Nursing-sensitive Indicators Research Articles

Minding the Details: The Importance of Assessment Accuracy and Consistency in Managing Nursing-Sensitive Indicator Interventions.

Description Evidence-based practice holds the potential to streamline health care, reduce costs, and improve patient outcomes. A good share of the data collected to create the evidence comes from electronic health records and other digital sources. Nurse-sensitive indicators, such as patient falls, pressure injuries, and hospital-acquired infections, are examples of data used to reflect the quality of nursing care. Other data may come from routine assessments nurses perform. It is crucial that nurses use valid and reliable instruments to create this data and that the use of the instruments is consistent across nurses in units, different shifts, and even different facilities. Ensuring awareness and consistency as well as interrater reliability in using validated instruments may seem esoteric, but it is as practical as it gets. This article will educate and explore these concepts, as well as provide examples of unintended consequences from inconsistent use of an instrument, and strategies to implement, ensuring best practices for instrument usage.

Forecasting the future demand on health workforce – the Austrian model

Abstract Background An aging population and upcoming retirements of health care professionals pose new challenges to the Austrian health care system. On the one hand the health care and nursing needs will increase while at the same time a shortage on health care personnel threatens adequate supply. We as the Austrian Public Health Institute estimate the risk of an undersupply with model-based health workforce forecasting and are therefore able to advise the federal states and the ministry of health on early measures. Methods We developed a forecasting model to estimate the future supply and demand. The main influencing factors are the demographic development as well as the upcoming retirements and graduates. Different environments and needs in different federal states (e.g. changing future skill mix) are considered and can be implemented as additional influencing factors. Usually a baseline scenario as a forward projection of the status quo is developed for defined professions and workplace settings. Then depending on the stakeholder needs additional scenarios are calculated and discussed. A usual forecast horizon is 10 to 15 years. Results Model output are time series of yearly workforce personnel numbers (heads and full-time equivalents) and demand in the defined settings. An analysis of possible gaps shows the need for action. Conclusions The Austrian health workforce model is a flexible tool to estimate future needs on health workforce based on different assumptions. But as assumptions and influencing factors must be represented as data, the data collection can be quite laborious. Comprehensive data is the basis for a comprehensive health workforce planning. Further work is needed to develop practical and evidence-based nursing-sensitive indicators for nursing workfoce reportings on a country level. In Austria the health professionals register forms the basis for the description of the nursing workforce structure, but that there is a need for data sources on care effectiveness. Key messages • Comprehensive data is the basis for a comprehensive health workforce planning. • An aging population and upcoming retirements of health care professionals pose new challenges to the Austrian health care system.

COVID-19 Pandemic Increases in Nursing-Sensitive Quality Indicators.

The pandemic profoundly stressed practicing nurses and could have thereby affected trends in nursing-sensitive quality indicators (NSIs), measures that detect changes in patient health status directly affected by nursing care. The aim of the study was to determine if NSIs have worsened in response to the pandemic and then returned to prepandemic levels using data from 2019 through 2022. We conducted a cross-sectional descriptive study of annual trends, examining unit data from the National Database of Nursing Quality Indicators (NDNQI) from 2019 through 2022 for five indicators: rates of falls, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injuries (HAPI), and ventilator-associated events (VAE). The NDNQI is the largest repository of nursing quality indicators, which are derived from patient-level events, reported at the nursing unit level, and submitted quarterly by over 2,000 member hospitals. Adult medical-surgical or critical care inpatient nursing units with complete data for the 4 years were included, with samples ranging from 456 to 5,818 nursing units in 2,346 hospitals. Analysis of variance was conducted by comparing the 2019 rates to each subsequent year. In decreasing order of prevalence, the mean prepandemic rates were 6.58 VAE per 1,000 ventilator days (critical care only), 2.41 HAPI per 1,000 device days, 2.20 falls per 1,000 patient days, 0.96 CAUTI per 1,000 catheter days, and 0.68 CLABSI per 1,000 central line days for medical-surgical and critical care units combined. The rates for all five nurse-sensitive indicators increased significantly beginning in 2020 and have begun to decline but have not returned to baseline by 2022. The maximum rate was observed in 2020 for falls and 2021 for the remaining indicators. These increases to the maximum ranged from a 12% increase in CAUTI to 49% for CLABSI. NSIs increased during the pandemic and are now returning to baseline. The pandemic underscored the importance of nursing practice. The pandemic's enduring negative effects on the nursing workforce must be addressed to preserve patient safety.

