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Cited by 28Delphi Technique in ResearchHealthcare Quality and ManagementDialysis and Renal Disease Management

Construction of haemodialysis nursing‐sensitive quality indicators based on Donabedian theory: A Delphi method study

Open access
Chen, Lin, Zhang, Yingjun, Li, Chao, Li, Qiao, He, Li·2023·Nursing Open
DOI 10.1002/nop2.1349PMC PMC9834505
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Abstract

Aims: To establish a sensitive, scientific and practical evaluation system for haemodialysis nursing and to provide a reference for the evaluation of haemodialysis nursing quality. Design: Through a literature review and Delphi method. Method: According to the literature review, a preliminary nursing‐sensitive quality indicators for haemodialysis were established, and an expert survey questionnaire was designed. Finally, the evaluation system for the nursing‐sensitive quality indicators was determined using the Delphi method. Results: Thirteen nursing‐sensitive quality indicators for haemodialysis were finally constructed, including two structural indicators, three process indicators and eight outcome indicators. The effective recovery rate of the two rounds of expert survey questionnaires was 100%, the coefficient of judgement basis is 0.956, the coefficient of familiarity is 0.833, the coefficient of authority is 0.895, and the Kendall's harmony coefficients of the two rounds of expert consultation were 0.158 ~ 0.307 and 0.170 ~ 0.315, respectively, with statistical significance (p < .05). Clinical relevance: In this study, the nursing‐sensitive quality indicators for haemodialysis were developed by the Delphi method and included structural indicators, outcome indicators and process indicators, which made up for some deficiencies noted in previous studies. The authors have provided a more reliable and comprehensive basis for evaluating the quality and safety of haemodialysis nursing in the future.

AI snapshot

Written from the paper’s full text.

TL;DR

This study used a literature review and two-round Delphi method to construct 13 nursing-sensitive quality indicators for haemodialysis based on Donabedian’s structure–process–outcome model. The final set comprised 2 structural, 3 process, and 8 outcome indicators, with 100% expert questionnaire recovery and statistically significant Kendall’s harmony coefficients.

Key findings

  • The final haemodialysis nursing-sensitive quality indicator system contained 13 indicators: 2 structural, 3 process, and 8 outcome indicators.
  • Structural indicators were nurse–patient ratio and blood purification specialist nurses to general nurse composition ratio; process indicators were correct rate of hand hygiene execution, standard fixation rate of catheter/puncture needle, and puncture execution rate of arteriovenous fistula rope ladder.
  • Outcome indicators included central venous catheter infection incidence, dialysis period weight control success rate, extracorporeal circulation coagulation incidence, unplanned extubation incidence, haemodialysis hypotension incidence, urea clearance index (Kt/V) compliance rate, falls incidence, and patient satisfaction.
  • Expert authority coefficients were judgement basis 0.956, familiarity 0.833, and authority 0.895; two-round questionnaire recovery was 100%, and Kendall’s harmony coefficients were 0.158–0.307 and 0.170–0.315, respectively, with p < .05.

Methods

  • Design: literature review followed by a two-round Delphi expert consultation, using Donabedian’s three-dimensional quality structure and China’s Medical Quality Control Indicators of Nephropathy (2020) as theoretical basis.
  • Sample: 15 experts from Sichuan, Chongqing, Hubei, Gansu and other places, including 4 doctors (26.7%) and 11 nurses (73.3%), aged 38–50 years; all had ≥10 years of working experience and at least an intermediate professional title.
  • Analysis: indicators were scored 1–5 for importance; deletion criteria were mean importance <3.50 or coefficient of variation >0.25. SPSS 23.0 and Excel were used, with non-parametric tests for expert coordination.

