ICU Nurses' Perception of Sensitive Indicators of Quality of Care for ECMO Patients in Guizhou Province, China: A Cross-Sectional Study.

Purpose: This study aimed to investigate the cognitive evaluation level of ICU nurses in Guizhou Province, China, on the sensitivity indicators of nursing quality for ECMO patients. Patients and Methods: This was a cross-sectional observational study conducted in Guizhou Province, China, from May to July 2023, 259 ICU nurses were surveyed. Objective sampling method was used to select the participants from 10 hospitals in Guizhou Province that carried out ECMO. Data were collected through questionnaire survey. Two researchers checked and recorded Epidata 3.1. SPSS 25.0 was used for statistical analysis of the data, and frequency, mean and component ratio were used for descriptive statistical analysis. The importance rating was used to reflect the degree of nurses' agreement with the indicators. Results: The results of this study showed that 79.1% of the 253 ICU nurses in Guizhou Province, China, had not participated in training and courses related to indicators of quality of care evaluation for ECMO patients. The main way for ICU nurses to acquire knowledge related to indicators of quality of care sensitivity for ECMO patients was departmental training, which accounted for 87.4%. And the other ways, in descending order, were public, the matic lectures or academic conferences, journals and magazines; their evaluation scores of the importance of most of the quality of care sensitivity indicators for ECMO patients was moderate, with the scores ranging from 73 to 150. Among them, the range of importance evaluation scores for each indicator was 4.01 ~ 4.48. Conclusion: The overall cognitive evaluation of ICU nurses in Guizhou Province, China, on most sensitivity indicators of quality of care for ECMO patients was moderate, and there is a general lack of systematic courses and training on the knowledge related to ECMO care quality sensitive indicators.

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.

Machine learning evaluation of inequities and disparities associated with nurse sensitive indicator safety events.

PURPOSE: To use machine learning to examine health equity and clinical outcomes in patients who experienced a nurse sensitive indicator (NSI) event, defined as a fall, a hospital-acquired pressure injury (HAPI) or a hospital-acquired infection (HAI). DESIGN: This was a retrospective observational study from a single academic hospital over six calendar years (2016-2021). Machine learning was used to examine patients with an NSI compared to those without. METHODS: Inclusion criteria: all adult inpatient admissions (2016-2021). Three approaches were used to analyze the NSI group compared to the No-NSI group. In the univariate analysis, descriptive statistics, and absolute standardized differences (ASDs) were employed to compare the demographics and clinical variables of patients who experienced a NSI and those who did not experience any NSIs. For the multivariate analysis, a light grading boosting machine (LightGBM) model was utilized to comprehensively examine the relationships associated with the development of an NSI. Lastly, a simulation study was conducted to quantify the strength of associations obtained from the machine learning model. RESULTS: From 163,507 admissions, 4643 (2.8%) were associated with at least one NSI. The mean, standard deviation (SD) age was 59.5 (18.2) years, males comprised 82,397 (50.4%). Non-Hispanic White 84,760 (51.8%), non-Hispanic Black 8703 (5.3%), non-Hispanic Asian 23,368 (14.3%), non-Hispanic Other 14,284 (8.7%), and Hispanic 30,271 (18.5%). Race and ethnicity alone were not associated with occurrence of an NSI. The NSI group had a statistically significant longer length of stay (LOS), longer intensive care unit (ICU) LOS, and was more likely to have an emergency admission compared to the group without an NSI. The simulation study results demonstrated that likelihood of NSI was higher in patients admitted under the major diagnostic categories (MDC) associated with circulatory, digestive, kidney/urinary tract, nervous, and infectious and parasitic disease diagnoses. CONCLUSION: In this study, race/ethnicity was not associated with the risk of an NSI event. The risk of an NSI event was associated with emergency admission, longer LOS, longer ICU-LOS and certain MDCs (circulatory, digestive, kidney/urinary, nervous, infectious, and parasitic diagnoses). CLINICAL RELEVANCE: Machine learning methodologies provide a new mechanism to investigate NSI events through the lens of health equity/disparity. Understanding which patients are at higher risk for adverse outcomes can help hospitals improve nursing care and prevent NSI injury and harm.

