Construction and evaluation of nursing-sensitive quality indicators for vaginal birth after cesarean: A Delphi study based on Chinese population.

Aim: To develop scientific, systematic and clinically applicable nursing-sensitive quality indicators for vaginal birth after cesarean in obstetrics, which provide a theoretical and clinical basis for monitoring and improving the nursing quality of vaginal birth after cesarean in China. Methods: A modified Delphi-consensus technique was used in this study. Based on literature retrieval published between January 2012 and December 2022 and group discussion, the preliminary nursing-sensitive quality indicators were selected using a structural-process-outcome model. Then a questionnaire was designed on the preliminary indicators. The modified Delphi method was used to conduct two rounds of expert consultation among 26 hospitals in China. The survey data of experts' opinions were collected and analyzed to determine the final nursing-sensitive quality indicators. The importance of indicators, rationality of calculation formula and operability of data collection were analyzed and discussed. Results: A total of 33 nursing-sensitive quality indicators were determined. The indicators were composed of 3-level ones, including 3 first-level indicators (structural, process and outcome indicators), 9 s-level ones and 33 third-level ones. The positive coefficients in the two rounds of expert consultation were 95.56 % and 97.67 %, respectively, and the authoritative coefficients were 0.88 and 0.94. The coefficients of variation ranged from 0.05 to 0.28. Conclusion: The nursing-sensitive quality indicators were successfully developed using the modified Delphi method. The indicators are scientific, systematic and clinically operable, and play an important role in improving the nursing quality for pregnant women with vaginal birth after cesarean.

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.

Application of obstetric nursing-sensitive quality indicators in continuous quality improvement.

OBJECTIVE: To verify the effect of obstetric nursing-sensitive quality indicators for continuously improving nursing quality. METHODS: We retrospectively analyzed the obstetric nurse quality in the First Affiliated Hospital of Chongqing Medical University and University-Town Hospital of Chongqing Medical University from October 2019 to September 2020. Nurses and patients in the Obstetrics Department of the First Affiliated Hospital of Chongqing Medical University and University-Town Hospital of Chongqing Medical University were respectively assigned into an experimental group and a control group. High-quality nursing services were provided to patients in both groups. In addition to the high-quality nursing services, the obstetric nurses in the experimental group received training on obstetric nursing-sensitive quality indicators based on the knowledge-attitude-practice model. An obstetric nursing quality evaluation was conducted between the two groups. Continuous quality improvement was achieved using the plan-do-check-act (PDCA) cycle. The nursing quality was reflected by 14 obstetric nursing-sensitive quality indicators and the nurses' job satisfaction was compared between the experimental group and the control group before and after intervention. RESULTS: The information regarding the nurses and parturients, and the nurses' job satisfaction were not significantly different between the two groups before intervention (P>0.05). Except for information regarding the lateral perineotomy at vaginal delivery, there was no significant difference in other obstetric nursing-sensitive quality indicators between the two groups before the intervention. In the experimental group, the rates of early skin-to-skin contact between mothers and infants, early sucking with exclusive breastfeeding during hospitalization, parturient satisfaction with the nurses' work, and nurses' job satisfaction after intervention were better than before (P<0.05). In the experimental group, the rates of neonatal asphyxia/severe neonatal asphyxia and postpartum hemorrhage following vaginal delivery after intervention was significantly lower than before (P<0.05). The experimental group had better outcomes than the control group in the rates of early skin-to-skin contact between mothers and infants, early sucking with exclusive breastfeeding during hospitalization, parturient satisfaction with the nurses' work, and nurses' job satisfaction (P<0.05). CONCLUSION: Obstetric nursing-sensitive quality indicators can be used to improve the nursing quality in continuous quality improvement, which is worthy of promotion in clinics.

Research progress of nursing sensitive quality indicators in breast cancer / 中国实用护理杂志

Based on Donabedian three-dimensional quality structure theory, this paper summarized the sensitive quality indicators of breast cancer nursing and summarized the research status from three aspects of structure, process and quality of results, to analyze the shortcomings of current research, and propose improvement strategies. The aim is to provide reference for the construction of scientific, standardized, practical and specialized sensitive quality indicators of breast cancer nursing in accordance with China′s national conditions.

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.

Using the Delphi method to establish nursing-sensitive quality indicators for ICU nursing in China.

In this study, the Delphi method was used to develop evidence-based indicators of intensive care unit (ICU) nursing quality of care in China. Nursing quality indicators reflect elements of patient care that are directly affected by nursing practice. A comprehensive literature search identified 2,857 potentially relevant articles. From the 50 articles that were included in this study, researchers identified 38 commonly used nursing quality indicators. A panel of experts reduced these to 20, which were then subjected to two rounds of Delphi discussion by a different panel, and a final consensus was achieved. The 20 indicators were grouped into three dimensions: structure, process, and outcome (including adverse consequences). The agreement among the experts for the 20 indicators was high. These evidence-based nursing quality indicators provide for ease in data collection and a basis for clinical application and improvement in the quality of ICU nursing throughout China.

Development of evidence-based nursing-sensitive quality indicators for emergency nursing: A Delphi study.

