Nursing-sensitive Indicators Research Articles

Nursing-sensitive indicators for nursing care: A systematic review (1997-2017).

AimTo provide a systematic review of the literature from 1997 to 2017 on nursing‐sensitive indicators.DesignA qualitative design with a deductive approach was used.Data sourcesOriginal and Grey Literature references from Cochrane Library, Medline/PubMed, Embase, and CINAHL, Google Scholar Original and Grey Literature.Review methodsQuality assessment was performed using the NIH Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies.ResultsA total of 3,633 articles were identified, and thirty‐nine studies met the inclusion criteria. The quantitative assessment of investigated relationships in these studies suggests that nursing staffing, mortality, and nosocomial infections were the most frequently reported nursing‐sensitive indicators.ConclusionThis review provides a comprehensive list of nursing‐sensitive indicators, their frequency of use, and the associations between these indicators and various outcome variables. Stakeholders of nursing research may use the findings to streamline the indicator development efforts and standardization of nursing‐sensitive indicators.ImpactThis review provides evidence‐based results that health organizations can benefit from nursing care quality.

The relevance, feasibility and benchmarking of nursing quality indicators: A Delphi study.

To identify indicators of nursing care performance by identifying structures, processes, and outcomes that are relevant, feasible and have the potential for benchmarking in Swiss acute hospitals. A modified Delphi-Consensus Technique. We examined 19 indicators based on the current evidence and that were pre-selected by nursing scientists. Between August-October 2019, a consortium of experts (representatives of different cantons, hospitals, and healthcare roles in Switzerland) determined the relevance, feasibility, and suitability for benchmarking these indicators in two-round modus of digital survey. Consensus was defined a priori by at least 75% agreement on the highest level of a 3-point Likert-type scale. The response rate was 70.4% in the first and 68.4% in the second round. In round one consensus was reached for three indicators on relevance but for none of the indicators regarding feasibility or potential for benchmarking. For round two, the experts suggested two additional indicators (new total of 21 indicators). Of 21 indicators, consensus was reached on twelve regarding relevance, seven regarding feasibility, and two regarding the potential for benchmarking. A national expert consortium defined 12 of 21 nursing care indicators as relevant. Feasibility, however, was estimated only among seven indicators and a consensus on suitability for benchmarking was reached for two nursing-sensitive indicators. The results show how the indicators to evaluate nursing care performance, which have been identified as priority by Canadian nursing scientists, are assessed in a different setting. There are many overlaps, but also some differences in the assessment of the indicators between the different settings. Different health systems prioritize the indicators to evaluate nursing care performance differently, which is why national surveys are important for the compilation of their own (priority) indicator sets.

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

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.

Staff Nurses’ Perception of the Hemodialysis Unit as Practice Environment and Patients’ Perception of Nurse Caring Behaviors and their Level of Satisfaction

Background: Despite the concomitant rise of kidney diseases and hemodialysis services nationwide, the Philippines still lacks research on hemodialysis nursing care quality. Using nursing-sensitive indicators under the Nursing Role Effectiveness Model, this study aimed to describe hemodialysis nurses’ perception of their unit as practice environment; patients’ perception of nurse caring behaviors based on Jean Watson’s 10 Caritas Processes; patients’ level of satisfaction on nursing care; and determine the association between perceived nurse caring behaviors and satisfaction levels.
 Methodology: This descriptive cross-sectional study purposely selected seven free-standing hemodialysis centers in Metro Manila. Ninety-four nurses were surveyed via complete enumeration using the Practice Environment Scale of Nursing Work Index (PES-NWI) while 345 randomly selected patients answered the Caring Factor Survey-Tagalog (CFS-T) and Patient Satisfaction of Nursing Care Quality Questionnaire-Tagalog (PSNCQQ-T). Pearson’s correlation was used to analyze the gathered data.
 Results: The study revealed that nurses perceived their respective work unit as a favorable practice environment while hemodialysis patients perceived nurse caring behaviors as practiced to a great extent and their satisfaction with nursing care as very good. The study also revealed a significant positive correlation between the process and outcome indicators (r=0.64, p=<0.0001).
 Conclusion: The study reflected positive nursing-sensitive indicators in hemodialysis. However, hemodi alysis facilities should improve nurse staffing, spiritual nurse caring behavior, and facilitate a more healing environment while maintaining their current favorable qualities.