Comprehending the disruptive influence of workplace gaslighting behaviours and mobbing on nurses' career entrenchment: A multi-centre inquiry.

To explore the disruptive influence of workplace gaslighting behaviours and mobbing on nurses' career entrenchment across multiple healthcare centres. A multi-centre cross-sectional. Data were collected from 483 nurses from various healthcare settings in Egypt, spanning from January 2024 to February 2024. The Gaslighting at Work Questionnaire, Luxembourg Workplace Mobbing Scale and Career Entrenchment Scale were employed for data collection. The study revealed moderate levels of gaslighting, mobbing and nurses' career entrenchment. Also, there is a negative correlation between nurses' career entrenchment and both gaslighting and mobbing, while gaslighting and mobbing exhibit a positive correlation. The study also highlighted regional disparities in the prevalence of these phenomena, with the highest incidences noted in urban healthcare settings. The findings underscore the critical impact of workplace gaslighting and mobbing on nurses' career entrenchment. The relevant reporting method has been adhered to, that is, STROBE. The future of the nursing profession requires building productive nurses who can cope with negative workplace experiences. This could be achieved by cultivating a workplace culture that has zero tolerance for these experiences. Offering counselling services or employee assistance programmes to help nurses cope with the emotional toll of these negative experiences is a promising strategy. This study is the first to examine serious workplace practices like gaslighting and mobbing in a nursing context, emphasizing their effect on nursing-sensitive indicators like career entrenchment. It is one of the important initiatives geared towards upgrading the competitiveness and magnetism of healthcare organizations in the era of green human resources management. Results provide valuable insights for nurse leaders to control nursing turnover and shortage crises in different endeavours. In our study, nurses from diverse geographical regions and varied specialties actively participate, offering a rich tapestry of experiences and perspectives.

Nurse-Sensitive Indicators as Predictors of Trauma Patient Discharge Disposition.

About 3.5 million trauma patients are hospitalized every year, but 35%-40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care. The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients. This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics. A total of n =29,642 patients were included, of which n =21,469 (72%) were male, n =16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4-1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor. Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes.

Nurse Sensitive Indicators as Predictors of Trauma Patient Discharge Disposition.

Nurse Sensitive Indicators as Predictors of Trauma Patient Discharge Disposition.

Nurse-sensitive quality and benchmarking in hospitals striving for Magnet® or Pathway® designation: A qualitative study.

To examine if and how selected German hospitals use nurse-sensitive clinical indicators and perspectives on national/international benchmarking. Qualitative study. In 2020, 18 expert interviews were conducted with key informants from five purposively selected hospitals, being the first in Germany implementing Magnet® or Pathway®. Interviews were analyzed using content analysis with deductive-inductive coding. The study followed the COREQ guideline. Three major themes emerged: first, limited pre-existence of and necessity for nurse-sensitive data. Although most interviewees reported data collection for hospital-acquired pressure ulcers and falls with injuries, implementation varied and interviewees highlighted the necessity to develop additional nurse-sensitive indicators for the German context. Second, the theme creating an enabling data environment comprised building clinicians' acceptance, establishing a data culture, and reducing workload by using electronic health records. Third, challenges and opportunities in establishing benchmarking were identified but most interviewees called for a national or European benchmarking system. The need for further development of nurse-sensitive clinical indicators and its implementation in practice was highlighted. Several actions were suggested at hospital level to establish an enabling data environment in clinical care, including a nationwide or European benchmarking system. Involving nurses in data collection, comparison and benchmarking of nurse-sensitive indicators and their use in practice can improve quality of patient care. Nurse-sensitive indicators were rarely collected, and a need for action was identified. The study results show research needs on nurse-sensitive indicators for Germany and Europe. Measures were identified to create an enabling data environment in hospitals. An initiative was started in Germany to establish a nurse-sensitive benchmarking capacity. Clinical practitioners and nurse/clinical managers were interviewed.

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

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. The aim is to identify NSIs for hospitals in Jordan. The Delphi approach was utilized to establish a consensus among a panel of national nursing experts (N=60). An initial list of 52indicators 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). By the conclusion of the third round, a total of 42indicators achieved group agreement. The agreed-upon indicators consisted of 10structure, 16process, and 16outcome indicators. This study successfully established a consensus and identified a comprehensive set of indicators that capturethe distinct contributions of nursing in the hospital setting. The results demonstrate a wide range of agreed-upon indicators across the domains ofstructure, process, and outcome. These findings are valuable in enhancing the monitoring and evaluation of nursing practice in hospitals. The findings of this study provide a solid foundationfor 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.

