Quality Care Processes Research Articles

Technological innovation for workload allocation in nursing care management: an integrative review

Background Technology reduces the nursing workload, improve the quality care processes, patient’s safety, and avoid staff burnout. Innovative technologies are disrupting healthcare systems by improving the efficiency of processes and management. There is a discussion on the benefits, challenges, and barriers of these technologies and considering human factors of nursing management. The aim was to analyze the influence of technologies on the distribution of workload for nursing care management. Methods An integrative literature review was performed. Four databases were searched: Scopus, Scielo, PUBMED, and CINALH following PRISMA guidelines. Articles published from January 2016 to December 2020, published in English, Spanish and Portuguese were included. Studies were excluded when they were not original research, did not met the quality criteria or they did not answer the research questions. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Two reviewers independently examined the title and abstract for eligibility according to the inclusion and exclusion criteria. Results 2818 potentially relevant articles were found, but once the inclusion and exclusion criteria in the abstracts were analyzed, 177 remained for evaluation. After following the PRISMA Guidelines, 35 studies were included in the review. Three categories were identified: Nursing workload; Information technologies and technological means for management; Technology acceptance. Conclusions Technology has the potential to improve care management by estimating nurse workload in ICUs and non-critical units, but scientific evidence is more detailed in the former type of services. The literature provides insights about the factors that factors and the barriers that promote the technology acceptance and usability. We did not find studies comparing technologies and no scientific evidence proving improvements in care.

Technological innovation for workload allocation in nursing care management: an integrative review.

Technology reduces the nursing workload, improve the quality care processes, patient's safety, and avoid staff burnout. Innovative technologies are disrupting healthcare systems by improving the efficiency of processes and management. There is a discussion on the benefits, challenges, and barriers of these technologies and considering human factors of nursing management. The aim was to analyze the influence of technologies on the distribution of workload for nursing care management. An integrative literature review was performed. Four databases were searched: Scopus, Scielo, PUBMED, and CINALH following PRISMA guidelines. Articles published from January 2016 to December 2020, published in English, Spanish and Portuguese were included. Studies were excluded when they were not original research, did not met the quality criteria or they did not answer the research questions. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Two reviewers independently examined the title and abstract for eligibility according to the inclusion and exclusion criteria. 2818 potentially relevant articles were found, but once the inclusion and exclusion criteria in the abstracts were analyzed, 177 remained for evaluation. After following the PRISMA Guidelines, 35 studies were included in the review. Three categories were identified: Nursing workload; Information technologies and technological means for management; Technology acceptance. Technology has the potential to improve care management by estimating nurse workload in ICUs and non-critical units, but scientific evidence is more detailed in the former type of services. The literature provides insights about the factors that factors and the barriers that promote the technology acceptance and usability. We did not find studies comparing technologies and no scientific evidence proving improvements in care.

PO-01-053 LESSONS LEARNED FROM PATIENT ENGAGEMENT: EVALUATION OF A CO-LED IMPLANTABLE CARDIOVERTER DEFIBRILLATOR PATIENT EDUCATION PROGRAM

