Nurse perspectives of nurse-sensitive indicators for positive patient outcomes: A Delphi study

Abstract

Background Patient safety, quality of care, and nurse-sensitive indicators are common areas of focus in international research relating to patient outcomes. Recent literature relating specifically to nurse-sensitive indicators has leaned towards an emphasis upon negative outcomes, such as ‘missed care’, ‘delayed care’, ‘failure to rescue’ or a reduction in adverse events rather than focus on nursing activities that lead to positive outcomes. In addition, little is known about nurse perspectives of nurse-sensitive indicators for positive patient outcomes. Objective To identify and describe priority nurse-sensitive indicators linked to positive patient outcomes in the acute care setting. Design A modified Delphi Technique consisting of three rounds of electronic questionnaires to 90 Clinical Nurse Specialists and Charge Nurse/Managers working in acute care settings in New Zealand. Methods Delphi round one survey collected data on key nursing activities and tools important to patient outcomes. Delphi round two survey presented round one data for rating importance to patient outcomes using a rating scale question design. Delphi round three survey presented round two data to participants within the ‘Patient Experience Indicators’ identified by the New Zealand Health Safety and Quality Commission’s domains for ranking in order of importance via a ranking question design. Round one data were analysed to discover themes emerging from the responses to formulate activity options. In round two, responses were given an average rating score, calculated on the weight assigned to each answer choice. In round three the ranking average was calculated using weighting and response count. Results The results from the third round presented activities from each domain and these were ranked from highest to least importance, with 75% or greater indicating consensus. Of highest importance within each domain were: Communication: Listening; Partnership: Establishing trust, building relationships; Coordination: The threshold of 75% consensus was not reached; Physical and Emotional Needs: Identification of rapid change/deterioration, observation/identification of patient status, and increased assessment skills. Conclusion Some nursing activities were difficult to rank in terms of importance as nurses perceived they were inter-related and of equal importance. The soft applied skills of nursing practice have been highlighted as important nursing activities by experienced nurses in this research, which poses a challenge for health care and nursing education sectors to label, value and support enactment of these skills in the nursing workforce as legitimate contributions to positive patient outcomes.