Oncology Nursing Considerations when Developing Outpatient Staffing and Acuity Models.

Objectives include review of existing benchmarks and nurse-sensitive indicators relevant to the ambulatory care setting. Applying the data to existing ambulatory staffing models with consideration of multiple clinic settings that include medical oncology, infusion, and stem cell transplant clinics. And to describe key considerations needed to optimize oncology care efficiently with an acuity-based staffing model. Published literature indexed in PubMed, CINAHL, textbooks. In today's complex oncology environment, optimization and utilization of outpatient facilities is essential in providing high-quality care and improving satisfaction of patients as well as providers and staff. Nurse leaders should utilize benchmarking data to ensure staffing levels are appropriate, given the size and scope of their facility. Staff nurses should be engaged to ensure that acuity tools are developed in accordance with their experiences and perceptions of patient care.

Compassion fatigue in critical care nurses and its impact on nurse-sensitive indicators in Saudi Arabian hospitals

AimTo examine the previously untested relationship between the level of compassion fatigue (CF) in critical care nurses and the rates of three nurse-sensitive indicators in four critical care units in hospitals in Saudi Arabia. BackgroundCF can manifest in nurses who provide direct, intimate care to patients with different levels of illness including nurses working in specialty areas such as critical care where they care for patients experiencing challenging illnesses. Pressure injuries, patient falls, and medication errors are key nurse-sensitive indicators that identify critical care nurses as the primary causal agent. These indicators also correlate with burnout and poor multidisciplinary team communication, both factors that govern CF. MethodsA multisite survey was conducted to collate and examine the number of reported pressure injuries, falls, and medication errors over 3 months at four hospitals in two Saudi Arabian cities during 2018 to determine the relationship between the occurrence of these nurse-sensitive indicators and the level of CF in critical care (intensive care unit [ICU]) nurses. A survey of 516 critical care nurses was undertaken; analysis was performed using the Professional Quality of Life Scale, version 5 (ProQol-5), and results were further analysed using Pearson's correlations and three-way analysis of variance. ResultsThe results of the regression analysis indicated resilience as a predictor explained 66% of the compassion satisfaction (CS) variance (B = 0.318, R2 = 0.436, F(2, 12.495) = 123.013, p < 0.001) and 26% of the burnout (BO) variance (B = 0.152, R2 = 0.067, F(2, 11.500) = 3.279, p < 0.001). In addition, the level of resilience as a predictor explained 15.4% of the secondary traumatic stress (STS) variance (B = 0.063, R2 = 0.024, F(2, 7.758) = 2.785, p = 0.006). Conversely, coping strategies did not predict CS, BO, or STS (p > 0.05) at a statistically significant level. The concurrent measure of CF, BO, and STS found that almost 20% of the critical care nurse participants reported having very low CS, indicating increased potential for the development of CF. In addition, male nurses reported experiencing higher levels of stress and BO than female nurses. This study also found that neither the number of patients being treated nor the number of beds in the care setting affected the rate of the nominated nurse-sensitive indicators. The results for rates of pressure injuries did vary among the hospitals, with the worst performing hospital reporting pressure injury rates of one in every 40 patients and the better performing hospital reporting no cases of pressure injuries after treating more than 100 patients. Patient falls and medication errors were rare occurrences and did not vary between hospitals. SignificanceThis study indicates that there is a possible issue contributing to the differential level of care between hospitals. The mode and length of time nurses spend on handover may also reflect communication issues that increase both the rate of nurse-sensitive indicators and the level of CF reported by nurses. Therefore, the implications of this study, in terms of improving nursing practice, occurs in handover to ensure that information on aspects of nonpatient critical care are fully covered, such as time of patient turning to avoid pressure injuries.

Using clinical quality databases to monitor the quality of fundamental care: Example with weight status after severe traumatic brain injury.

