍, 等. 成人 ICU 患者鎮痛鎮靜護理質量評價指標體系的構建研究[J]. 中華急危重癥護理雜志, 2023, 4(9): 773-778.
17.	歐陽紅, 婁晟, 劉炎鑫, 等. “互聯網+護理服務”質量敏感指標體系的構建[J]. 軍事護理, 2025, 42(3): 36-39.
18.	魏永婷, 田書梅, 楊嬌, 等. 護士循證決策能力量表的漢化及信效度檢驗[J]. 中華護理雜志, 2025, 60(6): 736-742.
19.	史靜琤, 莫顯昆, 孫振球. 量表編制中內容效度指數的應用[J]. 中南大學學報(醫學版), 2012, 37(2): 152-155.
20.	馬夢琪, 張小紅, 何紅, 等. 慢性心力衰竭患者治療負擔量表的編制及信效度檢驗[J]. 中華護理雜志, 2025, 60(16): 1948-1954.
21.	周麗, 鄭思遙, 李云澤, 等. 基于德爾菲法構建并初步驗證帶狀皰疹相關性疼痛評估中國量表[J]. 中華疼痛學雜志, 2025, 21(2): 210-219.
22.	Niederberger M, Sonnberger M. The participation of lifeworld experts in Delphi processes: a reflection on method and practice[J]. MethodsX, 2025, 14: 103274.
23.	Gormley E, Connolly M, Ryder M. The development of nursing-sensitive indicators: a critical discussion[J]. Int J Nurs Stud Adv, 2024, 7: 100227.
24.	袁淑蕾, 熊莉娟, 劉義蘭, 等. 基于柯氏模型的國家區域醫療中心輸出醫院同質化護理培訓效果評價[J]. 護理學雜志, 2025, 40(21): 40-44.
25.	劉婷婷, 浦麗敏, 林苗苗, 等. 頭頸癌游離皮瓣重建患者供受區皮瓣管理的證據總結[J]. 中華現代護理雜志, 2025, 31(34): 4643-4650.
26.	謝芬, 張媛媛, 張春麗, 等. 手外科血管危象預防護理質量評價指標的構建及應用[J]. 護理學雜志, 2024, 39(7): 40-43, 47.
27.	Kang D. Nurse-Led Microsurgical free flap monitoring: a scoping review and evidence-based framework[J]. Healthcare (Basel), 2025, 13(21): 2703.
28.	韓婧, 門宇航, 劉劍楠. 游離皮瓣監測技術[J]. 中華整形外科雜志, 2024, 40(12): 1351-1356.
29.	Lee CC, Kuo YR. Flap monitoring and postoperative ICU care after microsurgical head and neck reconstruction[J]. Semin Plast Surg, 2025, 39(4): 251-258.
30.	Rancu AL, Darby FA, Averbukh LD, et al. Methods to manage edema and reduce flap compression in postoperative nursing care following trauma to the lower extremity[J]. Orthop Nurs, 2024, 43(6): 325-329.
31.	何曉清, 楊曦, 段家章, 等. 基于 CTA 精準皮瓣外科的理念與初步實踐[J]. 中華骨科雜志, 2022, 42(6): 365-373.
32.	Yu H, Yang X, Xie F, et al. Effect of comfort nursing in the perioperative period of free flap transplantation to repair the defects after surgery for malignant head and neck tumors[J]. Medicine(Baltimore), 2023, 102(37): e35114.
33.	劉東苗, 李鑫, 張俊娟, 等. 皮瓣移植術后血管危象風險預測模型的構建及驗證[J]. 中華顯微外科雜志, 2025, 48(1): 86-91.
34.	吳淑萍, 侯琨, 周武, 等. 皮瓣修復惡性黑色瘤的圍手術期護理敏感指標體系的構建[J]. 皮膚性病診療學雜志, 2025, 32(5): 339-344.
