Identifying nurse sensitive indicators specific to haemodialysis nursing: A Delphi approach

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).”

Studies by McIntyre et al. (20) in Canada and Gao et al. (21) in China have verified the negative correlation between the nurse-to-patient ratio and the incidence of adverse events in hemodialysis patients.

“Additionally, studies by McIntyre et al. (20) in Canada and Gao et al. (21) in China have also verified the negative correlation between the nurse-to-patient ratio and the incidence of adverse events in hemodialysis patients.”

Inadequate nurse staffing will directly lead to an excessive number of patients per nurse, which in turn reduces the standardization of vascular access assessment and maintenance procedures, and elevates the risk of adverse events such as unplanned extubation and catheter-related infections.

“Inadequate nurse staffing will directly lead to an excessive number of patients per nurse, which in turn reduces the standardization of vascular access assessment and maintenance procedures, and elevates the risk of adverse events such as unplanned extubation and catheter-related infections.”

Among the 26 hemodialysis nursing quality indicators developed by McIntyre et al., only 5 items are related to vascular access.

“Among the 26 hemodialysis nursing quality indicators developed by McIntyre et al. (20), only 5 items are related to vascular access, and the 11 indicators identified by Gao et al. (21) include only 3 items related to vascular access, without dimension-specific categorization.”

Existing studies focus primarily on the construction of general hemodialysis nursing quality indicators, with only a few items related to vascular access.

“Existing studies focus primarily on the construction of general hemodialysis nursing quality indicators, with only a few items related to vascular access, and the constructed indicators do not fully encompass the three dimensions of structure–process–outcome.”

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.”

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.”

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.”

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.”

The constructed indicators in existing studies do not fully encompass the three dimensions of structure-process-outcome.

“Existing studies focus primarily on the construction of general hemodialysis nursing quality indicators, with only a few items related to vascular access, and the constructed indicators do not fully encompass the three dimensions of structure–process–outcome.”