Abstract
To determine nurse-sensitive outcomes in district nursing care for community-living older people. Nurse-sensitive outcomes are defined as patient outcomes that are relevant based on nurses' scope and domain of practice and that are influenced by nursing inputs and interventions. A Delphi study following the RAND/UCLA Appropriateness Method with two rounds of data collection. District nursing care in the community care setting in the Netherlands. Experts with current or recent clinical experience as district nurses as well as expertise in research, teaching, practice, or policy in the area of district nursing. Experts assessed potential nurse-sensitive outcomes for their sensitivity to nursing care by scoring the relevance of each outcome and the ability of the outcome to be influenced by nursing care (influenceability). The relevance and influenceability of each outcome were scored on a nine-point Likert scale. A group median of 7 to 9 indicated that the outcome was assessed as relevant and/or influenceable. To measure agreement among experts, the disagreement index was used, with a score of <1 indicating agreement. In Delphi round two, 11 experts assessed 46 outcomes. In total, 26 outcomes (56.5%) were assessed as nurse-sensitive. The nurse-sensitive outcomes with the highest median scores for both relevance and influenceability were the patient's autonomy, the patient's ability to make decisions regarding the provision of care, the patient's satisfaction with delivered district nursing care, the quality of dying and death, and the compliance of the patient with needed care. This study determined 26 nurse-sensitive outcomes for district nursing care for community-living older people based on the collective opinion of experts in district nursing care. This insight could guide the development of quality indicators for district nursing care. Further research is needed to operationalise the outcomes and to determine which outcomes are relevant for specific subgroups.
Highlights
Worldwide, healthcare services are challenged by the rapidly growing ageing population [1]
All other data underlying the results presented in the study are available from a public repository at the Open Science Framework (OSF) via the following URL: https://osf.io/pws8r/
This study determined 26 nurse-sensitive outcomes for district nursing care for communityliving older people based on the collective opinion of experts in district nursing care
Summary
Healthcare services are challenged by the rapidly growing ageing population [1]. With increasing age, adverse consequences such as frailty, disability, chronic diseases, and multiple complex long-term conditions are present among these community-living older people [3, 4]. Because of these adverse consequences, community-living older people often need assistance with their daily life activities to be able to live at home as long as possible. For the purpose of this paper, district nursing care is defined as any technical, medical, supportive or rehabilitative nursing care and the provision of assistance with personal care [7]. This definition is in line with the definition used for community care nursing in Europe [7, 9] and reflects district nursing care in the Netherlands [10]
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