35.	Ouyang SB, Wu ZH, Zhang YP, et al. Comprehensive analysis of risk factors for flap necrosis in free flap reconstruction of postoperative tissue defects in oral and maxillofacial tumors[J]. Sci Rep, 2024, 14(1): 18676.
36.	Cassidy S, Lintvedt O, Odeh F, et al. Moving forward, leaving the patients behind? A multilevel assessment framework for evaluating patient-centred, integrated care quality[J]. Qual Life Res, 2026, 35(2): 42.

1. 彭伶麗, 黃天雯. 顯微外科護理[M]. 北京: 人民衛生出版社, 2024: 2-3.
2. Yin X, Hua Q, Ye J, et al. Clinical application and developmental direction of free flaps in plastic and reconstructive surgery procedures: a bibliometric analysis[J]. Front Surg, 2025, 12: 1661571.
3. Lalonde SP, Voshage AM. Perioperative care of free flap patients: a scoping review of current evidence[J]. Plast Reconstr Surg Glob Open, 2025, 13(10): e7174.
4. 國家衛生健康委員會. 關于開展全面提升醫療質量行動(2023-2025 年)的通知[J]. 中華人民共和國國家衛生健康委員會公報, 2023(5): 8-14.
5. 國家衛生健康委網站. 國家衛生健康委辦公廳關于印發 2024 年國家醫療質量安全改進目標的通知[J]. 中國衛生質量管理, 2024, 31(2): 34.
6. 朱小雨, 喬曉斐, 劉戀蕊, 等. 基于加速康復外科理念的圍手術期護理質量評價標準體系構建[J]. 中國護理管理, 2024, 24(8): 1192-1197.
7. Donabedian A. Quality of care: problems of measurement. II. Some issues in evaluating the quality of nursing care[J]. Am J Public Health Nations Health, 1969, 59(10): 1833-1836.
8. Zhang G, Zheng D, Li A, et al. Assessing the quality for integrated guidelines: systematic comparison between the AGREE Ⅱ and AGREE-HS tools[J]. BMC Med Res Methodol, 2025, 25(1): 252.
9. 周英鳳, 胡雁, 朱政, 等. JBI 循證衛生保健中心文本證據的質量評價清單[J]. 護士進修雜志, 2024, 39(10): 1075-1080.
10. 顧鶯, 張慧文, 周英鳳, 等. JBI 循證衛生保健中心關于不同類型研究的質量評價工具——系統評價的方法學質量評價[J]. 護士進修雜志, 2018, 33(8): 701-703.
11. 周英鳳, 顧鶯, 胡雁, 等. JBI 循證衛生保健中心關于不同類型研究的質量評價工具——干預性研究的質量評價[J]. 護士進修雜志, 2018, 33(1): 24-26.
12. 韓娜菲, 馮華麗, 賀紅, 等. 肺癌合并慢性阻塞性肺疾病患者術后肺康復管理的證據總結[J]. 中華護理雜志, 2024, 59(1): 42-50.
13. 陳秀彥, 張遠妮, 關小倩, 等. 基于層次分析法的縣級綜合醫院醫療服務能力評價指標體系研究[J]. 現代預防醫學, 2024, 51(20): 3730-3735.
14. Tavana M, Soltanifar M, Santos-Arteaga FJ. Analytical hierarchy process: revolution and evolution[J]. Ann Oper Res, 2023, 326(2): 879-907.
15. Salehzadeh R, Ziaeian M. Decision making in human resource management: a systematic review of the applications of analytic hierarchy process[J]. Front Psychol, 2024, 15: 1400772.
16. 王莉, 何雪花, 陳香萍, 等. 成人 ICU 患者鎮痛鎮靜護理質量評價指標體系的構建研究[J]. 中華急危重癥護理雜志, 2023, 4(9): 773-778.
17. 歐陽紅, 婁晟, 劉炎鑫, 等. “互聯網+護理服務”質量敏感指標體系的構建[J]. 軍事護理, 2025, 42(3): 36-39.
18. 魏永婷, 田書梅, 楊嬌, 等. 護士循證決策能力量表的漢化及信效度檢驗[J]. 中華護理雜志, 2025, 60(6): 736-742.
