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

Abstract

Aim and objectives To 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. Background The 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. Design A comprehensive design included stakeholder consultation and a survey with embedded open‐ended questions. Methods A 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. Results A suite of eight nursing quality care process metrics and 67 associated process indicators was developed for children's nursing. Conclusions By 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 practice The 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.

Pediatric nurse‐sensitive outcomes: A systematic review of international literature

“…The included articles were performed in six countries, with the highest number (seven) conducted in North America (Connor et al., 2016; Graf, 2011; Kiss & Heiler, 2014; Lacey et al., 2006; Schwalenstocker et al., 2008; Stratton, 2008; Sullivan et al., 2021), three in Australia (Wilson et al., 2012a; Wilson et al., 2012b; Wilson et al., 2013c), and one in each of the following nations: China (Zhang et al., 2017), Ireland (Brenner et al., 2019), Korea (Kim & Kim, 2018), and South Africa (Coetzee et al., 2020). Of all the studies, seven focused on development (Brenner et al., 2019; Coetzee et al., 2020; Graf, 2011; Lacey et al., 2006; Schwalenstocker et al., 2008; Sullivan et al., 2021; Zhang et al., 2017), four focused on validation (Kim & Kim, 2018; Kiss & Heiler, 2014; Wilson et al., 2012a; Wilson et al., 2013c), and three aimed at both development and validation (Connor et al., 2016; Stratton, 2008; Wilson et al., 2012b) of NSOs. Six studies were cohort studies (Graf, 2011; Kim & Kim, 2018; Kiss & Heiler, 2014; Stratton, 2008; Wilson et al., 2012a; Wilson et al., 2013c ) and six were cross‐sectional surveys (Brenner et al., 2019; Connor et al., 2016; Lacey et al., 2006; Schwalenstocker et al., 2008; Wilson et al., 2012b; Zhang et al., 2017).…”

“…A flow diagram of the study screening process with reasons for exclusion as categorized by Edinger et al. (2013) is shown in Figure 1.…”

“…These practitioners are fundamental to the safe and effective care and subsequent health outcomes for this patient population in a range of settings as part of multiprofessional teams (RCN, 2021). Crucially, at both policy and practice levels, there is a growing emphasis on the need to demonstrate and understand the impact of pediatric nursing care delivery on patient outcomes (Brenner et al., 2019).…”

“…Nurse‐sensitive outcomes (NSOs) are defined as measurable items for assessing the appropriateness of healthcare structures, processes, and outcomes of nursing care (Kavanagh et al., 2009) and are seen as key potential policy and clinical practice mechanisms in the improvement of hospital care quality (Zhang et al., 2017). Therefore, it is important to identify relevant clinical NSOs as part of a broad policy initiative for assuring patients and the public that the expected care standards are upheld and practices are based on current evidence (Brenner et al., 2019; Department of Health [DoH], 2016).…”

Questionnaires to Measure Process and Structure of Quality Indicators for Pediatric Nursing

“…Because clinical nursing practice changes continuously, it is essential to implement measurements of the structure and process of pediatric nursing care quality. However, because Brenner et al 24 confirmed these indicators, the questionnaires developed in 2013 could still be judged as relevant. House et al 4 recognize the importance of implementing measures on structure and process besides outcome measures and adverse events to target areas for improvement.…”