Limitations

  • The paper states that experts were selected from only five provinces and cities in China due to time and space reasons, and suggests future stratified sampling among experts nationwide to improve representativeness.
  • The paper states this was a preliminary investigation using nursing-sensitive quality indicators to evaluate haemodialysis nursing quality; full application and establishment of a cross-regional, hierarchical database are left for future research.
  • Evident from the text: the indicators were developed through expert consensus but were not yet field-tested for measurement performance or patient outcomes in routine haemodialysis practice.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/nop2.1349

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

9 of 28 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured

  • Findingreasoning

    The three process indicators in this study were different from the eight process indicators in McIntyre et al. (2019).

    “The three process indicators in this study were different from the eight process indicators in McIntyre et al. (2019), which may be related to different national conditions and different care concerns of haemodialysis centres.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites McIntyre et al. (2019) source
  • Premisecitation

    At present, the urea clearance index (Kt/V) is commonly used to evaluate dialysis adequacy for haemodialysis patients.

    “At present, the urea clearance index (Kt/V) is commonly used to evaluate the dialysis adequacy for haemodialysis patients (Hasan et al., 2021), so in this study, the compliance rate of Kt/V was included as an outcome indicator.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hasan et al., 2021 source
  • Premisecitation

    Among structural indicators, the nurse-patient ratio is the most basic and important indicator.

    “Among the structural indicators, the most basic and important indicator is the nurse–patient ratio, which has been confirmed in the studies of McIntyre et al. (2019) and Gao et al. (2018).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites McIntyre et al. (2019) source

      Section 5.1 identifies the nurse-to-patient ratio as a necessary structural indicator in haemodialysis nursing. It does not call it the most basic or most important; section 4.2 says most structural indicators were rated important or highly important, without ranking the ratio above them. Page numbers are unavailable in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Gao et al. (2018) source
  • Findingown data

    The coefficient of authority was 0.895.

    “the coefficient of authority is 0.895”
    • Also stated in: § Enthusiasm and authority of experts · plain
      “the coefficient of authority is 0.895”
    Quote in the paperNot a substantial claim
  • Findingown data

    The second round of expert consultation had no modified opinions.

    “Finally, 13 indicators entered the second round of consultation, and the second round of expert consultation had no modified opinions.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 22
  • Classified as probably not a substantial claim. 15
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    In haemodialysis units, the ratio of nurses to patients can affect patient prognosis; fewer nurses directly affects treatment compliance, resulting in increased hospitalization and mortality.

    “In haemodialysis units, the ratio of nurses to patients can affect the prognosis of patients, and having fewer nurses directly affects the treatment compliance of patients, resulting in an increased hospitalization rate and mortality rate.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites McIntyre et al. (2019) source
    • cites Gao et al. (2018) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Process indicators refer to the process that patients undergo or that nurses specifically implement, which can reflect the specific activities required in the provision of medical services.

    “Process indicators refer to the process that patients undergo or that nurses specifically implement, which can reflect the specific activities required in the provision of medical services (Niihata et al., 2018).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Niihata et al., 2018 source

      The Data extraction section defines process indicators as activities modifiable by health care professionals, giving blood tests and noninvasive procedures as examples. The Discussion says they detect changes in practice. This supports the claim’s general description of care activities, but the paper does not define them specifically by what patients undergo or nurses implement; it also specifies that they do not depend on the patient’s condition. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Outcome indicators mainly include patient satisfaction and overall quality evaluation.

    “Outcome indicators mainly included patient satisfaction and overall quality evaluation (Zhang, Chen, et al., 2021).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Zhang, Chen, et al., 2021 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The difference between this study's process indicators and McIntyre et al. (2019) may be related to different national conditions and different care concerns of haemodialysis centres.

    “The three process indicators in this study were different from the eight process indicators in McIntyre et al. (2019), which may be related to different national conditions and different care concerns of haemodialysis centres.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites McIntyre et al. (2019) source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Approximately 30%-37% of haemodialysis patients have water retention, and excessive fluid volume is closely related to difficulty correcting haemodialysis-related complications and is a major factor affecting patient death.