Biogenic elements-informed assessment of the impact of human activities on river ecosystems.

River ecosystems, acting as pivotal conduits linking terrestrial, marine, and atmospheric realms, have faced significant disturbances due to human exploitation of their resources. Recent years have witnessed a heightened intensification of human activities, adversely affecting the equilibrium of water ecosystems. To systematically study the various factors that affect river ecosystems under human activities, we introduce a universally applicable approach that considers the diversity of watersheds, biogenic elements, and human activities. Using this method, this application uncovers the sensitive human activity types, biogenic factors, and species significantly influencing river biodiversity within the study area. Incorporating statistical modelling, sensitivity screening, and advanced correlation analyses within a random forest regression framework, Sensitive biogenic elements and biological types affected by human activities were identified in typical watersheds, and the stability of different aquatic ecosystems was evaluated. Suggestions for watershed management measures were proposed When human activities affect the degree of water resource development and utilization, the forms of sensitive biogenic elements include DIC and Tsi; When human activities affect the discharge of pollutants into rivers, the forms of sensitive biogenic elements include TP, PP, and DEP, and the ratio composition includes TC: TN, TC: TP, TP: TSi, and TN: TP, This study pioneers a novel method for assessing human impacts on river ecosystems and successfully applies this approach to inform management decisions for river segments and tributaries in the middle and upper reaches of the Yangtze River basin. thereby enhancing our understanding of the consequences of human-induced impacts on biodiversity.

Salinization of groundwater in shale gas extraction area in the Sichuan Basin, China: Implications for water protection in shale regions with well-developed faults.

The expanding growth of shale gas development has sparked global concern over water-related environmental issues. However, research on groundwater contamination in shale gas areas in China remains limited, impeding environmentally friendly industry practices. To address this gap, we investigated the Wufeng-Longmaxi shale region in the Sichuan Basin, encompassing both operational and prospective shale gas extraction sites, to assess the effects of shale gas operations on shallow groundwater quality. We found there was no significant correlation between groundwater quality and the minimum distance from the shale gas well pads, and some groundwater samples located far from shale gas well pads, rather than those close to pads, were salinized. These findings suggest minimal impacts from shale gas drilling and hydraulic fracturing. The salinized groundwater samples are characterized by high salinity levels and ion concentrations, and are located near fault zones. The primary source of shallow groundwater salinization was derived from the Triassic formation brines confirmed through the assessment of the sensitivity and conservative mixing models. Faults in the study area were identified as pathways for the upward migration of Triassic brines, evidenced by the proximity of salinized samples to fault zones. However, further investigation is required to ascertain whether shale gas extraction activities have induced the migration of formation brines. The occurrence and reactivation of faults, induced by microseismic activities, may pose an increased risk of groundwater contamination in tectonically complex fault zones during shale gas extraction. Therefore, it is imperative to enhance extraction strategies and technologies, particularly in shale regions with well-developed faults, such as optimizing well placement regulation, controlling hydraulic fracturing scale, and strengthening environmental monitoring. By shedding light on potential environmental ramifications of shale gas extraction, especially in fault-rich regions, our study informs water protection strategies and the sustainable advancement of the shale gas industry.

Research progress on indicators for early diagnosis of diabetic kidney disease / 沈阳医学院学报

Diabetic kidney disease(DKD)is one of the most serious microvascular complications of diabetes and a common cause of end-stage renal disease.Early kidney injury lacks typical clinical symptoms and its onset is insidiously.The common clinical indicators of kidney injury are urine microalbumin,glomerular filtration rate,etc.Due to their lack of sensitivity and specificity,it is easy to cause missed diagnosis,misdiagnosis,and delay the disease.Therefore,it is of great significance to find more convenient,stable,and less invasive detection indicators for the early diagnosis of DKD.This paper reviews the research progress of biological indicators related to glomerular and tubular injury,oxidative stress,inflammatory response,microRNA and proteomics,which provides a certain reference value for the early diagnosis of clinical DKD.

Development of a Machine Learning Model of Postoperative Acute Kidney Injury Using Non-Invasive Time-Sensitive Intraoperative Predictors.

