Nursing-sensitive Quality Indicators Research Articles

Development of a nursing-sensitive quality indicators profile in ambulatory surgery

Development of a nursing-sensitive quality indicators profile in ambulatory surgery

Establishing Nursing-Sensitive Quality Indicators for the Central Sterile Supply Department: A Modified Delphi Study.

Previous studies have shown that improving quality management in the central sterile supply department (CSSD) is an effective measure to control and decrease hospital-acquired infections. This study aimed to establish nursing-sensitive quality indicators for CSSD nursing in China. We drafted nursing-sensitive quality indicators on the basis of the Structure-Process-Outcome model, and then conducted 2 rounds of consultation with experts using a modified Delphi method to determine the indicators and scientific methods of measurement. We identified five CSSD nursing-sensitive quality indicators. Recovery rates of the 2 rounds of valid questionnaires were 100%. Expert authority coefficients were 0.810 and 0.902, respectively. Kendall's coefficients of concordance were 0.168 and 0.210, respectively ( P < .05). Evidence-based nursing-sensitive quality indicators for the CSSD were established.

Construction of nursing-sensitive quality indicator system for cardiac rehabilitation of patients undergoing percutaneous coronary intervention based on structure-process-outcome model

BackgroundCoronary heart disease (CHD) is a cardiovascular disease with high mortality. At present, percutaneous coronary intervention (PCI) is considered as the main effective treatment for CHD due to less trauma, shorter course of treatment, and better curative effect. However, PCI alone is not a permanent cure, so cardiac rehabilitation (CR) is needed for a supplement. Nowadays, the evaluation of the nursing-sensitive quality of CR after PCI focuses on the outcomes of patients, lacks a complete evaluation indicator system, and is prone to problems such as nursing management imbalance.ObjectiveA scientific, sensitive, comprehensive and practical nursing-sensitive quality indicator system based on the structure-process-outcome model was constructed to provide a reference for evaluating nursing-sensitive quality of CR after PCI.MethodsFirstly, through literature analysis and semi-structured interview, the indicator system was collected, screened and determined. Then, the framework of the indicator system was established, and the draft of nursing-sensitive quality indicator system of CR after PCI was formed. Subsequently, the nursing-sensitive quality indicator system of CR after PCI was initially established using Delphi method. Finally, the specific weight was determined by analytic hierarchy process (AHP), and the nursing-sensitive quality indicator system of CR after PCI was established and perfected.ResultsTwo rounds of expert consultations were separately given 15 questionnaires, and all these questionnaires were returned, with a questionnaire response rate of 100%. Such result indicated that experts were highly motivated. Besides, the authoritative coefficients for two rounds of expert consultations were 0.865 and 0.888, and the coordination coefficients were 0.491 and 0.522, respectively. Hence, the experts’ authority and coordination were high and the results were reliable. After the second round of expert consultation, the nursing-sensitive quality indicator system of CR after PCI was established, eventually. This system consisted of 3 first-level indicators (structural indicator, process indicator and outcome indicator), 11 s-level indicators and 29 third-level indicators.ConclusionA relatively complete and reliable nursing-sensitive quality indicator system of CR after PCI has been established in this study. Such system is scientific and reliable and can provide a reference for the evaluation of clinical teaching quality of CR after PCI.

Construction and evaluation of nursing-sensitive quality indicators for vaginal birth after cesarean: A Delphi study based on Chinese population