    “Approximately 30% ~ 37% of haemodialysis patients have water retention, and excessive fluid volume is closely related to difficulty correcting haemodialysis‐related complications and is a major factor affecting patient death (Fernandes et al., 2021; Keber et al., 2021).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Fernandes et al., 2021 source

      The Introduction says fluid overload in hemodialysis patients is associated with complications and increased mortality, supporting the claim's general link to poor outcomes. It gives no 30%–37% estimate and does not say that fluid overload makes hemodialysis-related complications difficult to correct. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Keber et al., 2021 source

  • May combine two claims.

    Premisecitation

    McIntyre et al. constructed 26 sensitive indicators of haemodialysis nursing quality through four rounds of Delphi expert consultation, including four structural, eight process, and 14 outcome indicators.

    “David (McIntyre et al., 2019) et al. constructed 26 sensitive indicators of haemodialysis nursing quality through four rounds of Delphi expert letter consultation, including four structural indicators, eight process indicators and 14 outcome indicators.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites McIntyre et al., 2019 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In the first round of consultation, eight experts put forward 20 suggestions for revising the text.

    “In the first round of consultation, eight experts put forward 20 suggestions for revising the text.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the second round, Kendall's harmony coefficients ranged from 0.170 to 0.315, with statistical significance (p < .05).

    “the Kendall's harmony coefficients of the two rounds of expert consultation were 0.158 ~ 0.307 and 0.170 ~ 0.315, respectively, with statistical significance (p < .05).”
    • Also stated in: § Degree of coordination of expert opinions · plain
      “Kendall's harmony coefficients of the two rounds of expert consultation were 0.158–0.307 and 0.170–0.315, respectively, both p < .05”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    After the first round of expert consultation, 13 indicators entered the second round.

    “Finally, 13 indicators entered the second round of consultation, and the second round of expert consultation had no modified opinions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    The other outcome indicators of this study were similar to those of Gao Ju Lin.

    “The other outcome indicators of this study were similar to those of Gao Ju Lin.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Thirteen nursing-sensitive quality indicators for haemodialysis were finally constructed, including two structural, three process, and eight outcome indicators.

    “Thirteen nursing‐sensitive quality indicators for haemodialysis were finally constructed, including two structural indicators, three process indicators and eight outcome indicators.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The literature review yielded 16 preliminary nursing-sensitive indicators for haemodialysis: three structural, four process, and nine outcome indicators.

    “finally obtained 16 indicators, including three structural indicators, four process indicators and nine outcome indicators, as shown in Figure 1.”
    • Also stated in: § Design · plain
      “The first round of survey questionnaires included three structural indicators, four process indicators, nine outcome indicators.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the first round, Kendall's harmony coefficients ranged from 0.158 to 0.307, with statistical significance (p < .05).

    “the Kendall's harmony coefficients of the two rounds of expert consultation were 0.158 ~ 0.307 and 0.170 ~ 0.315, respectively, with statistical significance (p < .05).”
    • Also stated in: § Degree of coordination of expert opinions · plain
      “Kendall's harmony coefficients of the two rounds of expert consultation were 0.158–0.307 and 0.170–0.315, respectively, both p < .05”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    This study constructed 13 sensitive quality indicators for haemodialysis nursing through two rounds of the Delphi method, comprising two structural, three process, and eight outcome indicators.

    “In conclusion, based on a literature search and Donabedian's theory, this study successfully constructed 13 sensitive quality indicators for haemodialysis nursing through two rounds of the Delphi method.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    If hand hygiene is not up to standard, haemodialysis nurses will become carriers of various pathogenic microorganisms, which can easily lead to nosocomial infections.

    “If hand hygiene is not up to standard, they will become carriers of various pathogenic microorganisms, which can easily lead to nosocomial infections (Luo Jia et al., 2021).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Luo Jia et al., 2021

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The two rounds of consulting experts were the same.

    “In this study, the two rounds of consulting experts were the same, and the coefficient of judgement basis is 0.956, the coefficient of familiarity is 0.833, and the coefficient of authority is 0.895.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The Institutional Review Board approved the study as a quality improvement study and waived the need for informed consent.