Acute kidney injury (AKI) is a major postoperative complication that lacks established intraoperative predictors. Our objective was to develop a prediction model using preoperative and high-frequency intraoperative data for postoperative AKI. In this retrospective cohort study, we evaluated 77,428 operative cases at a single academic center between 2016 and 2022. A total of 11,212 cases with serum creatinine (sCr) data were included in the analysis. Then, 8519 cases were randomly assigned to the training set and the remainder to the validation set. Fourteen preoperative and twenty intraoperative variables were evaluated using elastic net followed by hierarchical group least absolute shrinkage and selection operator (LASSO) regression. The training set was 56% male and had a median [IQR] age of 62 (51-72) and a 6% AKI rate. Retained model variables were preoperative sCr values, the number of minutes meeting cutoffs for urine output, heart rate, perfusion index intraoperatively, and the total estimated blood loss. The area under the receiver operator characteristic curve was 0.81 (95% CI, 0.77-0.85). At a score threshold of 0.767, specificity was 77% and sensitivity was 74%. A web application that calculates the model score is available online. Our findings demonstrate the utility of intraoperative time series data for prediction problems, including a new potential use of the perfusion index. Further research is needed to evaluate the model in clinical settings.

Digital Information Management for Advanced Practice Nursing: Needs Assessment.

The aim of this pilot study was to explore needs related to a quality dashboard for advanced practice nursing to support quality management in a Finnish university hospital.

The coverage of indicators of sensitive and specific intervention programs and prevalence of stunting under-five children: A cross-sectional study in Aceh Province, Indonesia.

Background: The prevalence of stunting children under-five in Aceh Province is still high due to multiple factors, including the sub-optimal coverage of intervention programs. Aim: This study aimed at finding out the correlation between the coverage of indicators of sensitive and specific intervention programs with prevalence of stunting in Aceh. Methods: A cross-sectional design analyzed secondary data from the Indonesia nutritional status survey and program coverage data in 13 regencies/cities in Aceh Province. The dependent variable was the prevalence of stunting. Meanwhile, the independent variable covered 20 sensitive and specific intervention program indicators. We apply STATA 16 to analyze the correlation between sensitive and specific coverage and stunting prevalence. Results: The coverage of indicators of pregnant women with chronic energy deficiency (CED) receiving supplementary feeding, young children with diarrhea receiving zinc supplementation, parents taking parenting classes, and participation in the health insurance program had a significant correlation with prevalence stunting in Aceh (r = -0.57; r = -0.50; r = -0.65; and r = -0.60). Conclusion: Intervention measures to avert childhood stunting in Aceh should include strengthening supplementary feeding programs for mothers and toddlers, supplementation to prevent toddler diarrhea, and counseling parents on parenting and health insurance.

Emergency nursing nurse sensitive indicators: An integrative review.

BACKGROUND: Nurse sensitive indicators (NSIs) capture the outcomes of each nursing function impacted by nursing care. NSIs are critical in clarifying foci for emergency nurses when providing care in the emergency department (ED). OBJECTIVE: To establish NSIs key to emergency nursing from existing published literature. METHODS: Ten databases were searched as well as grey literature and Google Scholar in the development of data for this integrative review. Articles underwent a title and abstract review to establish inclusion/exclusion suitability followed by a full text critical appraisal. Data were extracted, synthesized, and analyzed using a structured process. RESULTS: Twenty-eight emergency nursing NSIs were identified from three included studies, with little consensus across the literature. The NSIs established in the literature reflected a broad range of non-specific technical skills. Overall, the quality of the included articles was low due to factors including study design and high risk of bias. CONCLUSIONS: The constrained range of NSIs and the limited literature exploring the outcomes of emergency nursing care perhaps reflects a wide ranging and seemingly evolving scope of emergency nurses. Further research is needed to delineate emergency nursing NSI, perhaps underpinned by a clear definition of an emergency nurse in terms of capability statements, core skills and defining attributes.

Nursing representatives in clinical quality databases and the presence of nursing-sensitive indicators of fundamental nursing care.