AimTo develop scientific, systematic and clinically applicable nursing-sensitive quality indicators for vaginal birth after cesarean in obstetrics, which provide a theoretical and clinical basis for monitoring and improving the nursing quality of vaginal birth after cesarean in China. MethodsA modified Delphi-consensus technique was used in this study. Based on literature retrieval published between January 2012 and December 2022 and group discussion, the preliminary nursing-sensitive quality indicators were selected using a structural-process-outcome model. Then a questionnaire was designed on the preliminary indicators. The modified Delphi method was used to conduct two rounds of expert consultation among 26 hospitals in China. The survey data of experts’ opinions were collected and analyzed to determine the final nursing-sensitive quality indicators. The importance of indicators, rationality of calculation formula and operability of data collection were analyzed and discussed. ResultsA total of 33 nursing-sensitive quality indicators were determined. The indicators were composed of 3-level ones, including 3 first-level indicators (structural, process and outcome indicators), 9 s-level ones and 33 third-level ones. The positive coefficients in the two rounds of expert consultation were 95.56 % and 97.67 %, respectively, and the authoritative coefficients were 0.88 and 0.94. The coefficients of variation ranged from 0.05 to 0.28. ConclusionThe nursing-sensitive quality indicators were successfully developed using the modified Delphi method. The indicators are scientific, systematic and clinically operable, and play an important role in improving the nursing quality for pregnant women with vaginal birth after cesarean.

Nursing-sensitive quality indicators for quality improvement in Norwegian nursing homes – a modified Delphi study

BackgroundUse of nursing-sensitive quality indicators (QIs) is one way to monitor the quality of care in nursing homes (NHs). The aim of this study was to develop a consensus list of nursing-sensitive QIs for Norwegian NHs.MethodsA narrative literature review followed by a non-in-person, two-round, six-step modified Delphi survey was conducted. A five-member project group was established to draw up a list of nursing-sensitive QIs from a preliminary list of 24 QIs selected from Minimum Data Set (2.0) (MDS) and the international Resident Assessment Instrument for Long-Term Care Facilities (interRAI LTCF). We included scientific experts (researchers), clinical experts (healthcare professionals in NHs), and experts of experience (next-of-kin of NH residents). The experts rated nursing-sensitive QIs in two rounds on a seven-point Likert scale. Consensus was based on median value and level of dispersion. Analyses were conducted for four groups: 1) all experts, 2) scientific experts, 3) clinical experts, and 4) experts of experience.ResultsThe project group drew up a list of 20 nursing-sensitive QIs. Nineteen QIs were selected from MDS/interRAI LTCF and one (‘systematic medication review’) from the Norwegian quality assessment system IPLOS (‘Statistics linked to individual needs of care’). In the first and second Delphi round, 44 experts (13 researchers, 17 healthcare professionals, 14 next-of-kin) and 28 experts (8 researchers, 10 healthcare professionals, 10 next-of-kin) participated, respectively. The final consensus list consisted of 16 nursing-sensitive QIs, which were ranked in this order by the ‘all expert group’: 1) systematic medication review, 2) pressure ulcers, 3) behavioral symptoms, 4) pain, 5) dehydration, 6) oral/dental health problems, 7) urinary tract infection, 8) fecal impaction, 9) depression, 10) use of aids that inhibit freedom of movement, 11) participation in activities of interest, 12) participation in social activities, 13) decline in activities of daily living, 14) weight loss, 15) falls, and 16) hearing loss without the use of hearing aids.ConclusionsMultidisciplinary experts were able to reach consensus on 16 nursing-sensitive QIs. The results from this study can be used to implement QIs in Norwegian NHs, which can improve the quality of care.

Construction of nursing-sensitive quality indicators for the care of patients with prone position ventilation using the Delphi method