Best practices for implementation of Kamishibai cards in the healthcare setting to improve nursing-sensitive indicator associated outcomes: An integrative review.

Many adverse events are identified as nursing-sensitive indicators (NSIs) and have evidence-based care bundles known to reduce risk of occurrence. Kamishibai cards are a tool from the manufacturing industry used for practice auditing and improvements. Use of Kamishibai cards is believed to be common in the healthcare setting, but true evidence-based guidelines do not yet exist to guide their implementation. The aim of this integrative review was to identify best practices around the implementation of Kamishibai cards in the healthcare setting for improvement in NSI-associated outcomes. Eleven nurses at three facilities worked through the evidence using the Johns Hopkins Evidence-Based Practice Model. Ten articles were included for this review. Broad themes included direct observation with non-punitive and timely feedback, clearly visualized results, use of evidence-based care bundles, pre-implementation education, and both leadership and frontline-staff involvement. All facilities showed improvement in NSI-associated outcomes after the implementation of K-cards. In health care, K-cards can be implemented and designed with additional focus on the bundles of care they are intended to audit and staff support, but further evidence would better define guidelines around implementation.

Design and Implementation of an Inpatient Fall Risk Management Information System.

Falls had been identified as one of the nursing-sensitive indicators for nursing care in hospitals. With technological progress, health information systems make it possible for health care professionals to manage patient care better. However, there is a dearth of research on health information systems used to manage inpatient falls. This study aimed to design and implement a novel hospital-based fall risk management information system (FRMIS) to prevent inpatient falls and improve nursing quality. This implementation was conducted at a large academic medical center in central China. We established a nurse-led multidisciplinary fall prevention team in January 2016. The hospital's fall risk management problems were summarized by interviewing fall-related stakeholders, observing fall prevention workflow and post-fall care process, and investigating patients' satisfaction. The FRMIS was developed using an iterative design process, involving collaboration among health care professionals, software developers, and system architects. We used process indicators and outcome indicators to evaluate the implementation effect. The FRMIS includes a fall risk assessment platform, a fall risk warning platform, a fall preventive strategies platform, fall incident reporting, and a tracking improvement platform. Since the implementation of the FRMIS, the inpatient fall rate was significantly lower than that before implementation (P<.05). In addition, the percentage of major fall-related injuries was significantly lower than that before implementation. The implementation rate of fall-related process indicators and the reporting rate of high risk of falls were significantly different before and after system implementation (P<.05). The FRMIS provides support to nursing staff in preventing falls among hospitalized patients while facilitating process control for nursing managers.

Evidence Synthesis for the Development of National Nursing-Sensitive Indicators in Malaysia: A Literature Review and Stakeholder Engagement Approach.

Nursing-sensitive indicators measure and evaluate nursing care quality and its contribution to patient care. The identification of indicators that demonstrate nursing care contribution and the quality of care delivered locally is of paramount importance, and national indicators that demonstrate this are essential. This paper aims to provide an evidence base of nursing-sensitive indicators that can facilitate the conceptualization of local nursing national indicators. A multifaceted and iterative approach incorporating literature review, and stakeholder engagements was utilized in evidence synthesis. A review of indicators present internationally complemented by the inclusion of context-specific local NSIs through stakeholder engagements was performed. Secondary data analysis of documents from an environmental scan was also included to highlight areas of concern for nursing-sensitive indicator prioritization from the viewpoint of nurses. A total of 64 articles were reviewed and indicators were coded according to the Nursing Care Performance Framework subsystems, dimensions, and variables. All papers reviewed had documented outcome indicators. From our secondary data analysis, nurses identified areas of concern such as nursing staff supply, staff maintenance, nursing processes and risk outcomes, and safety to be prioritized for developing quality indicators. This paper provides a list of NSIs coded systematically with definitions to aid stakeholders in prioritizing indicators for national indicator development. The inclusion of areas of concern provides insight into NSIs that nurse practitioners find relevant to the local context. To our knowledge, this is the first paper that includes evidence available in the literature and incorporates stakeholders' perspectives in synthesizing evidence needed to guide the development of national nursing indicators. This iterative approach is crucial because it enhances the likelihood of knowledge translation.

