Construction of nursing-sensitive quality indicators for haemodialysis using Delphi method

The development of nursing-sensitive indicators: A critical discussion

Discussion arguments

In a science-based profession, nurses must continuously monitor and evaluate the effectiveness of their care. However, data on what constitutes nursing care in practice and the delivery process is lacking. Insufficient evidence on how nurses contribute to patient care hampers the evaluation of nursing practice.We discuss nursing-sensitive indicators, their origins, current applications, and challenges related to their use in evaluating the quality of nursing care. We analyse nursing-sensitive indicators in the context of criticisms levelled at the profession related to the lack of evidence to support their value in the larger healthcare environment.

Conclusions

We have a disjointed approach to evaluating nursing care. Current systems designed to monitor nursing care, such as metrics and data sets, are not adequate or effective for comprehensively evaluating nursing care, considering the fundamentals and values of the nursing profession.

Feasibility of the McIntyre audit tool for haemodialysis nurses

BACKGROUND

Nurse-sensitive indicators (NSI) assess the quality of nursing care provided to patients. These indicators assess the structures (supportive measures), processes (nursing actions) and outcomes of care. The McIntyre Audit Tool (MAT) was developed to measure haemodialysis NSIs.

OBJECTIVES

The objective of this study is to evaluate the feasibility and utility of the MAT in measuring haemodialysis NSIs in clinical practice.

DESIGN

Multisite nonrandomized feasibility study.

PARTICIPANTS

A convenience sample of nurses (n = 30) were recruited from two haemodialysis units in Australia.

MEASUREMENTS

Participants completed the MAT once daily for 1 week, to measure the extent the clinical indicators were being met. Feasibility data including utility and acceptability of the tool was collected once from each participant. Data were analysed descriptively.

RESULTS

Participants completed a total of 97 audits. Results revealed the majority of structural (75%) and process indicators (73%) were being achieved although some variation between sites was observed. Results for the outcome indicators showed more variation (5.9%-94.1). Feasibility results found most nurses (79%) took <5 min to complete the MAT and found the tool easy to use (91.7%). Most participants (83.3%) reported audits could be completed during a shift and auditing was easily implemented (79.2%).

CONCLUSION

Use of the MAT in clinical practice is a feasible and acceptable way of auditing the quality of haemodialysis nursing practice. The tool could be used to establish minimum standards and improve the quality of nursing care in haemodialysis units, also enabling benchmarking between services.

Toward a Medication Information Literacy Indicator System for Older Adults: A Delphi Study

BACKGROUND

The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages.

METHODS

This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two-round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator.

RESULTS

The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall's coefficient of concordance (Kendall's W) ranging from 0.157 to 0.33 (p < 0.05) indicates a consensus among experts on the identified indicators. Utilizing the Delphi process, a MIL indicator system for older adults was developed, comprising five primary and 23 secondary indicators. These indicators were weighted, with medication information cognition and acquisition emerging as pivotal factors in enhancing medication literacy among older adults.

CONCLUSIONS

This study developed a MIL indicator system tailored for older adults using the Delphi approach. The findings can inform healthcare professionals in providing customized medication guidance and assist policymakers in crafting policies to enhance medication safety among older adults.

PATIENT OR PUBLIC CONTRIBUTION

Patient and public engagement played a pivotal role in the development of our medication information literacy indicator system for older adults. Their involvement contributed to shaping research questions, facilitating study participation, and enriching evidence interpretation. Collaborations with experts in geriatric nursing, medicine, and public health, along with discussions with caregivers and individuals with lived experience, provided invaluable insights into medication management among older adults. Their input guided our research direction and ensured the relevance and comprehensiveness of our findings.

Identifying Nursing-Sensitive Indicators for Hospitals: A Modified Delphi Approach

BACKGROUND

Nursing-sensitive indicators (NSIs) play a crucial role in measuring the quality of care specific to nursing practice. Currently, hospitals monitor several NSIs which may vary between hospitals. Conducting research on NSIs can enhance the monitoring of nursing practice.

AIM

The aim is to identify NSIs for hospitals in Jordan.

METHODS AND MATERIAL

The Delphi approach was utilized to establish a consensus among a panel of national nursing experts (N=60). An initial list of 52 indicators was developed through a rigorous process and subsequently distributed to the panel members. The panelists provided their quantitative responses in three rounds. Consensus was determined based on the following criteria: agreement greater than 51.0%, interquartile range (IQR) below 1.5, standard deviation (SD) below 1, and moderate Kendall's coefficient of concordance (Kendall's W).