BackgroundProne position ventilation (PPV) has gradually become an adjuvant treatment to improve oxygenation in patients with acute respiratory distress syndrome. Scientific and comprehensive evaluation of the quality of nursing care for patients with PPV is of great significance to ensure the effectiveness of treatment and patient safety. However, there are no established objective indicators for evaluating the quality of nursing care for patients with PPV. This study intended to identify a set of scientific, systematic and clinically applicable nursing-sensitive quality indicators for the care of patients with PPV.MethodsBased on the Donabedian structure-process-result theory model, the quality evaluation indicators of nursing care for patients with PPV were preliminarily constructed based on an evidence-based perspective, and two rounds of Delphi surveys were conducted with the purpose of collecting opinions from a panel of independent experts.ResultsThe questionnaire recovery rates of the two rounds of correspondence were 100.00% and 95.00%, the recovery rates of expert opinions were 80.00% and 26.32%, the expert authority coefficient values were 0.89, and the Kendall coordination coefficient W values were 0.110 and 0.133, respectively. The final nursing-sensitive quality indicators for the care of patients with PPV included 3 first-level indicators, 9 s-level indicators and 29 third-level indicators.ConclusionThe constructed nursing-sensitive quality indicators for the care of patients with PPV involve quality supervision during the whole process of PPV from three dimensions: structure, process and results. These indicators have strong operability, reliability, practicability and scientificity and can provide a reference for the quality evaluation and monitoring of nursing care for patients with PPV.Implications for nursing managementThe quality indicators of nursing care for patients with PPV constructed in this research are scientific and reliable, and the content of the quality indicators can better reflect the technical characteristics of special nursing. Nursing managers are encouraged to use these quality indicators to evaluate the quality of clinical nursing care and improve safety for patients with PPV.

Construction of nursing-sensitive quality indicators for epilepsy in China: A Delphi consensus study

ObjectiveThe quality and safety of epilepsy care are of great importance because seizures are unpredictable. The aim of this study was to develop a set of nursing-sensitive quality indicators (NSQIs) for assessing and improving the quality of epilepsy nursing care in China. MethodsAn international literature review, a cross-sectional survey and a qualitative study were conducted to identify candidate NSQIs for epilepsy care and compile a questionnaire. Then, two rounds of electronic Delphi studies were conducted with a panel of 27 independent experts to identify the final NSQIs for epilepsy. ResultsThirty-nine candidate NSQIs were extracted for the Delphi process. The recovery rates in the first and second rounds of expert consultations were 92.6% and 96.2%, respectively. The experts’ authority coefficients of the two rounds were 0.876 and 0.878, respectively. The Kendall W value of the two rounds ranged between 0.094 and 0.200 (p<0.001). Eight structure indicators, 9 process indicators and 7 outcome indicators that represented the following three domains were included in the set of NSQIs for epilepsy: nursing resource allocation, implementation of nursing care, and outcomes of patients with epilepsy. ConclusionThese NSQIs for epilepsy provide a primary foundation for monitoring and improving the quality of epilepsy nursing care in China. However, the effects of these indicators on improvements in epilepsy care and outcomes in patients need to be verified in clinical practice.

Individualized Management of Quality of Care in Orthopedic Nurses Based on Sensitive Indicators.

Sensitive indicators of nursing quality focus on the core elements of nursing quality management. Nursing-sensitive quality indicators will play an increasingly important role in the macro and micro management of nursing quality in my country. This study were aimed at formulating the sensitive index management of orthopedic nursing quality based on individual nurses for improvement of the quality of orthopedic nursing. Based on the previous literature, the existing challenges in the early application of the orthopedic nursing quality evaluation index were summarized. Moreover, the management system of the orthopedic nursing quality-sensitive index based on individual nurses was devised and implemented, including monitoring the structure and result indices of individual nurses on duty and sampling the process indicators of patients managed by individual nurses. At the quarter-end, the data analysis was performed and fed back to determine the key points of the changes in the quality of specialized nursing affecting the individual, and the PDCA method was utilized for persistent improvement. The changes of sensitive indices of orthopedic nursing quality before (July-December 2018) and 6 months after implementation (July-December 2019) were compared. There were significant differences in other indices (accuracy of limb blood circulation assessment/accuracy of pain assessment/postural care pass rate/accuracy of rehabilitation behavioral training/satisfaction of discharged patients) (P < 0.05). The formulation of an individual-based orthopedic nursing quality-sensitive index management system modifies the traditional quality management model, improves the specialized nursing level, contributes to the accurate core competence training of specialized nursing, and improves the quality of specialized nursing of individual nurses. Consequently, there is an overall improvement in the specialized nursing quality of the department, and fine management is attained.