A Scoping Review of Ambulatory Care Nurse-Sensitive Indicators: Implications for Today's Practice and Policy

A Scoping Review of Ambulatory Care Nurse-Sensitive Indicators: Implications for Today's Practice and Policy

Measuring the intensive care experience of intensive care unit patients: A cross-sectional study in western China

BackgroundThe negative experiences of intensive care unit (ICU) patients seriously affect their quality of life and survival outcomes. Thus, it is of great significance to evaluate the monitoring experience of ICU patients for the clinical improvement of their experiences and promote interventions. ObjectivesThe objective of this study was to investigate patients' experiences of ICU and to understand the sources of patient experience and influencing factors. MethodsFrom November 2021 to September 2022, a cross-sectional survey was conducted with 600 inpatients from four grade A–III hospitals in western China. Data were collected using the Chinese version of the Intensive Care Experience Questionnaire. Results585 valid questionnaires were collected, the response rate was 97.5%. ICU patients in western China scored below-the-average for their intensive care experience. Family monthly income, occupation types, medical payment method, type of ICU, ICU admission plan, ICU admission times, mechanical ventilation use, fertility status, analgesia, sedation, and Acute Physiology and Chronic Health Evaluation II scores are important factors influencing ICU patients' intensive care experience. ConclusionsMedical staff need to pay attention to patient experience, improve the awareness of patient stressors and influencing factors, design nursing programs conducive to patient-positive experience, and promote interventions to further improve the long-term prognosis of patients. The results of this study can also be used as a set of nursing-sensitive indicators for evaluating nursing structure, process, and outcomes.

Development of the Harm Prevention Partners Clinical Model: An Academic-Practice Partnership for Prevention of Patient Harm Events.

This innovative academic-practice partnership applied user-centered design, resulting in a new clinical model, the "Harm Prevention Partners Program." The model engaged students working as teams with faculty to intervene on nurse-sensitive indicators by documenting care on a novel smartphone tool and generating an intervention dashboard to visualize impact. Faculty utilized the dashboard to guide postclinical debriefing and highlight students' impact on patient outcomes.

Associations and Predictive Pathways Between Shared Governance, Autonomy, Magnet Status, Nurse-Sensitive Indicators, and Nurse Satisfaction: A Multisite Study.

Evidence is limited to the effects of shared governance (SG) and autonomy on nurse-sensitive indicators (NSIs). To explore the effects of SG, autonomy, and Magnet status on nurse and patient outcomes. A cross-sectional survey study was conducted using a convenience sample of 404 nurses from 4 hospitals. Descriptive analyses of variance (ANOVAs), and path analysis were conducted to identify hypothesized associations and predictive pathways among study variables. Nurse managers reported higher perceptions of SG, autonomy, and satisfaction than staff nurses. SG and autonomy were significant predictors of patient falls and hospital-acquired pressure injuries. Nurses' autonomy, SG, and Magnet accreditation were significant predictors of nurse satisfaction. Leadership support of SG and autonomous practice are key strategies to improve nurse satisfaction and NSI outcomes.

Feasibility of the McIntyre audit tool for haemodialysis nurses.

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. The objective of this study is to evaluate the feasibility and utility of the MAT in measuring haemodialysis NSIs in clinical practice. Multisite nonrandomized feasibility study. A convenience sample of nurses (n = 30) were recruited from two haemodialysis units in Australia. 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. 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%). 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.

Nursing Research Priorities based on the Nurse-sensitive Indicators: Scoping Review

Background: Patient-centeredness, safety, and quality of care are major healthcare concerns worldwide. Clinical indicators are essential for monitoring and evaluating safety and quality of care within the health care system. Therefore, research on clinical indicators can improve the quality of care, promote good practices, clarify key concepts, and identify gaps vital to nursing care. Objective: The study aims to explore nurse-sensitive indicators to find significant research areas and prioritize them. Design: The study design is exploratory research conducted through scoping review, followed by Delphi consultation to identify nurse-sensitive indicators applicable in the Saudi Arabia health care system and prioritize these indicators as research areas. Results: The most frequently cited indicators are patient fall, medication error, patient satisfaction, catheter-associated infection, pain, pressure ulcer, the incidence of deep vein thrombosis or pulmonary embolism, appropriate levels of nursing skill mix, and nursing initial and need assessment. The result shows that (33) NSIs are essential to the quality of nursing care and patient safety in Saudi Arabia. Conclusion: Patient-centeredness, patient safety, a healthy work environment, and a nursing informatics system are significant research dimensions. We found that nurse satisfaction, patient satisfaction, pressure ulcers, patient falls, nurse-patient communication, patient engagement, and pain management are research priorities. Recommendations: Further studies must be conducted on NSIs that address patient-centeredness, safety, a healthy work environment, and a nursing informatics system. It can be observed that most of the studies focused on outcome indicators, and there is a need to study patient-reported indicators as a significant patient-centered concept.