    “The Institutional Review Board approved the study as a quality improvement study and waived the need for informed consent by issuing a statement of no objection.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The developed indicator set includes structural, process, and outcome indicators, making up for deficiencies noted in previous studies.

    “In this study, the nursing‐sensitive quality indicators for haemodialysis were developed by the Delphi method and included structural indicators, outcome indicators and process indicators, which made up for some deficiencies noted in previous studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Some outcome indicators identified in this study are directly related to process indicators; for example, hand hygiene performance is directly linked to infection occurrence.

    “Some outcome indicators identified in this study are directly related to process indicators. For example, there is a direct link between how well hand hygiene is performed and the occurrence of infection.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The sensitive quality indicators of haemodialysis developed by the Delphi method in this study made up for some deficiencies of previous studies and provided a more reliable and comprehensive basis for evaluating the quality and safety of haemodialysis nursing in the future.

    “In this study, the sensitive quality indicators of haemodialysis developed by the Delphi method included structural indicators, outcome indicators and process indicators, which made up for some deficiencies of previous studies and provided a more reliable and comprehensive basis for evaluating the quality and safety of haemodialysis nursing in the future.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Specialized blood purification nurses have higher skills than ordinary nurses, and patient satisfaction is higher than with ordinary nurses.

    “The specialized blood purification nurses have higher skills than ordinary nurses, and patient satisfaction is also higher than with ordinary nurses (Huang Ling et al., 2019).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Huang Ling et al., 2019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    This is a preliminary investigation using NSQIs to evaluate the nursing quality of haemodialysis.

    “Second, this is a preliminary investigation using NSQIs to evaluate the nursing quality of haemodialysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    The 13 sensitive quality indicators constructed in this study are scientific, reliable and practical in their application, and can be used as an evaluation tool for patient outcomes and as a quantitative assessment tool for the provision of haemodialysis nursing services.

    “These indicators are scientific, reliable and practical in their application, and they can be used as an evaluation tool for patient outcomes and as a quantitative assessment tool for the provision of haemodialysis nursing services.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The expert panel consisted of 15 experts, including four doctors and 11 nurses.

    “A total of 15 experts aged between 38–50 participated in the first round and 15 in the second round (100% response rate), including four doctors (26.7%) and 11 nurses (73.3%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Li Yi (2019) constructed 13 sensitive quality indicators for specialized care of blood purification, including three structural and 10 outcome indicators.

    “Li Yi (2019) constructed a set of 13 sensitive quality indicators for the specialized care of blood purification, including three structural indicators and 10 outcome indicators.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Li Yi (2019)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The incidence of unplanned extubation in haemodialysis patients is 23.3%.

    “Study have reported that the incidence of unplanned extubation in haemodialysis patients is 23.3% (Hu Liping et al., 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hu Liping et al., 2016

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    IDH is closely related to the quality of life and long-term survival time of MHD patients.

    “IDH is closely related to the quality of life and long‐term survival time of MHD patients (Chou et al., 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chou et al., 2018

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisereasoning

    The studies by Li Yi (2019) and Gao et al. (2018) did not include process indicators.

    “However, these two studies did not include process indicators, and because process quality is an important link to ensure nursing quality through the implementation of oversight in the nursing process, it should be included in the index system.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Li Yi (2019)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Gao et al. (2018) source
    • Rests on an assumption: Process quality is an important link to ensuring nursing quality and should be included in the indicator system.

  • May combine two claims.

    Premisecitation

    Existing studies have confirmed that rope ladder puncture results in fewer complications, and many guidelines recommend rope ladder puncture as the preferred puncture method.

    “As existing studies have confirmed that rope ladder puncture will result in fewer complications, many guidelines recommend rope ladder puncture as the preferred puncture method (Jin Qizhuang & Chaoyang, 2019; Lok et al., 2020).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Jin Qizhuang & Chaoyang, 2019

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Lok et al., 2020 source

  • May combine two claims.