Public health nurses’ views on quality measures: A cross-sectional study

BackgroundThe quality indicators program has intended and unintended consequences that may affect nurses’ professional performance and organisational outcomes. AimsTo explore public health nurses’ knowledge, attitudes, and perceptions of the nursing-sensitive quality indicators applied in mother–child health clinics and their associations with organisational quality outcomes: quality of care, burnout, and communication. MethodsA cross-sectional study with a convenience sample. In total, 177 public health nurses completed a self-administered questionnaire measuring their knowledge, attitudes, and perceptions of the quality indicators regarding their performance and organisational outcomes. A structural equation modelling analysis was performed to describe the associations between the variables and to identify the mediating variables. FindingsThe structural equation modelling analysis revealed that the intended (positive) impact on the nurse's professional level was the mediating variable between the nurses’ knowledge and attitudes towards the National Health Quality Measure program, their seniority, and the unintended (negative) impact on the nurse's professional level, and the organisational outcomes. Discussion and conclusionPublic health nurses perceive quality indicators as contributing to and improving their professional work, with a positive impact on organisational outcomes. Nursing leaders and policymakers may promote good organisational outcomes by developing methods that will emphasise the importance of quality indicators in nursing practice.

Effects of a fixed nurse team in the orthopaedic surgery operating room on work efficiency and patient outcomes: a propensity score-matched historically controlled study

BackgroundThe work value of operating room (OR) nurses is directly reflected in nursing quality. However, evaluating the work value of these nurses has not been sufficiently investigated. This study evaluated the effects of a fixed nurse team (FNT) in an orthopaedic surgery OR on work efficiency and patient outcomes.MethodsA propensity score-matched historically controlled study conducted from 1 July 2015 to 30 June 2018 was used to investigate the difference in nursing quality between an FNT period and a non-FNT period in the orthopaedic surgery OR at a tertiary care hospital in China. The primary outcome was surgical site infections (SSIs) during in-hospital visits, and as a secondary outcome, other nursing-sensitive quality indicators were assessed with historically controlled data. A multifactor logistic regression model was constructed to examine the primary outcome differences between the FNT and non-FNT periods before and after propensity score matching.ResultsIn total, 5365 patients and 33 nurses were included in the final analysis. The overall SSI rate was 2.1% (110/5365; the non-FNT period 2.6% [64/2474], the FNT period 1.6% [46/2891]). A lower incidence of SSIs in patients (odds ratio 0.57, 95% CI 0.36 to 0.88, P=0.013), a lower turnover time of the surgical procedure (odds ratio 0.653, 95% CI 0.505 to 0.844, P<0.001), and improvement in surgeon satisfaction (odds ratio 1.543, 95% CI 1.039 to 2.292, P=0.031), were associated with the FNT period compared with the non-FNT period. However, we did not find significant differences between the FNT period and the non-FNT period in terms of the other indicators.ConclusionsThe presence of an FNT in an OR reduces the incidence of SSIs in surgical patients and the turnover time of surgical procedures and improves surgeon satisfaction. Further implementation of an advanced-practice nurse model with nurse specialists is encouraged.

Views of Nurses About “Nursing-Sensitive Quality Indicators”