The implantable cardioverter defibrillator (ICD) is an effective treatment modality but potential risks and complications can negatively impact psychological well-being in areas such as: shock-related anxiety, depression and reduced quality of life (QOL). Ensuring patients receive timely and comprehensive education contributes to informed decision-making, improved device acceptance and ability to live well with an ICD. Incorporating patient engagement in education programs can be an effective strategy to provide peer support and real-world experiences. Development of a co-led educational program provided by expert clinicians and patient partners living with an ICD is an effective strategy and patient-centred approach to care. To evaluate a collaborate delivery model of education co-led by clinicians and patient partners to provide information, support treatment decision and facilitate living well with an ICD. Patient partners with previously implanted ICDs were recruited through a provincial network matching volunteers with healthcare providers to engage in quality care processes. Device clinicians and patient partners implemented a 1-hour, monthly education session for potential and newly implanted recipients. Curriculum was informed through current literature reporting ICD patients’ educational needs. Format transitioned from in-person to virtual at the onset of the pandemic. Participants’ experiences were evaluated using site-developed questionnaires measuring ICD curriculum knowledge and satisfaction with program delivery. Between January 2019 and December 2021, 126 participants (median age: 62 years; women: 30%) attended. Four key components were identified in the program delivery: 1) referral to program, 2) contact and coordination, 3) education session and 4) follow-up. In-person participants (n=62, 49.2%) reported the session as helpful (n=56, 94%). Virtual participants 64 (50.8%) completed an electronic survey (n=27, 45%); reporting the co-led design as very helpful (n=22, 82%) or somewhat helpful (n=5, 18%). Pivoting to a virtual format expanded access to participants living in rural areas and facilitated opportunity for family and caregivers to attend. Patient engagement is an innovative approach for clinicians to incorporate into the education provided to ICD patients. Results of this project provide practice-ready recommendations for healthcare providers to design similar programs addressing the needs of patients considering or living with an ICD.

Technological innovation for workload allocation in nursing care management: an integrative review

Background: Technology reduces the nursing workload, improve the quality care processes, patient's safety, and avoid staff burnout. Innovative technologies are disrupting healthcare systems by improving the efficiency of processes and management. There is a discussion on the benefits, challenges, and barriers of these technologies and considering human factors of nursing management. Methods: To analyse the nursing workload models, the predictors of nursing burnout and outcomes, the new technologies and its acceptance for nursing care management based on the literature. An integrative literature review is performed. Scopus, Scielo, PUBMED, and CINALH databases were searched to perform an integrative review following PRISMA guidelines. Articles published from January 2016 to December 2020 were included. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Two reviewers independently examined the title and abstract for eligibility according to the inclusion and exclusion criteria. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Results: Initially 2,818 articles were potentially relevant. After following the PRISMA Guidelines, 35 studies were included in the review. Four themes appeared: Nursing workload models; Predictors of nursing burnout and outcomes; Information technologies and technological means for management; Technology acceptance. Conclusions: Technology has the potential to improve care management by estimating nurse workload in ICUs and non-critical units, but scientific evidence is more detailed in the former type of services. The literature provides insights about the factors that factors and the barriers that promote the technology acceptance and usability. We did not find studies comparing technologies and no scientific evidence proving improvements in care.

Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care

Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses' contribution remains 'invisible'. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus. Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland. The objectives were to: classify quality care process nursing metrics and corresponding indicators pertinent to acute care; reach agreement on a selected set of robust metrics and corresponding indicators; and implement the findings of the study. A modified four-round Delphi study. The modified Delphi study integrated a four-round survey of 422 nurses, face-to-face meetings with a patient representative and key stakeholders within acute services with a final consensus meeting inclusive of a panel of 26 expert nurse clinicians. There was consensus on 11 quality care process nursing metrics and 53 corresponding indicators for the acute care setting. Despite the rating of 'critical' in the Delphi rounds, a concern was reported by participants on the subjective nature of three of the developed metrics: 'patient experience', 'patient engagement' and 'professional and ethical approach to care' based on the absence of objective measurement tools that include patient input. Conversely, this led to the conundrum for the panel of experts at the final consensus meeting who were divided in their views on objectively observing, recording and subsequent auditing of those three developed metrics in real-time clinical practice. This paper describes the operationalisation of a modified Delphi technique that progressed a set of 11 quality care process metrics and 53 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that nurses' contribution to patient-centred care is tangible in acute care.