RESULTS

By the conclusion of the third round, a total of 42 indicators achieved group agreement. The agreed-upon indicators consisted of 10 structure, 16 process, and 16 outcome indicators.

CONCLUSION

This study successfully established a consensus and identified a comprehensive set of indicators that capture the distinct contributions of nursing in the hospital setting. The results demonstrate a wide range of agreed-upon indicators across the domains of structure, process, and outcome. These findings are valuable in enhancing the monitoring and evaluation of nursing practice in hospitals.

PRACTICAL IMPLICATIONS

 The findings of this study provide a solid foundation for monitoring and reporting the quality of nursing practice in hospitals. Nursing policymakers can utilize these findings to develop policies that promote the voluntary reporting of NSIs.

Construction of nursing-sensitive quality indicators for the care of patients with prone position ventilation using the Delphi method

BACKGROUND

Prone position ventilation (PPV) has gradually become an adjuvant treatment to improve oxygenation in patients with acute respiratory distress syndrome. Scientific and comprehensive evaluation of the quality of nursing care for patients with PPV is of great significance to ensure the effectiveness of treatment and patient safety. However, there are no established objective indicators for evaluating the quality of nursing care for patients with PPV. This study intended to identify a set of scientific, systematic and clinically applicable nursing-sensitive quality indicators for the care of patients with PPV.

METHODS

Based on the Donabedian structure-process-result theory model, the quality evaluation indicators of nursing care for patients with PPV were preliminarily constructed based on an evidence-based perspective, and two rounds of Delphi surveys were conducted with the purpose of collecting opinions from a panel of independent experts.

RESULTS

The questionnaire recovery rates of the two rounds of correspondence were 100.00% and 95.00%, the recovery rates of expert opinions were 80.00% and 26.32%, the expert authority coefficient values were 0.89, and the Kendall coordination coefficient W values were 0.110 and 0.133, respectively. The final nursing-sensitive quality indicators for the care of patients with PPV included 3 first-level indicators, 9 s-level indicators and 29 third-level indicators.

CONCLUSION

The constructed nursing-sensitive quality indicators for the care of patients with PPV involve quality supervision during the whole process of PPV from three dimensions: structure, process and results. These indicators have strong operability, reliability, practicability and scientificity and can provide a reference for the quality evaluation and monitoring of nursing care for patients with PPV.

IMPLICATIONS FOR NURSING MANAGEMENT

The quality indicators of nursing care for patients with PPV constructed in this research are scientific and reliable, and the content of the quality indicators can better reflect the technical characteristics of special nursing. Nursing managers are encouraged to use these quality indicators to evaluate the quality of clinical nursing care and improve safety for patients with PPV.

Development and validation of the regarding infection prevention and control among environmental service workers on knowledge, attitudes, practise, and experience questionnaire

Purpose

This study aimed to develop and test the validity and reliability of the Knowledge, Attitudes, Practise, and Experience regarding Infection Prevention and Control-associated Questionnaire for environmental service workers.

Design

This study was a development and validation study of a questionnaire using multiple methods, including literature review, questionnaire survey, and Delphi technique.

Methods

Phase I of the study entailed the development of items through an extensive literature review and two round Delphi process with 15 experts specialised in infection prevention and control, environmental service worker management, or scale construction to examine the content validity of the questionnaire. Phase II involved administering the questionnaire to a convenience sample of 1,176 environmental service workers from the public hospital from 13 provinces in China to evaluate its construct validity and reliability.

Findings

In the two rounds of Delphi consultation, the recovery rate were 93.75 and 100%. Moreover, the expert authority coefficient was 0.93, and the coordination coefficients of expert opinions in the first round were as follows: correlation of 0.204 and importance of 0.249 for the first-level index; correlation of 0.128 and importance of 0.142 for the secondary index. In round two, the coordination coefficients of expert opinions were as follows: correlation of 0.221 and importance of 0.221 for the first-level indicators; correlation of 0.096 and importance of 0.101 for the secondary index. The results for the index were P < 0.05 for the two rounds. The pilot survey shows the instrument was excellent content validity (S-CVI/Ave = 0.989). The overall internal consistency was excellent (Cronbach's α = 0.967). The questionnaire ultimately comprised four first-level indices (knowledge, attitudes, practise, and experience) and 49 second-level indices.