AIM: To identify and describe nursing-sensitive indicators in Danish clinical quality databases and to examine the association between nurse representation on database steering committees and the presence of indicators related to aspects of fundamental care. DESIGN: This was a cross-sectional study. The STROBE checklist was employed to ensure reporting quality. METHODS: We reviewed data from the latest annual report of 71 clinical quality databases in April 2021. Aspects of fundamental care were defined as the 12 nursing domains defined in the Danish Minimum Nursing Data framework. For each database, we recorded the number and type of indicators and identified indicators measuring fundamental care aspects. We used the prevalence ratio to estimate the likelihood of indicators related to aspects of fundamental care in databases with nurse representation on the steering committee. RESULTS: One-third of the databases included indicators related to aspects of fundamental care. The most common aspects were Respiration and circulation, Nutrition and Psychosocial conditions, whereas Skin and mucous membranes, Elimination and Pain were rarely measured. Nurse representation on the steering committee of a quality database increased the likelihood of having indicators related to aspects of fundamental care three-fold (prevalence ratio 3.25). CONCLUSION: Fundamental care was rarely monitored in Danish clinical quality databases, but databases with nurse representation on the steering committee had a higher likelihood of monitoring fundamental care. IMPACT: This study addressed the knowledge gap of how fundamental nursing care is measured in clinical quality databases. It introduces nurses to the measurement of fundamental care as a first step toward performing nursing intervention studies and investigating associations with patient outcomes. The increased likelihood of fundamental care monitoring in clinical databases with nurse representation on the steering committee indicates a feasible way for decision makers and nurse leaders to ensure a stronger focus on fundamental care to the patients' benefit.

Consensus on Quality Indicators for Pediatric Oncology Nursing Care in Mainland China: A Delphi Method and Analytic Hierarchy Process.

Background: Because routine nursing quality indicators are not suitable to evaluate pediatric oncology nursing care, this study aimed to identify a set of quality indicators for pediatric oncology nursing care in mainland China. Method: This prospective investigation utilized a modified Delphi technique and an analytic hierarchy process. A survey questionnaire was developed using a literature review and semi-structured interviews. Fifteen invited experts evaluated the importance of potential indicators through three rounds of Delphi survey by email in 2018. The importance weight of each indicator was identified through analytic hierarchy process. Results: In the Delphi survey, the average authoritative coefficient was 0.93-0.96 for each round of the inquiry. After three rounds of survey, 29 quality indicators were identified as important nursing outcomes for assessing the quality of pediatric oncology nursing care in mainland China. The importance rating mean score of indicators ranged between 4.67 and 5.00 on a 5-point scale, and the variation coefficient ranged between 0 and 0.19. Expert-assigned indicator importance weight varied between 0.0040 and 0.0870. Conclusion: This study identified an indicator system with 29 nursing-sensitive quality indicators that may represent potential indicator candidates for quality assessment of pediatric oncology nursing practice in mainland China.

Identifying nursing sensitive indicators from electronic health records in acute cardiac care-Towards intelligent automated assessment of care quality.

AIM: The aim of this study is to explore the potential of using electronic health records for assessment of nursing care quality through nursing-sensitive indicators in acute cardiac care. BACKGROUND: Nursing care quality is a multifaceted phenomenon, making a holistic assessment of it difficult. Quality assessment systems in acute cardiac care units could benefit from big data-based solutions that automatically extract and help interpret data from electronic health records. METHODS: This is a deductive descriptive study that followed the theory of value-added analysis. A random sample from electronic health records of 230 patients was analysed for selected indicators. The data included documentation in structured and free-text format. RESULTS: One thousand six hundred seventy-six expressions were extracted and divided into (1) established and (2) unestablished expressions, providing positive, neutral and negative descriptions related to care quality. CONCLUSIONS: Electronic health records provide a potential source of information for information systems to support assessment of care quality. More research is warranted to develop, test and evaluate the effectiveness of such tools in practice. IMPLICATIONS FOR NURSING MANAGEMENT: Knowledge-based health care management would benefit from the development and implementation of advanced information systems, which use continuously generated already available real-time big data for improved data access and interpretation to better support nursing management in quality assessment.

Tools to Improve Quality and Safety in the Acute Dialysis Unit.