Commentary: Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care

Commentary: Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care

MILITARY FAMILIES SOCIETY TO ADAPT CHILD WITH LEADERSHIP QUALITY WITH PSYCHOLOGICAL AND PHYSICAL DEVELOPMENT

Today’s Children’s are the leaders of future. To become a leader, balanced quality care process is in paramount requirement for children in a family. Caring of children has various dimensions like physical growth, mental growth etcetera. The ultimate aim is to become a good leader. As a requirement all families do care their children to become a good leader. Where Military families were prominent in the race. Military families have norms and traditions which leads the children to grow up. Military environment had also a significant role in children’s growing process. After the birth of Bangladesh children of military family led the society in all sector namely Government job, social affairs, society development, nation building even in international forum. Obviously business sector was not untouched after nineteen eighties nationally and internationally. The reason of doing well in all sector was, proper molding of military children’s as a leader. Even currently most of the sector has quality leaders, who have military background but not leading as it was in early Eighties and Nineties. Being a developing countries Bangladesh is in need of quality leaders.

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol.

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O'Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.

A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice

Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theory 4: Relates to nurses’ and midwives’ knowledge and beliefs. Program Theory 5: Builds on the staff theme of Programme Theory four, extending the culture of organizational learning, and highlights the meaningful engagement of nurses and midwives in the implementation process as a key characteristic of success. Program Theory 6: Relates to patient needs. The results provide nursing and midwifery policymakers and professionals with evidence-based program theory that can be translated into action-orientated strategies to help guide successful QCP-M implementation.

Developing an implantable cardioverter defibrillator patient education program: preliminary findings of a knowledge translation project

Abstract Funding Acknowledgements Type of funding sources: None. Background The implantable cardioverter defibrillator (ICD) provides effective prevention of sudden cardiac death in select populations. Its impact on quality of life (QOL) is associated with mixed results because of treatment delivery, risks and potential complications. Studies have shown comprehensive education before implantation contributes to informed decision-making and improved QOL. Providing peer support and opportunity to obtain real-life experiences from individuals living with an ICD is pivotal to effective education. Joint leadership with patients is an effective strategy to meet these goals as part of a patient and family-centred approach to care. Purpose Our objective was to adapt this knowledge and design an education program co-led by clinicians and patient partners to provide information, support treatment decision, and facilitate patients’ adaptation to living well with an ICD. Methods Patient partners with previously implanted ICDs were recruited from a regional network matching volunteers with healthcare providers seeking to engage patients and families in quality care processes. A monthly 1-hour, in-person group education session was developed by the Heart Rhythm Program team. Potential and newly implanted patients from two tertiary sites were invited to attend sessions combining education led by the clinical team and facilitated discussion with the patient co-leads. Participants completed an evaluation questionnaire inclusive of open-ended and Likert scale questions developed by the team. Sessions were halted for three months at the onset of the Covid-19 pandemic but resumed solely using a video conferencing platform. Results Since implementation in November 2018, there have been 62 in-person attendees and 34 using a virtual videoconferencing platform (female 31%, median age 62 years). All participants who attended in-person reported finding the session helpful with positive comments regarding the ability to have specific questions addressed in an informal, non-stressful environment. Virtual attendees did not complete written evaluations but positive feedback was received regarding session content and satisfaction in the ability to participate virtually. The involvement and contributions of the patient partners were consistently described as the most valuable component. Findings were used in an iterative fashion to inform session format and content. Conclusion In the era of patient-centred care and shared decision-making, it is imperative to integrate effective strategies that forefront patient voices and leadership. Transitioning to a virtual method of delivery was highly successful and demonstrated the importance of continuing this knowledge translation project providing practice-ready recommendations to healthcare providers to help address the needs of patients living with an ICD.