Conclusion

The Questionnaire demonstrated good reliability and validity and is effective in measuring levels of infection prevention and control-related knowledge, attitudes, practise, and experience among environmental service workers. It will provide a tool for future national investigations of the current infection prevention and control situation among environmental service workers. Future research should explore determinants of environmental service workers' knowledge, attitudes, practise, and experience and associations between infection prevention and control knowledge, attitudes, practises, and experience.

Ambulatory Care Nurse-Sensitive Indicators: A Scoping Review of the Literature 2006-2021

BACKGROUND/PURPOSE

Meeting recommendations that nurses should partner in leading health care change is hampered by the lack of ambulatory care nurse-sensitive indicators (ACNSIs). This scoping review was conducted to identify evidence regarding ACNSI identification, development, implementation, and benchmarking.

METHODS

Following the PRISMA-ScR reporting guide, we performed PubMed/MEDLINE, CINAHL, and Cochrane Library searches for the period January 2006 to March 2021.

RESULTS

Twelve of the 1984 articles from 6 countries met inclusion criteria. All focused on identifying, developing/pilot testing indicators, and included structure, process, and outcome indicators. Seven articles were level II and all were at least grade B quality. Leverage points involved leadership support, automated data extraction infrastructure, and validating links between nurses' roles/actions and patient outcomes.

CONCLUSIONS

While high-quality work is ongoing to identify clinically meaningful and feasible ACNSIs, knowledge in this field remains underdeveloped. Prioritizing this work is imperative to address gaps and facilitate national strategic health care goals.

Construction of haemodialysis nursing-sensitive quality indicators based on Donabedian theory: A Delphi method study

AIMS

To establish a sensitive, scientific and practical evaluation system for haemodialysis nursing and to provide a reference for the evaluation of haemodialysis nursing quality.

DESIGN

Through a literature review and Delphi method.

METHOD

According to the literature review, a preliminary nursing-sensitive quality indicators for haemodialysis were established, and an expert survey questionnaire was designed. Finally, the evaluation system for the nursing-sensitive quality indicators was determined using the Delphi method.

RESULTS

Thirteen nursing-sensitive quality indicators for haemodialysis were finally constructed, including two structural indicators, three process indicators and eight outcome indicators. The effective recovery rate of the two rounds of expert survey questionnaires was 100%, the coefficient of judgement basis is 0.956, the coefficient of familiarity is 0.833, the coefficient of authority is 0.895, and the Kendall's harmony coefficients of the two rounds of expert consultation were 0.158 ~ 0.307 and 0.170 ~ 0.315, respectively, with statistical significance (p < .05).

CLINICAL RELEVANCE

In this study, the nursing-sensitive quality indicators for haemodialysis were developed by the Delphi method and included structural indicators, outcome indicators and process indicators, which made up for some deficiencies noted in previous studies. The authors have provided a more reliable and comprehensive basis for evaluating the quality and safety of haemodialysis nursing in the future.

Validation of the McIntyre Audit Tool to measure haemodialysis nurse sensitive indicators

BACKGROUND

Nurse sensitive indicators measure the quality of nursing care. Although there are some haemodialysis nurse sensitive indicators, there are currently no validated audit tools available to measure the indicators.

OBJECTIVES

To test the validity of the McIntyre Audit Tool.

DESIGN

This study used a descriptive observation design conducted over two phases to assess face and content validity.

PARTICIPANTS

An expert panel of haemodialysis nurses (n = 13).

METHODS

Face validity (phase 1) involved 13 nurses in two focus groups who reviewed the audit tool with qualitative data generated analysed to identify common themes. Phase 2 used a modified version of the audit tool to test for content validity for each item and then scale level content validity was calculated by combining all item scores.

MEASUREMENTS

Ten nurses rated 26 indicators in the audit tool using a 4-point Likert scale to assess each item for clarity, relevance, appropriateness, and ambiguity.

RESULTS

All 26-haemodialysis nurse sensitive indicators achieved item content validity indices ranging from 0.825 to 1.00 with a scale content validity index average of 0.910. However, based on feedback from phase 2, 6 outcome indicators were removed from the audit tool to reduce staff burden and assist with ease of use. The final audit tool had an excellent average scale content validity index of 0.924.

CONCLUSIONS

The McIntyre Audit Tool to measure 20 haemodialysis nurse sensitive indicators has been validated. It now requires feasibility and reliability testing before auditing the quality of haemodialysis nursing care.

Establishment of a no-notice drill mode evaluation system for public health emergencies

OBJECTIVE

At present, there are some no-notice drill mode evaluation systems for public health emergencies in Chinese hospitals, which are the subjects of assessment in this study. However, there is a lack of CDC. This study builds a set of no-notice drill mode evaluation systems for public health emergencies that involve the CDC.