To determine weight status and risk of overweight up to 1year after severe traumatic brain injury (TBI) as basis for defining nursing-sensitive indicators of fundamental nutritional nursing care in a clinical quality database. Patients' nutritional needs are recognised as fundamental care during hospitalisation, but less attention has been given to nutritional status after discharge. Nationwide cohort study. The STROBE checklist was used to ensure reporting quality. Data were retrieved from the Danish Head Trauma Database, a clinical quality database aiming at improving the quality of neurorehabilitation. Individuals aged≥15years with severe TBI 2011-2015 (N=424) were included. Normal weight, underweight and overweight were described according to the body mass index (BMI) at admission to subacute rehabilitation, at discharge and at 1year postinjury. The probability of transition between weight groups from admission to 1year postinjury was calculated. Multivariable binominal regression analyses compared risk of overweight between age groups. The prevalence of underweight decreased from 13% at admission to 6% and 3% at discharge and 1year postinjury, respectively. The prevalence of overweight was stable at 26%-27% at admission and discharge and increased to 44% at 1year postinjury. Of the individuals not overweight at admission, 28% became overweight by 1year postinjury. Overweight was significantly more prevalent in older compared to younger individuals. The risk of becoming overweight among those not overweight at admission did not differ between age groups. Underweight individuals achieved normal weight during inpatient rehabilitation. By 1year postinjury, individuals were increasingly overweight. Weight status has potential as nursing-sensitive indicators that may be included in clinical quality databases to inform the organisational and policy level on the state of fundamental nutritional nursing care. The inclusion emphasise requested responsibilities of nursing care. This facilitates health economic attention and influences nursing professional execution.

Consistency of Nursing Directors, Nursing Supervisors, and Nursing Quality Specialists’ Perception about Nursing-Sensitive Indicators in Acute Care Settings

Introduction: Nursing-Sensitive Indicators (NSIs) is a critical concept for the advancement of the nursing profession. However, different managerial positions may have a different perspective on the appropriate NSIs that should be used in hospitals for the monitoring of nursing care quality. This study aims to find if there is a difference between three groups of nursing managerial positions on the appropriateness of NSIs for the monitoring of nursing care quality. Methods: Descriptive cross-sectional approach was employed to evaluate if there is a difference among the three managerial groups in their evaluation for the appropriateness of using a cluster of NSIs in acute care settings. The study was conducted in Jordan between February and March 2020. Result: The study participants were 60 nurses from different managerial positions. The mean scores of the participants were: directors of nursing (200.6), nursing supervisors (199.1), and nursing quality specialists (198.62). The findings revealed no statistical difference between the three groups of their evaluation of the appropriateness of the NSIs. Conclusion: Standardizing the nursing mangers perspectives of NSIs may advance utilization of the NSIs for the monitoring and reporting of nursing care quality. Implications for Nursing Management: Consistent understanding of the measures that can be used to monitor quality of nursing care can establish the foundation for quality measurement and quality improvement in acute care settings.

Measurement and Validation of Primary Care Nursing Indicators Based on a Wound Care Tracer Condition.

Access to both valid and reliable nursing-sensitive indicators is currently limited in primary care. The objectives were to (1) measure primary care nursing indicators using a wound care tracer condition and (2) study the associations between process and outcome indicators. We conducted a longitudinal study in an ambulatory care clinic in Quebec, Canada. The sample included 482 episodes of care. We studied 5 indicators related to processes and 3 to outcomes. Performance levels were moderately high for indicators of initial assessment and duration and low for those of continuity and education. Associations between nursing follow-up and continuity indicators and 3 outcome indicators were highly significant. Continuity and nursing follow-up are associated with improved outcomes. Increasing these indicators' performance level can improve both nursing processes and patient outcomes.

CORRIGENDUM.