Quality assessment and process improvement (QAPI) is an essential component to ensure the safety and quality of patient care in an acute dialysis unit. This article details the Structure-Process-Outcome model of quality analysis and suggests involving the entire acute care team in quality improvement processes, gathering data from environmental and infection control rounds and direct staff observations, as well as holding monthly quality improvement meetings with a standard and timed agenda. QAPI should be integrated into the fabric of the unit, and its processes should be seamless and automated.

Information realization of nursing quality sensitive index data based on failure mode and effect analysis / 中国实用护理杂志

Objective:To monitor and collect data information through failure mode and effect analysis (FMEA) and establish a data information system for nursing quality sensitive indicators.Methods:From July 2019 to July 2021, FMEA was used to evaluate the formation process of nursing quality sensitive index data, formulate specific improvement measures, and compare the proportion of risk priority index (risk priority number, RPN) value and index data informatization before and after the implementation.Results:Before the application of FMEA in nursing quality sensitive index data information management, the RPN value of index data element confirmation, index definition understanding, record specification, problem solving limitation, information communication and system data integration were (362.00 ± 101.56), (539.90 ± 174.39), (603.20 ± 128.71), (395.10 ± 184.83), (448.90 ± 185.58), (334.80 ± 107.74) points, while those after the intervention were (17.10 ± 9.96), (30.90 ± 31.66), (42.40 ± 28.99), (30.30 ± 33.94), (16.30 ± 17.02), (18.90 ± 19.27) points, with statistical significance ( t values were 9.11 to 14.74, all P<0.05). The proportion of sensitive index data informatization increased from 46.43% (39/84) to 95.51%(85/89). Conclusions:Using FMEA mode to manage the data information is effective and feasible for the realization of sensitive index information data.

To whom health care aides report: Effect on nursing home resident outcomes.

INTRODUCTION: Health care aides (personal support workers and nursing assistants) provide ~80%-90% of direct care to residents in nursing homes; it is therefore important to understand whether supervision of health care aides affects quality of care. We sought to determine whether health care aide reporting practices are associated with resident outcomes in nursing homes. DESIGN AND METHODS: We conducted a cross-sectional secondary analysis of survey data of 3991 health care aides from 322 units in 89 nursing homes in Western Canada. We then linked resident data from the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 database to care aide surveys at the unit level. We used hierarchical mixed models to determine if the proportion of health care aides reporting to a respective nursing leader role was associated with 13 practice sensitive quality indicators of resident care. RESULTS: Most health care aides reported to a registered nurse (RN, 44.5%) or licenced practical nurse (LPN, 53.3%). Only 2.2% of health care aides reported to a care manager and were excluded from the analysis. Resident outcomes for only declining behavioural symptoms were more favourable when a higher proportion of health care aides (on a unit) reported to RNs, ß = -0.004 (95% CI -0.006, -0.001, p = .004). The remaining indicators were not affected by care aide reporting practices. DISCUSSION AND IMPLICATIONS: Resident outcomes as evaluated by the indicators appear largely unaffected by care aide reporting practices. LPNs' increasing scope of practice and changing work roles and responsibilities in nursing homes across Western Canada may explain the findings.

Pelvic Ultrasound Parameters of Long-Acting Depot Formulation of Leuprorelin in the Treatment of Idiopathic Central Precocious Puberty in Girls.

OBJECTIVE: The present study was designed to compare the changes in ovarian and uterine parameters in girls with idiopathic central precocious puberty (ICPP) before and after gonadotropin-releasing hormone analogues (GnRHa) treatment to determine which sensitive indexes effectively reflect the therapeutic effect. METHODS: Sixty girls diagnosed with ICPP were enrolled in the present study. Relevant data were recorded before treatment. Leuprorelin acetate microspheres were injected at a dose of 30-180 µg/(kg four weeks). Relevant parameters were measured and recorded every three months. Changes in each parameter were analyzed to evaluate the clinical effect of leuprorelin in the treatment of girls with ICPP. RESULTS: 1) The height grew at a constant rate. 2) The breasts retracted. 3) Changes in pelvic parameters: the volume of the ovary and uterus and major axes of the ovary, uterus, and cervix were reduced; there were no significant changes in vaginal thickness or the uterine fundal-cervical ratio (FCR). 4) Body mass index (BMI) increased. CONCLUSION: Pelvic ultrasound is helpful in evaluating the efficacy of GnRHA treatment. The changes of ovarian volume and the major axes of the ovary, uterus, cervix can be used as sensitive observation indexes.