METHODS

The indexes for these systems were based on the performance of two no-notice drills for public health emergencies in Guangdong Province. Twenty experts were invited to screen the indicators during two rounds of the Delphi method to determine the weight of first- and second-level indexes through the analytic hierarchy process, and the weight of the third-level index was calculated using the percentage method.

RESULTS

After two rounds of expert consultation, we obtained four first-level indicators, twenty-six second-level indicators and eighty-six third-level indicators. According to the weight calculated by analytic hierarchy process, the weights of the first-level indicators are emergency preparation (0.2775), verification and consultation regarding an epidemic situation (0.165), field investigation and control (0.3925) and summary report (0.165). Sensitivity analysis shows that the stability of the index is good.

CONCLUSION

The no-notice drill mode evaluation system for public health emergencies constructed in this study can be applied to public health departments such as the CDC. Through promotion, it can provide a scientific basis for epidemiological investigation assessment.

Nursing-sensitive quality indicators for pernicious placenta previa in obstetrics: A Delphi study based across Chinese institutions

AIM

To identify a set of scientific, systematic and clinically applicable nursing-sensitive quality indicators for pernicious placenta previa (PPP).

DESIGN

A modified Delphi-Consensus Technique.

METHODS

According to literature retrieval published between 2009-2019, 38 nursing-sensitive quality indicators were chosen and a questionnaire was designed. An online survey was conducted in 20 hospitals in China, and data of experts' opinions were collected and analysed by improved Delphi method.

RESULTS

38 nursing-sensitive quality indicators were identified. The response rates in the two rounds of expert consultation were 97.4% and 100%, and the authoritative coefficients were 0.89 and 0.92. The coefficients of variation ranged from 0.04-0.28. The nursing-sensitive quality indicators were successfully constructed based on the modified Delphi technique.

Research on the Effect of 5Why-Based Nursing Intervention in Blood Purification Nursing

In order to explore the effectiveness of the 5Why-based nursing intervention method in blood purification nursing, this paper takes 108 patients from Changzhou Second Hospital in the past three years as an example for experimental analysis. Moreover, this paper uses mathematical statistics to group patients into groups, and the two groups of patients are comparable. After grouping, this paper conducts preexperiment processing and then conducts patient grooming through various basic tasks so that the test results have a certain degree of reliability. On this basis, this paper verifies the nursing intervention methods through controlled trials. Among them, the control group is treated with the hospital's conventional nursing methods and allowed patients to master self-nursing methods, while the test group is treated with 5Why-based nursing intervention on the basis of traditional nursing methods. Finally, this paper combines mathematical statistics to evaluate the effect of blood purification nursing. From the research results, it can be known that the 5Why-based nursing intervention method has certain effectiveness in blood purification nursing.

Nursing-sensitive indicators: a concept analysis

Nursing-sensitive indicators (NSIs) are the criteria for changes in a person's health status that nursing care can directly affect, and they form the foundation for monitoring the quality of nursing care. For example, they can assist in establishing a common ground for benchmarking and in providing evidence of the cost-effectiveness of nursing care. However, despite the considerable influence of nursing interventions on the quality of healthcare, measuring the quality of nursing care and its effects on patient outcomes and healthcare systems remains challenging. There is also little consensus on what constitutes an NSI, resulting in inconsistent conceptualisations for measuring the quality of nursing care and the use of several different terms to describe indicators that are sensitive to nursing interventions. This article describes a literature review and concept analysis, which enabled the authors to develop a concept model for NSIs, with the intention of improving the concept of NSIs.

Design of assessment tool for unplanned endotracheal extubation of artificial airway patients

Aim

Unplanned endotracheal extubation (UEE) is one of the most common adverse events reported in patients with artificial airway. Current research in UEE is mostly limited to the summary of risk factors and analysis of prevention strategies. The aim of the study was to develop an assessment tool for medical staff to assess the risk of unplanned extubation in endotracheal intubation patients.

Design

The design was a qualitative study.

Methods

Based on literature review, group discussion, pre‐investigation, the initial risk assessment scale on unplanned extubation for endotracheal intubation patients was established. Fifteen experts from thirteen tertiary‐A hospitals across eight provinces participated in two rounds of Delphi panel.

Results

The risk assessment tool on unplanned extubation for endotracheal intubation patients was established by the Delphi method. It was composed of 11 indicators, which got agreement among two rounds panel.