    Interpretationown data

    The second round's Kendall's W was higher than the first round's, indicating that expert opinions tended to be consistent.

    “Although Kendall's W was not high, the second round was higher than the first round, indicating that expert opinions tended to be consistent.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Structural indicators express the impact of the environment on nursing, including material resources, human resources and organizational structure.

    “Structural indicators express the impact of the environment on nursing, including material resources, human resources and organizational structure (Waltering et al., 2020).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Waltering et al., 2020 source

  • May combine two claims.

    Premisecitation

    Unplanned extubation is mainly caused by irregular catheter fixation, and it can be reduced to 11.1% through nursing interventions.

    “Analysis of the reasons found that it is mainly caused by irregular catheter fixation, which can be reduced to 11.1% through nursing interventions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hu Liping et al., 2016

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Blood purification specialist nurses provide professional nursing services such as treatment, monitoring, support and help to blood purification patients.

    “Blood purification specialist nurses take blood purification patients as their focus and provide them with a series of professional nursing services, such as treatment, monitoring, support and help (Gao Yan et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gao Yan et al., 2020

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

33 of 33

  • The paper relies on this without support.

    Process quality is an important link to ensuring nursing quality and should be included in the indicator system.

    “because process quality is an important link to ensure nursing quality through the implementation of oversight in the nursing process, it should be included in the index system.”

  • The paper relies on this without support.

    Some indicators from McIntyre et al. are not suitable for haemodialysis nursing management in China due to cultural differences.

    “However, due to cultural differences, some indicators are not suitable for the nursing management of haemodialysis centres in China.”

  • The paper relies on this without support.

    The haemodialysis room is a high-risk department for nosocomial infection and a key department for nosocomial infection management.

    “The haemodialysis room is a high‐risk department for nosocomial infection and a key department for nosocomial infection management.”

  • The paper relies on this without support.

    Haemodialysis nurses undertake most of the tasks in haemodialysis rooms.

    “Haemodialysis nurses undertake most of the tasks in haemodialysis rooms.”

  • The paper relies on this without support.

    Hand hygiene is the most basic and important means for haemodialysis patients to prevent nosocomial infection.

    “Hand hygiene is the most basic and important means for haemodialysis patients to prevent nosocomial infection, so it is necessary to strengthen the monitoring and the rate of the correct hand hygiene execution.”

  • The paper relies on this without support.

    Arteriovenous fistula is the most ideal vascular access for haemodialysis patients.

    “Arteriovenous fistula is the most ideal vascular access for haemodialysis patients.”

  • The paper relies on this without support.

    Dialysis patients with indurated central venous catheters are prone to hospital-acquired infections, which can reduce the efficiency of haemodialysis, increase the economic burden of the patients and even endanger their lives.

    “Dialysis patients with indurated central venous catheters are prone to hospital‐acquired infections, which can reduce the efficiency of haemodialysis, increase the economic burden of the patients and even endanger their lives.”

  • The paper relies on this without support.

    Dialysis catheters must be removed for serious infections.

    “Dialysis catheters must be removed for serious infections.”

  • The paper relies on this without support.

    Interdialytic weight gain is an effective objective indicator to evaluate the fluid intake behaviour of haemodialysis patients.

    “Interdialytic weight gain is an effective objective indicator to evaluate the fluid intake behaviour of haemodialysis patients.”

  • The paper relies on this without support.

    During haemodialysis, minor external coagulation may affect the adequacy of dialysis, while severe coagulation may even lead to dialysis interruption and anaemia.

    “During haemodialysis, minor external coagulation may affect the adequacy of dialysis, while severe coagulation may even lead to dialysis interruption and anaemia.”

  • The paper relies on this without support.

    The incidence of intradialytic hypotension (IDH) in dialysis is high, and it occurs in approximately 20–30% of dialysis patients.

    “The incidence of intradialytic hypotension (IDH) in dialysis is high, and it occurs in approximately 20–30% of dialysis patients.”