Giriş: Hemşireliğe duyarlı kalite göstergeleri, hemşirelik uygulamalarını görünür kılmıştır. Amaç: Araştırma, hemşirelerin “hemşirelik bakımına duyarlı kalite göstergeleri” hakkındaki görüşlerinin belirlenmesi amacıyla yapılmıştır. Yöntem: Tanımlayıcı tipteki bu araştırma, Orta Karadeniz Bölgesi’nde yer alan bir üniversite ile bir devlet hastanesinin dahili ve cerrahi kliniklerinde çalışan toplam 144 hemşire ile gerçekleştirilmiştir. Araştırma verileri 15 Şubat-15 Mayıs 2018 tarihleri arasında toplanmıştır. Araştırmaya başlamadan önce etik kurul izni, kurum izni ve hemşirelerden sözel onam alınmıştır. Veriler, araştırmacılar tarafından geliştirilen anket formu aracılığıyla toplanmıştır. Verilerin değerlendirilmesinde tanımlayıcı istatistiksel yöntemler ve nonparametrik testler kullanılmıştır. Bulgular: Araştırmaya katılan hemşirelerin bakım kalite göstergeleri tanımlamalarının %46.4’ü hemşirelik, %38.1’i sağlık kurumu ve %15.5’i hasta ile ilgilidir. Hemşireler tarafından en fazla belirtilen hemşirelik bakımına duyarlı kalite göstergeleri; enfeksiyon oranı (%76.8), basınç yaralanması oranı (%59.4), hasta düşme oranı (%44.9), hasta memnuniyet düzeyi (%33.3) ve hemşire memnuniyet düzeyidir (%15.9). Hemşirelere bazı kalite göstergelerinin hemşirelik bakımına duyarlı olup olmadığı sorulduğunda; hemşire eğitim düzeyi (8.09±2.69), hasta memnuniyeti (8±2.28) ve hasta bakımına ayrılan süre (7.72±3.09) en fazla bakım kalitesi ile ilişkilendirilen göstergeler olarak belirlenmiştir. Sonuç ve Öneriler: Araştırmada hemşirelerin çoğunun hemşirelik bakımına duyarlı kalite göstergeleri hakkında görüş sahibi olduğu ve bazı ilave kalite göstergeleri önerdikleri belirlenmiştir. Bu sonuçlara göre sağlık kurumlarında hemşirelik bakım uygulamalarının etkinliğinin düzenli olarak değerlendirilmesi önerilmektedir.

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.

Construction of nursing-sensitive quality indicators for cardiac catheterisation: A Delphi study and an analytic hierarchy process.

Nursing care can profoundly reduce the risk of emergencies related to cardiac catheterisation. Therefore, identifying nursing-sensitive quality indicators (NSQIs) to evaluate nursing quality is critical for optimal cardiac catheterisation. However, studies on NSQIs for cardiac catheterisation are scarce. This study was conducted to develop a set of NSQIs for cardiac catheterisation. Literature retrieval and expert group discussions were conducted to identify potential NSQIs and compile an inquiry questionnaire. Then, Delphi surveys were used to collect opinions from experts in the field of cardiac catheterisation. The consistency of the consultation results formed the basis on which we conducted the next rounds of consultation. Based on the importance given to each NSQI by the consulted experts in the previous round, we determined the weight coefficient of each indicator with the analytic hierarchy process. This study was performed according to the SRQR guidelines. We conducted two rounds of expert inquiry. The recovery rates of the first and second questionnaires were 100% and 66.67%, respectively. The average authoritative coefficients were 0.86 and 0.91. The Kendall W values ranged from 0.214~0.361 (p<.001). Consensus was reached on 3 primary indicators, 8secondary indicators and 20 tertiary indicators. A set of NSQIs for cardiac catheterisation was developed. However, the effects of these NSQIs on the evaluation and continuous improvement of nursing quality in cardiac catheterisation need to be verified in clinical practice.

Nursing-sensitive quality indicators for pernicious placenta previa in obstetrics: A Delphi study based across Chinese institutions.

AimTo identify a set of scientific, systematic and clinically applicable nursing‐sensitive quality indicators for pernicious placenta previa (PPP).DesignA modified Delphi‐Consensus Technique.MethodsAccording to literature retrieval published between 2009–2019, 38 nursing‐sensitive quality indicators were chosen and a questionnaire was designed. An online survey was conducted in 20 hospitals in China, and data of experts’ opinions were collected and analysed by improved Delphi method.Results38 nursing‐sensitive quality indicators were identified. The response rates in the two rounds of expert consultation were 97.4% and 100%, and the authoritative coefficients were 0.89 and 0.92. The coefficients of variation ranged from 0.04–0.28. The nursing‐sensitive quality indicators were successfully constructed based on the modified Delphi technique.