Journal of Advanced NursingVolume 75, Issue 12 p. 3844-3844 CORRIGENDUMFree Access CORRIGENDUM 勘误表 This article corrects the following: Nursing-sensitive indicators: a concept analysis Liza Heslop PhD RN, Sai Lu BMed PhD, Xiaoquan Xu, Volume 70Issue 11Journal of Advanced Nursing pages: 2469-2482 First Published online: August 12, 2014 First published: 04 November 2019 https://doi.org/10.1111/jan.14168Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In this paper (Heslop & Lu, 2014), the third author, Xiaoquan Xu, her affiliation has been added in the author by-line and author affiliation sections respectively. Here is the updated author by-line and author affiliation sections following the changes: Liza Heslop1 | Sai Lu1 | Xiaoquan Xu1 1College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia The online version of the article has been corrected. The authors would like to apologize for the inconvenience caused. REFERENCE Heslop, L., & Lu, S. (2014). Nursing-sensitive indicators: a concept analysis. Journal of Advanced Nursing, 70, 2469– 2482. https://doi.org/10.1111/jan.12503 Citing Literature Volume75, Issue12December 2019Pages 3844-3844 ReferencesRelatedInformation

Nursing Process Addressing the Nursing Focus "Hallucination": A Scoping Review.

Although hallucinations are prevalent in psychiatric disorders, such as psychosis or dementia, no studies were to be found in literature about the nursing process addressing the focus "Hallucination". This literature review, which is integrated with a scoping study framework, was performed to determine a clinical data model addressing the focus "Hallucination". PRISMA checklist for scoping reviews was followed. From the total of 328 papers found, 32 were selected. The findings of this review were summarized according to the nursing process addressing the focus "Hallucination". These findings led to determine a clinical data model addressing the focus "Hallucination", comprising the elements of the nursing process. This clinical data model may contribute toward improving nursing decision-making and nursing care quality in relation to a client suffering from hallucination, as well as contribute toward producing more reliable nursing-sensitive indicators.

Effects of E-Learning in a Continuing Education Context on Nursing Care: Systematic Review of Systematic Qualitative, Quantitative, and Mixed-Studies Reviews.

BackgroundE-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses’ continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context.ObjectiveWe aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context.MethodsWe conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results).ResultsWe identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick’s levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration.ConclusionsThe effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective.Trial RegistrationInternational Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714

Using Systems Thinking to Implement the QSEN Informatics Competency

There is an urgent need to improve the use and usability of the electronic health record (EHR) in health care to prevent undue patient harm. Professional development educators can use systems thinking and the QSEN competency, Informatics, to educate nurses about such things as nurse-sensitive indicators in preventing medical errors. This article presents teaching tips in using systems thinking to champion communication technologies that support error prevention (betterment). [J Contin Educ Nurs. 2019;50(9):392-397.].

Data, diagnoses, and interventions addressing the nursing focus "delusion": A scoping review.

To explore and synthesize literature related to the nursing process addressing the focus "Delusion". This literature review is integrated with a scoping study framework. From the total 252 papers found, 39 were selected. Relevant data and diagnostic activities, hypothetic nursing diagnoses, and interventions addressing the focus "Delusion" were identified. This literature review allowed the development of a clinical data model addressing the focus "Delusion", based on the steps of the nursing process identified. This clinical data model may contribute towards improving nursing clinical decision-making and nursing care quality in relation to a client suffering from delusion as well as producing more reliable nursing-sensitive indicators.

Pressure Injuries: Nursing-Sensitive Indicator or Team- and Systems-Sensitive Indicator?

Pressure Injuries: Nursing-Sensitive Indicator or Team- and Systems-Sensitive Indicator?

Making the Transition: A Critical Care Skills Program to Support Newly Hired Nurses.

This article describes the impact of a hands-on critical care skills day led by clinical nurse specialist (CNS) to enhance junior nurses' clinical skills. Program objectives included providing specialized skills training to meet the needs of high-acuity patient population and reviewing nurse-sensitive indicator-associated care bundles with the goal of increasing compliance. An 8-hour program of lecture and hands-on skills was developed. Curriculum included nursing-sensitive indicators, sepsis management, complex tubes and drains, airway management, and emergency response. Clinical nurse specialists mentored senior nurses to colead program planning and execution. The program has been offered 9 times. Qualitative and quantitative data were collected on attendees. Quantitative data analysis showed that 89% of the assessed components were affected by the program. Medium effect was noted in defibrillator skills, retrieving items from code care, care of suicidal patient, and sepsis screening. Qualitative data based on attendee survey are also presented and analyzed. Decreases in indwelling catheter utilization on select units are discussed. The CNS has the responsibility to ensure nursing practice is reflective of hospital policy and current evidence. This program demonstrates the impact of CNSs in staff education, mentorship, and competency assessment.