19. 史靜琤, 莫顯昆, 孫振球. 量表編制中內容效度指數的應用[J]. 中南大學學報(醫學版), 2012, 37(2): 152-155.
20. 馬夢琪, 張小紅, 何紅, 等. 慢性心力衰竭患者治療負擔量表的編制及信效度檢驗[J]. 中華護理雜志, 2025, 60(16): 1948-1954.
21. 周麗, 鄭思遙, 李云澤, 等. 基于德爾菲法構建并初步驗證帶狀皰疹相關性疼痛評估中國量表[J]. 中華疼痛學雜志, 2025, 21(2): 210-219.
22. Niederberger M, Sonnberger M. The participation of lifeworld experts in Delphi processes: a reflection on method and practice[J]. MethodsX, 2025, 14: 103274.
23. Gormley E, Connolly M, Ryder M. The development of nursing-sensitive indicators: a critical discussion[J]. Int J Nurs Stud Adv, 2024, 7: 100227.
24. 袁淑蕾, 熊莉娟, 劉義蘭, 等. 基于柯氏模型的國家區域醫療中心輸出醫院同質化護理培訓效果評價[J]. 護理學雜志, 2025, 40(21): 40-44.
25. 劉婷婷, 浦麗敏, 林苗苗, 等. 頭頸癌游離皮瓣重建患者供受區皮瓣管理的證據總結[J]. 中華現代護理雜志, 2025, 31(34): 4643-4650.
26. 謝芬, 張媛媛, 張春麗, 等. 手外科血管危象預防護理質量評價指標的構建及應用[J]. 護理學雜志, 2024, 39(7): 40-43, 47.
27. Kang D. Nurse-Led Microsurgical free flap monitoring: a scoping review and evidence-based framework[J]. Healthcare (Basel), 2025, 13(21): 2703.
28. 韓婧, 門宇航, 劉劍楠. 游離皮瓣監測技術[J]. 中華整形外科雜志, 2024, 40(12): 1351-1356.
29. Lee CC, Kuo YR. Flap monitoring and postoperative ICU care after microsurgical head and neck reconstruction[J]. Semin Plast Surg, 2025, 39(4): 251-258.
30. Rancu AL, Darby FA, Averbukh LD, et al. Methods to manage edema and reduce flap compression in postoperative nursing care following trauma to the lower extremity[J]. Orthop Nurs, 2024, 43(6): 325-329.
31. 何曉清, 楊曦, 段家章, 等. 基于 CTA 精準皮瓣外科的理念與初步實踐[J]. 中華骨科雜志, 2022, 42(6): 365-373.
32. Yu H, Yang X, Xie F, et al. Effect of comfort nursing in the perioperative period of free flap transplantation to repair the defects after surgery for malignant head and neck tumors[J]. Medicine(Baltimore), 2023, 102(37): e35114.
33. 劉東苗, 李鑫, 張俊娟, 等. 皮瓣移植術后血管危象風險預測模型的構建及驗證[J]. 中華顯微外科雜志, 2025, 48(1): 86-91.
34. 吳淑萍, 侯琨, 周武, 等. 皮瓣修復惡性黑色瘤的圍手術期護理敏感指標體系的構建[J]. 皮膚性病診療學雜志, 2025, 32(5): 339-344.
35. Ouyang SB, Wu ZH, Zhang YP, et al. Comprehensive analysis of risk factors for flap necrosis in free flap reconstruction of postoperative tissue defects in oral and maxillofacial tumors[J]. Sci Rep, 2024, 14(1): 18676.
36. Cassidy S, Lintvedt O, Odeh F, et al. Moving forward, leaving the patients behind? A multilevel assessment framework for evaluating patient-centred, integrated care quality[J]. Qual Life Res, 2026, 35(2): 42.

West China Medical Journal

Construction and validation of the nursing quality evaluation indicator system for patients with skin flap transplantation

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