Improving the quality of nursing care in Austria: 10 years of success.

AimsWe provide more updated and comprehensive insights, including descriptions of changes that have taken place in the quality of pressure injury care provided in hospitals over a 10‐year period.BackgroundVarious nursing quality measurements do not present a comprehensive view on nursing‐sensitive quality indicators or place a focus on one specific care problem.MethodsIt is a repeated cross‐sectional multicentre study conducted annually on 1 day including comprehensive data regarding nursing‐sensitive care problems and quality indicators on the structure, process and outcome levels.ResultsThe prevalence of pressure injuries decreased over the years from 4.4% to 2.9%, and the frequency of interventions increased.ConclusionThe Nursing Quality Measurement 2.0 initiative shows considerable improvements over a 10‐year period. Therefore, the maintenance of such nursing databases should be treated as a prerequisite to providing high‐quality nursing care and safe nursing practice. One main benefit of creating and maintaining such databases is that allow users to screen for improvements, for example in pressure injury care. These observations can be used to develop marketing strategies and/or to empower and engage nursing staff.Implications for Nursing ManagementParticipation in such quality measurements allows the comparison of data collected in wards and institutions in many different countries, enabling them to set appropriate benchmarks. Furthermore, the results can be compared over a period of time, highlighting systematic changes, trends or improvements (e.g., due to implemented innovations).

Appropriate Nursing Home Nurse Hours per Resident Day in Korea: A Secondary Analysis of Longitudinal Data.

To encourage the enactment of laws about mandatory nurse staffing in nursing homes, researchers should provide evidence of concrete nurse hours per resident day (HPRD). This article estimates optimal nurse staffing HPRD to achieve increased quality-of-care outcomes for nursing home residents. Secondary analysis of longitudinal data. This study used secondary analysis of longitudinal nursing home survey data. Nurse staffing HPRD and quality-of-care survey data accrued from nursing homes operating under long-term-care insurance in Korea. The collected data include a total of six quarterly base measurements on nurse staffing HPRD and 15 quality indicators from 2014 to 2017. The proposed optimization model emerged to most appropriately combine nurse staffing HPRD to increase quality-of-care outcomes for nursing home residents by 3% to 8%. Optimal outcome measures were fixed as best outcomes and compiled from 15 nursing-sensitive quality indicators. Constrained nonlinear optimization was used for analysis. A 12% increase in registered nurse (RN) HPRD (from 0.168 HPRD [10 min 5 s] to 0.177 [10 min 38 s]) aligned with a 3% improvement in quality-of-care outcomes. A 20% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality-of-care outcomes (from 0.168 HPRD [10 min 5 s] to 0.202 HPRD [12 min 6 s]) without increasing certified nurse aide HPRD. About a 30% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality-of-care outcomes (from 0.168 HPRD [10 min 5 s] to 0.218 HPRD [13 min 6 s]) without increasing certified nurse aide HPRD. It is urgent to institute mandatory nurse HPRD for nursing homes in Korea by law. This research provides evidence that increasing nursing HPRD improved residents' outcomes in nursing homes. Findings from the optimization model implied that stable care by RNs in nursing homes is a key factor in achieving acceptable quality of care for residents.

Using the Delphi method to establish nursing-sensitive quality indicators for ICU nursing in China.

In this study, the Delphi method was used to develop evidence-based indicators of intensive care unit (ICU) nursing quality of care in China. Nursing quality indicators reflect elements of patient care that are directly affected by nursing practice. A comprehensive literature search identified 2,857 potentially relevant articles. From the 50 articles that were included in this study, researchers identified 38 commonly used nursing quality indicators. A panel of experts reduced these to 20, which were then subjected to two rounds of Delphi discussion by a different panel, and a final consensus was achieved. The 20 indicators were grouped into three dimensions: structure, process, and outcome (including adverse consequences). The agreement among the experts for the 20 indicators was high. These evidence-based nursing quality indicators provide for ease in data collection and a basis for clinical application and improvement in the quality of ICU nursing throughout China.