Determination of Nursing Sensitive Indicators for Intensive Care Units in Turkey: A Qualitative Study

Introduction: Assessment of the quality of health services continues to be one of the top research areas from past to present. The development of nursing-sensitive indicators is one of the critical elements in assessing the quality of nursing care. This study aims to determine the nursing-sensitive indicators for intensive care unit (ICU)s.&#x0D; Methods: This research was conducted between May 2017 and October 2017 using a descriptive qualitative research phenomenological design. The research was assessed by the qualitative research paradigm based on Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethics committee approval of the study and written permissions from the selected hospitals were obtained. The research was performed with in-depth face-to-face interviews with 12 participants from three different hospitals and nursing education institutions through a semi-structured interview form. During the interviews, voice recordings were taken with prior permission, and the recordings obtained were deciphered word by word and evaluated with content analysis.&#x0D; Results: As a result of the research, four main themes were created; the patient-focused outcome indicators, the nurse-focused outcome indicators, the nursing-focused process/intervention indicators, and the organizational-focused structural indicators. Under these main themes, nursing-sensitive indicators have been determined.&#x0D; Conclusion: Nosocomial infections and pressure ulcers were the two-leading nursing-sensitive indicators. This research suggests developing policies and procedures for forming a national database specific to nursing, including nursing-sensitive indicators.

Nurse-Sensitive Indicators in the Care of Individuals With Opioid Use Disorder.

Patients with opioid use disorder (OUD) seek care in primary care settings where nurses support the provision of medication-assisted treatment. Office-based opioid treatment (OBOT) that includes buprenorphine hydrochloride administration under the supervision of a nurse for stabilization and maintenance therapy has the potential to improve outcomes for patients with OUD in primary care settings. However, the first step is to determine if OBOT nurses provide nurse-sensitive care, which consists of activities that have been shown to make a difference in patient outcomes. Content analysis of 368 nursing notes from 100 patients enrolled in an OBOT program in an urban hospital-based primary care clinic was conducted. Data were analyzed descriptively according to quantity and qualitatively according to the content. Entries indicative of care coordination and transition management were extracted. Seven content categories within care coordination were identified, including harm reduction, medication management, symptom management, communication between providers, promoting adherence, self-management goal setting, and patient education. Four areas within transition management were identified including supporting connections to resources, referrals for care, medication reconciliation, and communication with other facilities. Care coordination was documented more frequently than transition management. The presence of nurse-sensitive indicators provides evidence for and distinguishes the role of the nurse in OUD care.

Knowledge and practices of nurses regarding pain assessment in Intensive Care Units of tertiary care hospitals in Peshawar

Background: Pain is a significant problem experienced by patients, especially in the adult Intensive Care Unit (ICU). Inexorable pain is the most common condition among critical patients that may seriously affect their well-being, health outcomes, and quality of life. Objective: This study aimed to assess the nurses’ knowledge and practices related to pain assessment in critically ill patients. Methodology: A descriptive cross-sectional study was carried out among 58 registered nurses working at different ICUs in public and private hospitals. A non-probability purposive sampling technique was used, and frequency distribution and percentages were used for different variables. The data was collected through a modified adoptive questionnaire and the data was analyzed using SPSS 22.0 version and Microsoft excel 2010. Results: Among all participants, 23 (39.7%) participants were from public hospitals and 35 (60.3%) from private hospitals, 24 (41.4%) were male and 34 (59.6%) were female. The overall knowledge and practice of participants 6.90% had poor knowledge, 53.40% had good knowledge, 39.70%had a very good knowledge, 13.80% of participants had poor practice, 69.0% had a good practice and 17.20% had a very good practice. Conclusions: Nurses have a key role in the assessment and management of pain because pain is a nursing-sensitive indicator. Unfortunately, the treatment of pain is highly insufficient because of inadequate clinical knowledge about the best ways to manage pain; the current study findings reported that the nurses were having good knowledge about pain assessment. Most of the respondents had adequate knowledge about it and have good practice. And the majority of them were using pain assessment tools.