Are emotional intelligence and compassion associated with nursing safety and quality care? A cross-sectional investigation in pediatric settings

PurposeTo assess and compare the perceptions of emotional intelligence, compassion, and safety and quality care held by parents of hospitalized children and nurses, and to examine the association between emotional intelligence, compassion, and safety and quality care among nurses. Design and methodsThis cross-sectional study comprised 80 parents whose children were hospitalized for at least three days, and 71 nurses who treated these children. The data were collected during April-June 2018 using a self-administered questionnaire addressing socio-demographic characteristics, safety and quality care in the ward, emotional intelligence, and compassion. A hierarchical multiple regression model was used to assess whether emotional intelligence and compassion could be associated with safety and quality care among pediatric nurses. ResultsParents considered the safety and quality care in the ward to be significantly (p = .003) higher (M = 4.23 ± 0.61) than did nurses (M = 3.97 ± 0.46). Compassion had a significant positive effect on safety and quality of care (β = 0.260; p = .041), while seniority in nursing had a significant negative effect on safety and quality care (β = −0.289;p = .021). Null effect was found between emotional intelligence and safety and quality care. ConclusionCompassionate care should be targeted to improve the safety and quality of nursing care delivered to children and their parents. Practice implicationsNurse ward managers should promote procedures and guidelines concerning safety and quality care processes among older nurses. Specifically, we recommend nurse ward managers to leverage the results and dedicate efforts to continue to provide compassionate care in pediatric settings as an integral part of safety and quality care.

Addressing Quality of Care in Pediatric Units using a Digital Tool: Implementation Experience from 18 SNCU of India.

Lack of quality care is associated with newborn mortality and stillbirth. India launched the Special newborn care unit (SNCU) Quality of Care Index (SQCI) for measuring quality indicators in SNCU. The USAID Vriddhi project provided support to the use of SQCI in 19 SNCU across aspirational districts of Jharkhand, Uttarakhand, Himachal Pradesh, Punjab and Haryana. The objective was to provide holistic support to quality care processes by generating analyzed quarterly reports for action with the goal toward sustainability by capacitating SNCU personnel and program officers to use SQCI, over a 1period from April 2019 to June 2020. The composite index has seven indicators and converts them into indices, each having a range from 0.1 to 1, to measure performance of SNCU.7 of the 18 SNCU improved their composite scores from the first to the last quarter. Rational use of antibiotics showed improvement in 12 SNCU. Survival in newborns >2500 g and <2500, low birth weight admission and optimal bed utilization had the most variations between and within facilities. Based on quarterly data analysis, all facilities introduced KMC, 10 facilities improved equipment and drug supply, 9 facilities launched in-house capacity building to improve asphyxia management. The SQCI implementation helped to show a process of using SQCI data for identifying bottlenecks and addressing quality concerns. The project has transitioned to complete responsibility of SQCI usage by the district and facility teams. Use of an existing mechanism of quality monitoring without any major external support makes the SQCI usable and doable.

Quality care process metrics (QCP-Ms) in nursing and midwifery care processes: a rapid realist review (RRR) protocol.

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QCP-Ms) and respective indicators for the practice areas - acute care, midwifery, children's, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QCP-Ms in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods : The review will explore if there are benefits of using the QCP-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QCP-Ms work in practice; for whom, why and in what circumstances.Findings of this review could help to give insights into the use of a rapid realist review as a framework and how nursing and midwifery QCP-Ms have been implemented previously.

Quality care process metrics (QCP-Ms) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QCP-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QCP-Ms in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods : The review will explore if there are benefits of using the QCP-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QCP-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into the use of a rapid realist review as a framework and how nursing and midwifery QCP-Ms have been implemented previously.

Quality care metrics (QC-M) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QC-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QC-M in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods: The review will explore if there are benefits of using the QC-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QC-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into realism as a framework and how nursing and midwifery QC-Ms have been implemented previously.