Development of a nursing-sensitive quality indicator system based on the structure-process-outcome theory in orthopedic wards

Objective To establish a nursing-sensitive quality indicator system in orthopedic wards based on the structure-process-outcome theory, so as to guide clinical nursing. Methods Based on structure-process-outcome theory, the indicator definition and weight were identified by literature review, expert group discussion, Delphi method and Hierarchy analysis. Results The returning rates of questionnaires in the first and second round expert consultation were 94.87% (37/39) and 89.74% (35/39),respectively. The authority coefficient of the experts was 0.88,and the coordination coefficient of experts' opinion was 0.309.The program included 3 first indexes,14 second index, and 83 items. Conclusion The result of the study is scientific reliable and credible, Whichcan provide evaluation for the Clinical nursing operation. Key words: Orthopedic wards; Delphi technique; Quality indicators

Construction of nursing-sensitive quality indicators for haemodialysis using Delphi method.

To provide a set of nursing-sensitive quality indicators (NSQIs) for the evaluation of clinical nursing quality in haemodialysis unit. There are no established objective indicators for evaluation of the quality of nursing care in haemodialysis units in China. We performed a literature search for eligible studies published from 2006-2016. A total of six studies were screened out from which 13 potential NSQIs were identified. Two rounds of Delphi surveys were conducted with the purpose of collecting opinions from a panel of independent experts. At last, 11 NSQIs were selected by consensus after exclusion of 8 NSQIs and addition of another 6 NSQIs. Two rounds of expert inquiry were conducted; the questionnaire recovery rate was 100%. The average authoritative coefficients Cr for the two rounds were 0.79 and 0.90, respectively. The Kendall W values ranged from 0.273-0.388 (p<0.001). Eleven NSQIs were identified: nurse-to-patient ratio, dialysis ultrafiltration rate compliance rate, KT/V compliance rate, incidence of emergency during haemodialysis, person-time incidence rate of haemodialysis catheter-related bloodstream infections, incidence of coagulation in extracorporeal circulation, incidence of blood loss in extracorporeal circulation, incidence of pseudoaneurysm induced by fistula puncture, incidence of falls among haemodialysis patients, emergency dialysis rate of outpatients and incidence of fistula complications. The identified NSQIs reflect three aspects of haemodialysis nursing quality: importance, rationality of calculation formula and applicability of data collection methods. The study provides a reference for the evaluation of clinical nursing quality in haemodialysis units.

Development of evidence-based nursing-sensitive quality indicators for emergency nursing: A Delphi study.

To establish evidence-based nursing-sensitive quality indicators for emergency nursing in China. China lacks nursing-sensitive quality indicators necessary for assessing the quality of emergency nursing and essential to nursing management. Prospective. A literature search for relevant evidence-based studies was performed using several databases from January 2009-May 2014. Previously reported quality indicators were identified as appropriate for assessment by a panel of 40 experts in emergency medicine and nursing. Two successive rounds of Delphi surveys were conducted using questionnaires designed by the experts. Kendal's W coordination coefficients were calculated for indicator importance, rationality of calculation and feasibility of data collection. Thirty-three quality indicators were initially proposed for expert evaluation. After round 1 of expert discussion, Kendal's W coordination coefficients were .152 for importance, .092 for rationality and .141 for feasibility of data collection (all p<.001). Seven unsuitable items were discarded in round 1 and 11 discarded in round 2, which also added one new item. Finally, the experts reached consensus on 16 items established as appropriate nursing-sensitive quality indicators for emergency nursing care. Evidence-based nursing-sensitive quality indicators were established through a consensus of experts in emergency nursing and medicine. The current findings may provide a theoretical basis for establishing an emergency nursing quality database and improving the quality of emergency nursing care in China.