AIMS AND OBJECTIVES: To establish evidence-based nursing-sensitive quality indicators for emergency nursing in China. BACKGROUND: China lacks nursing-sensitive quality indicators necessary for assessing the quality of emergency nursing and essential to nursing management. DESIGN: Prospective. METHODS: A literature search for relevant evidence-based studies was performed using several databases from January 2009-May 2014. Previously reported quality indicators were identified as appropriate for assessment by a panel of 40 experts in emergency medicine and nursing. Two successive rounds of Delphi surveys were conducted using questionnaires designed by the experts. Kendal's W coordination coefficients were calculated for indicator importance, rationality of calculation and feasibility of data collection. RESULTS: Thirty-three quality indicators were initially proposed for expert evaluation. After round 1 of expert discussion, Kendal's W coordination coefficients were .152 for importance, .092 for rationality and .141 for feasibility of data collection (all p < .001). Seven unsuitable items were discarded in round 1 and 11 discarded in round 2, which also added one new item. Finally, the experts reached consensus on 16 items established as appropriate nursing-sensitive quality indicators for emergency nursing care. CONCLUSION: Evidence-based nursing-sensitive quality indicators were established through a consensus of experts in emergency nursing and medicine. RELEVANCE TO CLINICAL PRACTICE: The current findings may provide a theoretical basis for establishing an emergency nursing quality database and improving the quality of emergency nursing care in China.

Literature review of nursing-sensitive quality indicators for ICU / 中国实用护理杂志

This article briefly reviewed the development of nursing-sensitive quality indicators. On this basis, it expounded the connotation and clinical application of nursing-sensitive quality indicators for critical care. Problems that exposed during building and implementing these indicators were also discussed. The main purpose of this literature review is to provide evidence for improving nursing quality assessment in ICU settings.

Establishment of evaluationpediatrics nursing- sensitive quality indicatorssystembasedon Donabedian structure-process-outcome theory / 中国实用护理杂志

ObjectiveA preliminary study on pediatrics nursing-sensitive qualityindicators was carried out to construct a systematic, scientific and sensitive quality system. Methods Delphi method was used to conduct two rounds of questionnaires for 55 pediatric nursing experts, used SPSS20.0 statistical software for data analysis. Analytic hierarchy process method was used to determine the weight of the indicators. Results The final determination agreed rate of experts equal to 75 percent, the importance of assignment mean was>3.5 and the variation coefficient<0.25, which including 5 structure indicators, 17 process indicators and 18 outcome indicators. Conclusion The evaluation system of pediatrics nursing-sensitive quality indicators was constructed in preliminary which could provide the reference and basis for pediatric nursing managers.

Establishing nursing-sensitive quality indicators for the operating room: A cross-sectional Delphi survey conducted in China.

BACKGROUND: Nursing-sensitive quality indicators comprise principles, procedures, and assessments to quantify the level of nursing quality in hospital departments. Although studies have demonstrated that quality indicators are essential for monitoring nursing practice in the operating room (OR), nursing quality in China is highly subjective and localised OR nursing-sensitive quality indicators are lacking. OBJECTIVE: This study aimed to establish scientific, objective and comprehensive nursing-sensitive quality indicators for the OR to evaluate and monitor OR nursing care quality in China. METHODS: Literature search for relevant evidence-based studies was performed using Cochrane, Medline, PubMed, Embase, and other databases, followed by literature review and group discussion by the expert panel. Two successive rounds of Delphi surveys were conducted using questionnaires completed by the expert panel to reach consensus and define nursing-sensitive quality indicators for the OR. RESULTS: Two rounds of Delphi surveys each had 100% questionnaire retrieval rate, with Kendall W coordination coefficients ranging from 0.096 to 0.263 (P<0.001). In round 1 of expert evaluation of 26 indicators, Kendall's W was 0.263 for importance, 0.126 for rationality, and 0.125 for feasibility of data collection (all P<0.001). After round 2, 23 items were established as OR nursing-sensitive quality indicators, including rates of work time wastage, surgery start-time delay, OR turnover time between surgeries, same-day surgery cancellation, and number of monthly surgeries in each OR; checking surgical patients, surgery site marking, allergy history, and antibiotics use 60min before incision; and also assessing expected surgical time, sterilisation indicator results, availability of surgical instruments and materials, and instrument count. CONCLUSIONS: Scientific, practical, and reliable OR nursing-sensitive quality indicators can be established based on evidence-based studies and expert consensus using the Delphi method. The quality indicators developed in this study may provide an objective and quantitative reference for evaluating nursing quality in Chinese ORs.

Paths to partnership: Veterans Health Administration's Journey in pilot testing breast cancer care quality measures.

Prioritizing personalized, proactive, patient-driven health care is among the Veterans Health Administration's (VHA's) transformational initiatives. As one of the largest integrated healthcare systems, the VHA sets standards for performance measures and outcomes achieved in quality of care. Evidence-based practice (EBP) is a hallmark in oncology nursing care. EBP can be linked to positive outcomes and improving quality that can be influenced directly by nursing interventions. VHA oncology nurses had the opportunity to partner with the Oncology Nursing Society (ONS), ONS Foundation, and the Joint Commission in the multiyear development of a comprehensive approach to quality cancer care. Building on a platform of existing measures and refining measurement sets culminated in testing evidence-based, nursing-sensitive quality measures for reliability through the ONS Foundation-supported Breast Cancer Care (BCC) Quality Measures Set. The BCC Measures afforded the VHA to have its many sites collectively assess documentation of the symptoms of patients with breast cancer, the use of colony-stimulating factors, and education about neutropenia precautions provided. Parallel paths of the groups, seeking evidence-based measures, led to the perfect partnership in the VHA's journey in pilot testing the BCC Measures in veterans with breast cancer. This generated further quality assessments and continuous improvement projects for spread and sustainability throughout the VHA.