Quality indicators in clinical nursing: a review of the literature

Abstract

The purpose of the present study was, by means of a literature review, to describe and analyse the characteristics of clinical indicators used to assess and promote quality improvement in nursing care. It was found that a generally accepted definition of a clinical indicator is a 'quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities'. By the seriousness of the event and the degree to which it can be avoided, clinical indicators are described as sentinel event or rate-based indicators. They can measure structure, process or outcome of care. Authors have had different approaches in focus when selecting and developing indicators viz. specific aspects of care/nursing diagnosis, medical diagnosis, generic aspects of care and clinical areas. These different points of departure were influenced by research knowledge, theories/frameworks, or by the opinions of patients or staff. The threshold of an indicator is essential when measuring the quality of care as it describes a critical level between what is considered good or not. Thresholds should be dynamic, realistic, and improve over time. However, the literature on how to establish specific thresholds is limited. The review has also revealed that there is an uncertainty regarding the use of terms such as indicators, standards, norm, criteria and aspects of care.

Use of performance indicators in the nursing service of a public hospital

“…The data analysis showed that 44% of the subjects When the occurrence of PUI and falls in the hospital studied were analyzed, it was found that these indicators were considered by 100% of the nurses as highly relevant to evaluate the quality of the nursing care, corroborating the literature (15)(16) . Other indicators considered by the nurses as highly relevant or relevant for the qualification of the care are intimately related to the daily nursing tasks, such as incidence of phlebitis, accidental extubation and incidence of non-compliance in the medication administration.…”

“…It is noteworthy that the rate of work accidents was also considered, by 100% of the sample, as a qualifier of the care by the nurses. This indicator may evidence structural or procedural failures of the care, as shown by the study (15) that encountered rates of 72% of concordance of the Gabriel CS, Melo MRAC, Rocha FLR, Bernardes A, Miguelaci T, Silva MLP.…”

Identifying paediatric nursing-sensitive outcomes in linked administrative health data

“…The concept arose from the quality improvement agenda of the Joint Commission on Accreditation of Health Care Organizations (JCAHO) in the United States (US) in the late 1980s [3]. More recently, concerns about the changing nurse skill mix have led researchers to investigate associations between the incidence of nursing-sensitive outcomes and levels of nurse staffing [4-8].…”

Validação de conteúdo de indicadores de qualidade para avaliação do cuidado de enfermagem

“…The determination of care aspects to be measured was founded on the recommendation of high frequency problems that affect a great number of patients, thus establishing a risk situation (6) . Problems related to ethical and legal aspects of care documentation were also taken into account, as well as those problems liable to being minimized or solved with permanent and continuous education measures (6,14) .…”

“…Indicators signal discrepancies toward the determined desired standard, and act as an alert that identifies and draws attention to the necessary review of key care elements (6) .…”