A longitudinal study on implicit rationing of nursing care among Lebanese patients - Study protocol.

To gain an in-depth understanding of the variations and trends of implicit rationing of nursing care, of its associated factors and of its relation to with nurse and patient outcomes. Maintaining and improving the quality of nursing care and patient safety have been the focus of health services researchers over the last decade. Cross-sectional studies have showed the magnitude of implicit rationing of nursing care and its associations with negative patient and nurse outcomes. Observational longitudinal study. Two-year funded study (between 2018-2020), including a sample of 317 Registered Nurses working on 19 units in two large Lebanese urban hospitals. The study included a cross-sectional baseline survey followed by multiple follow-up assessments over 90days. The repeated measurements on each of the units include repeated surveys on nurses' rationing of care, hospital administration reported nurse-sensitive indicators, nurse staffing levels, and patient mortality data. The study results will describe variations and trends of implicit rationing of nursing care in hospital units over time and whether and which elements of the nurses' work environment are associated with these variations. Data will inform on the impact of implicit rationing of care on patient and nurse outcomes. These data are needed to advance future planning and interventional research to efficiently reduce rationing of nursing care and improve the quality of care. Generating new knowledge (variations and trends) on the association between rationing of care and other element of nurses' work environment and nurse and patient outcomes.

Development of a data registry to evaluate the quality and safety of nursing practice.

To describe the development, testing, and implementation of a data registry of nursing-sensitive indicators for measuring the quality and safety of nursing practice. Recent research has established causal links between nurse staffing and patient outcomes. Unit level data is necessary for implementation of evidence-based strategies on nurse staffing and nursing care processes. Multi-site, cross-sectional design. Retrospective data were collected from administrative data sets on nurse staffing, patient flow, and adverse events in three hospitals in 2016. Periodic observational surveys on pressure injury prevalence, hand hygiene practices, and documentation of processes of care were also conducted. Prospective data were collected from patients at time of discharge using the Caring Assessment Tool. Nurses' perceptions of their practice environment were assessed using the Nursing Work Index - Revised: Australian. Data from annual Press Ganey® surveys on patient satisfaction/experience were obtained. The Australian Nursing Outcomes Collaborative (AUSNOC) data registry was developed in three phases. Phase 1 involved development of a data codebook; phase 2 involved development and testing of data collection methods; and phase 3 involved development of data reports and data dissemination strategies. This paper gives an overview of these phases and includes a summary of the descriptive statistics from the indicator set. Unit level data is pivotal for measuring the quality and safety of nursing care. Data from the Australian Nursing Outcomes Collaborative (AUSNOC) can be feasibly collected and used to benchmark nursing performance, evaluate patient outcomes, and identify areas for practice improvement.

Developing a Nursing Scorecard Using the National Database of Nursing Quality Indicators®: A Canadian Hospital's Experience.

Nursing-sensitive indicators are often reported on scorecards that enable nurse leaders to evaluate their progress in achieving their strategic goals and operational and quality targets. Providing unit-level reporting of nursing-sensitive indicators is one of the requirements of the American Nursing Credentialing Center's Magnet Recognition Program®. This descriptive article outlines one healthcare organization's experience in refining their nursing scorecard using the indicators as part of their Magnet Recognition Program® re-designation efforts.

Shifting Culture: A New CNO Leading to Nursing Excellence.

A new chief nursing officer describes the transformational leadership strategies she and her team used to turn their hospital, once below the national mean on National Database of Nurse Sensitive Indicators and patient/RN satisfaction scores, into a highly engaged and effective organization achieving top-performing outcomes.