Progressing Quality Care Process Metrics for Public Health Nursing: Viewed Through the Lens of a Modified Delphi Approach

Progressing Quality Care Process Metrics for Public Health Nursing: Viewed Through the Lens of a Modified Delphi Approach

Development of nursing quality care process metrics and indicators for intellectual disability services: a literature review and modified Delphi consensus study

BackgroundNursing process quality care metrics and indicators are quantifiable measures of the nursing care delivered to clients. They can be used to identify and support nurses’ contribution to high quality, safe, client care and are lacking in specialist intellectual disability nursing. In a national Nursing Quality Care-Metrics project for Irish intellectual disability services, a set of nursing quality care process metrics and associated indicators were established for intellectual disability services.MethodsA two-stage design approach was undertaken; a broad scoping review of the literature and a modified Delphi consensus process. The Delphi included a four round e-Delphi survey and a consensus meeting. Four hundred one intellectual disability nurses working in Ireland were recruited for the surveys and 20 stakeholders attended the consensus meeting.ResultsFrom the review, 20 existing and 16 potential intellectual disability nursing metrics were identified for nurses to prioritise in the e-surveys. After the four survey rounds, 12 intellectual disability nursing metrics and 84 associated indicators were identified. Following the consensus meeting, these were reduced to 12 metrics and 79 indicators.ConclusionsThis first set of intellectual disability nursing process metrics and associated indicators has been identified for implementation in practice. These metrics while developed in Ireland have international relevance and their application and appropriateness in practice needs to be evaluated.

The development of Nursing Quality Care Process Metrics and Indicators for use in Older Persons Care Settings: A Delphi-Consensus Study.

To develop a suite of nursing quality care process metrics and indicators for older persons care settings in Ireland. Regulatory investigations of health system failures highlight non-adherence to clinical guidelines and standards resulting in deficiencies in nursing care delivery. Limited attention has been paid to measuring nursing care processes particularly in the care of older people. Quality care process metrics can facilitate measurement of nurse-sensitive measures of care. A scoping literature review and modified Delphi-Consensus Technique. A scoping review of literature published between January 2007 - January 2017 was conducted to identify nursing process metrics and indicators. The Delphi Consensus phase incorporated a four-round electronic survey of 404 nurses and a consensus meeting with 13 stakeholders working in Older Persons Care Settings in Ireland. From the review, 33 potential metrics were identified. After all Delphi survey rounds, 20 metrics and 90 associated indicators were selected by the nurses. Following the consensus meeting, 19 metrics and 80 indicators were included in the final suite of nursing quality care process metrics and indicators. Developing this suite of nursing quality care process metrics and indicators for use in older persons care settings provided consensus on what nursing processes should be measured to improve the quality and safety of care delivery. The nursing processes identified, provide a framework for future research and educational programmes in the care of older persons. Although conducted in the Irish healthcare system, there is potential for adoption or adaption in other healthcare settings.

Development of a suite of metrics and indicators for children's nursing using consensus methodology.

Aim and objectivesTo develop a suite of metrics and indicators to measure the quality of children's nursing care processes. The objectives were to identify available metrics and indicators and to develop consensus on the metrics and indicators to be measured.BackgroundThe Office of Nursing and Midwifery Services Director, Health Service Executive, in Ireland established seven workstreams aligned to the following care areas: acute, older persons, children's, mental health, intellectual disability, public health nursing and midwifery.DesignA comprehensive design included stakeholder consultation and a survey with embedded open‐ended questions.MethodsA two‐round online Delphi survey was conducted to identify metrics to be measured in practice, followed by a two‐round online Delphi survey to identify the associated indicators for these metrics. A face‐to‐face consensus meeting was held with key stakeholders to review the findings and build consensus on the final metrics and indicators for use. A STROBE checklist was completed.ResultsA suite of eight nursing quality care process metrics and 67 associated process indicators was developed for children's nursing.ConclusionsBy creating a national suite of metrics and indicators, more robust measurement and monitoring of nursing care processes can be achieved. This will enable the provision of evidence for any local and/or national level changes to policy and practice to enhance care delivery.Relevance to clinical practiceThe roll‐out of the metrics and indicators in clinical practice has commenced. This national suite of metrics and indicators will ensure that a robust system of measurement for improvement is in place to provide assurance to Directors of Nursing of the quality of nursing care being provided to children and their families. It supports the value of nursing sensitive data to inform change and improvement in healthcare delivery and to demonstrate the contribution of the nursing workforce to safe patient care.