  • The paper relies on this without support.

    Haemodialysis nurses are the closest contacts of haemodialysis patients and can be the first to observe the changes in patients' condition during dialysis.

    “Haemodialysis nurses are the closest contacts of haemodialysis patients and can be the first to observe the changes in patients' condition during dialysis.”

  • The paper relies on this without support.

    Dialysis patients with fragile bones are prone to renal anaemia, mineral metabolism disorders, malnutrition, dizziness, fatigue and other symptoms affecting their ability to exercise.

    “Dialysis patients with fragile bones are prone to renal anaemia, mineral metabolism disorders, malnutrition, dizziness, fatigue and other symptoms affecting their ability to exercise.”

  • The paper relies on this without support.

    Compared with the general population, haemodialysis patients have a higher incidence of accidental falls and related fractures.

    “Compared with the general population, haemodialysis patients have a higher incidence of accidental falls and related fractures.”

  • The paper relies on this without support.

    Haemodialysis patients are often associated with cardiopulmonary dysfunction, such as arrhythmias and postdialysis orthostatic hypotension, all of which led to a higher propensity for cardiogenic syncope, leading to falls.

    “In addition, these patients are often associated with cardiopulmonary dysfunction, such as arrhythmias and postdialysis orthostatic hypotension, all of which led to a higher propensity for cardiogenic syncope, leading to falls.”
15 of 15

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Nurse-patient ratio is calculated in the opposite direction from its definition

    Minor

    The definition specifies nurses divided by patients, but the calculation formula divides patients by nurses.

  • Falls indicator counts patients in its definition but falls in its formula

    Minor

    The definition counts patients who fell; the formula counts falls. A patient who falls more than once would produce different results.

2 of 2

Cites

Flagged first, then by citations

1 of the 32 references couldn’t be matched to a known paper.

Research works printed but not linked: 7

  1. 10.3760/cma.j.cn115682‐20191125‐04292 · DOI
  2. 10.16460/j.issn1008‐9969.2016.09.019 · DOI
  3. 10.12102/j.issn.1009‐6493.2019.01.026 · DOI
  4. Jin Qizhuang W. Y., 2019, Consensus among experts on blood access used for hemodialyis in China (The 2nd edition), Chinese Journal of Blood Purification, 18, 365
  5. Li Y., 2016, Practical manual of nursing sensitive quality indicators
  6. Luo Jia F. L., 2021, Application of Donabedian quality theory in continuous improvement of hand hygiene in blood purification center, Chinese Journal of Infection Control, 20, 462
  7. Zhang Jieting L. J., 2015, Renal care and hemodialysis in Hong Kong, Chinese Journal of Blood Purification, 14, 379

Cited by

Sorted by citations

Related

Authors
Chen, L., Zhang, Y., Li, C., Li, Q., & He, L.
Affiliations
Sichuan University (CN)
Corresponding author
Chen, Lin
ORCID
Venue
Nursing Open
Publisher
Wiley
Published
2022-08-30
Volume
10
Issue
2
Pages
807-816
ISSN
2054-1058 (ISSN-L)
DOI
10.1002/nop2.1349
PMC
PMC9834505
OpenAlex
W4293679156
Semantic Scholar
46580cb3a364eb0e5a85e52abbf2fd7f0a241ee8
Cited by
28
References
32
Citations by year
2026: 10 · 2025: 7 · 2024: 4 · 2023: 6 · 2022: 1
FWCI
6.47
Type
journal article
Language
en
Open access
Licence
Locations
  • Nursing Open (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Sichuan University
Topics
  • Social Sciences › Sociology and Political Science › Delphi Technique in Research
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
nursing-sensitive quality indicators, nursing quality assessment, structural indicators, process indicators, outcome indicators
MeSH terms
Delphi Technique, Group Processes, Renal Dialysis, Surveys and Questionnaires, Quality Indicators, Health Care

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-27.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-27.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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