Signal Detection to Measure Allostatic Load.

PURPOSE: To illustrate a means to calculate allostatic load in hospitalized patients using big data from the electronic medical record (EMR). ORGANIZING CONSTRUCT: To describe the development of the Troubled Outcome Risk (TOR) scale using signal detection in big data. METHODS: Using both retrospective and prospective observational studies, I describe a mechanism to determine meaning from retrospective data then use the results to improve nursing surveillance to reduce length of stay (LOS) and nursing sensitive indicators on an inpatient medical surgical unit. FINDINGS: Results from the retrospective study contained over 290,000 individual data points and established an interpretation standard for the TOR score using an algorithm to detect signals. The prospective observational study used the TOR scale and developed an interpretation standard to assist unit charge nurses in assigning staff to patients based on a fully objective measure of patient allostatic load. CONCLUSIONS: The TOR scale in conjunction with existing nurse staffing methodology reduced inpatient LOS by 0.3 days, reduced allostatic load as measured by the TOR scale, and changed staffing patterns from purely geographic to patient-need based. CLINICAL RELEVANCE: The TOR scale demonstrates that careful evidence-based criteria can be easily gathered from the EMR and used to positively impact nursing practice and patient outcomes.

The experience of Catalonia measuring nurse-sensitive indicators: Trends study 2012-2018.

AIM: To describe nursing-sensitive indicators measured in Catalonia. BACKGROUND: In Catalonia, since 2012, under the umbrella of the Results Centre, outcomes of every health care setting have been published and made open to health care professionals and citizens. METHODS: Trends study of nursing-sensitive indicators was based on data collected systematically from each setting from 2012 to 2018. Percentages and rates were calculated for each of 14 indicators analysed from all primary care, hospitals and long-term care centres. RESULTS: Percentage of population aged 60 years or older correctly vaccinated against flu has been decreasing, while percentage of population aged 14 years or under with correct vaccine status is high (over 91%) and has remained stable over time. Mortality in patients who have developed complications has increased, from 27.1% in 2012 to 34.0% in 2017. Most centres achieved functional improvements during the first 30 days of admission. CONCLUSIONS: Among all indicators measured in primary care, hospital and long-term care, only 14 analysed are nursing-sensitive; no nursing-sensitive indicators regarding mental health are measured. IMPLICATIONS FOR NURSING MANAGEMENT: Research focused on development of nursing-sensitive indicators offers an opportunity to measure and benchmark nurses' quality of care and their contribution in achieving populations' health improvement and health care system sustainability.

Development and clinical application of nursing-sensitive indicators for midline catheterization care using evidence-based methods.

BACKGROUND: Midline catheters (MCs) have been widely applied in clinical settings as they can provide painless venous access, thus improving the quality of life and reducing medical costs. Nursing-sensitive indicators (NSIs) are real and effective measures of nursing quality. Using evidence-based methods, we established the NSIs of MC care, with an attempt to provide a basis for evaluating and monitoring nursing quality for MC use. METHODS: An electronic search was performed in 5 databases including China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang Data, PubMed, and Web of Science to identify studies that evaluated nursing quality during MC use. Two evaluators independently selected literature, extracted data, and evaluated the risk of bias. According to the Donabedian's structure-process-outcome model, we divided the NSIs into 3 levels. RESULTS: The established NSIs for MC use included 3 indicators (i.e., structure indicators, process indicators, and outcome indicators), among which there were 3 level-2 indicators and 7 level-3 indicators at the structure level, 2 level-2 indicators and 9 level-3 indicators at the process level, and 5 level-2 indicators and 17 level-3 indicators at the outcome level. CONCLUSIONS: The established NSIs for MC use offer a set of objective criteria for evaluating nursing performance during MC use and will help to improve nursing quality control.