Construction of nursing-sensitive quality indicators for hemodialysis vascular access: a Delphi study

Classified as probably not a substantial claim.

Indicators with a mean importance score ≤ 3.5 were excluded.

“(3) indicators with a mean importance score ≤ 3.5 were excluded.”

• cites [23] Yin, 2026, Construction of a core competence index system for undergraduate anesthesia nursing graduates: a Delphi and Analytic Hierarchy Process, BMC Nurs. sourceDisputed

  The Methods section (Phase 2: Delphi consultation and feedback cycle; page unavailable) sets the consensus criterion at a mean importance score ≥ 3.5, so an indicator scoring exactly 3.5 meets that criterion rather than being excluded by it. The paper also says revisions considered other consensus criteria and expert opinions; it does not state that all indicators scoring ≤ 3.5 were excluded. (LLM, conf=0.86)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites [24] Bai, 2022, Construction of a competency evaluation index system for front-line nurses during the outbreak of major infectious diseases: a Delphi study, PLoS ONE. sourceSupported

Classified as probably not a substantial claim.

Indicators with a mean importance score >3.5 and a CV ≥0.25 that were deemed important on the basis of clinical experience were modified and advanced to the next round of inquiry.

“(2) indicators with a mean importance score >3.5 and a CV ≥0.25 that were deemed important on the basis of clinical experience were modified and advanced to the next round of inquiry;”

• cites [23] Yin, 2026, Construction of a core competence index system for undergraduate anesthesia nursing graduates: a Delphi and Analytic Hierarchy Process, BMC Nurs. sourcePartly supported

  The Methods section (Phase 2, Delphi consultation and feedback cycle; page not specified) says the team revised indicators after the first round using expert opinions and sent the revisions into the next round. It does not state that indicators with CV ≥0.25 were advanced because clinical experience deemed them important; its stated consensus criterion was CV ≤0.25, alongside a mean importance score ≥3.5 and a full-score rate ≥20%. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [24] Bai, 2022, Construction of a competency evaluation index system for front-line nurses during the outbreak of major infectious diseases: a Delphi study, PLoS ONE. sourceDisputed

  The Materials and methods section (Data collection; page not provided) describes using a mean score >3.5 and a coefficient of variation <0.25 when discussing adjustments before the second round. The claim reverses the coefficient-of-variation threshold to ≥0.25. The passage also does not specify clinical experience as the reason for advancing such indicators. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

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

CVCIs have become the second leading cause of mortality among hemodialysis patients.

“CVCIs have become the second leading cause of mortality among hemodialysis patients (44).”

• cites [44] Zhang, 2019, Dialysis catheter-related bloodstream infections in patients receiving hemodialysis on an emergency-only basis: a retrospective cohort analysis, Clin Infect Dis. sourceDisputed

  The Results (page not provided) report four deaths from catheter-related bloodstream infection in this emergency-only hemodialysis cohort, compared with 12 from cardiovascular events and eight from other infections. That death count does not support calling catheter-related infection the second leading cause of mortality, and the study does not establish a ranking for hemodialysis patients generally. (LLM, conf=0.84)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

May combine two claims.

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.”

• cites Balouchi et al. [25] Balouchi, 2021, Patient perceived quality of nursing care in hemodialysis: a meta-synthesis, Healthc Low Resour Settings. sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites McIntyre et al. [20] McIntyre, 2020, Identifying nurse sensitive indicators specific to haemodialysis nursing: a Delphi approach, Collegian. sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites Gao et al. [21] Gao, 2018, Construction of nursing-sensitive quality indicators for haemodialysis using Delphi method, J Clin Nurs. sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Indicators with a mean importance score >3.5, a coefficient of variation <0.25, and a full-score rate >20% were retained.

“(1) indicators with a mean importance score >3.5, a coefficient of variation (CV) < 0.25, and a full-score rate >20% were retained;”

• cites [23] Yin, 2026, Construction of a core competence index system for undergraduate anesthesia nursing graduates: a Delphi and Analytic Hierarchy Process, BMC Nurs. sourcePartly supported

  The Methods section (Delphi consultation and feedback cycle) identifies the same three consensus criteria and numerical cutoffs, but uses inclusive thresholds: importance score ≥3.5, CV ≤0.25, and full-score rate ≥20%. The claim’s strict inequalities exclude indicators at those boundary values, which the source does not exclude. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [24] Bai, 2022, Construction of a competency evaluation index system for front-line nurses during the outbreak of major infectious diseases: a Delphi study, PLoS ONE. sourcePartly supported

  The Materials and methods section (Data collection; page unavailable) says the team adjusted indicators using a mean score >3.5 and coefficient of variation <0.25. Neither that section nor the additional passages retrieved from our copy state a full-score-rate threshold >20%, so the third criterion is unsupported. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Prior to expert consultation, the research team established indicator screening criteria.

“Prior to expert consultation, the research team established the following criteria for indicator screening (23, 24):”

• cites [23] Yin, 2026, Construction of a core competence index system for undergraduate anesthesia nursing graduates: a Delphi and Analytic Hierarchy Process, BMC Nurs. sourceSupported
• cites [24] Bai, 2022, Construction of a competency evaluation index system for front-line nurses during the outbreak of major infectious diseases: a Delphi study, PLoS ONE. sourceSupported

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

The expert panel included 8 experts with intermediate professional titles, 8 with senior professional titles, 5 with master's degrees, and 11 with bachelor's degrees.

“The experts included 8 with intermediate professional titles, 8 with senior professional titles, 5 with master's degrees, and 11 with bachelor's degrees.”

Classified as probably not a substantial claim. May combine two claims.

The consultation was terminated after two rounds because all indicators met the pre-specified retention criteria and no further substantive modifications were proposed by any expert in the second round.

“The consultation was terminated after two rounds because all indicators met the pre-specified retention criteria and no further substantive modifications were proposed by any expert in the second round.”

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

A total of 22 studies were included in the evidence summary.

“A summary of the 22 included studies and their evidence sources is presented in Supplementary Table S3.”

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

Experts proposed 23 revision suggestions regarding the indicator content.

“with experts proposing 23 revision suggestions regarding the indicator content”

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

The quality evaluation of the included articles yielded the following evidence levels: Ia, 1 article; IIIa, 2 articles; IVa, 3 articles; Ib, 5 articles; IIb, 6 articles; IIIb, 3 articles; and Vb, 2 articles.

“The quality evaluation results of the included articles were as follows: Ia, 1 article; IIIa, 2 articles; IVa, 3 articles; Ib, 5 articles; IIb, 6 articles; IIIb, 3 articles; and Vb, 2 articles.”

Classified as probably not a substantial claim.

A preliminary questionnaire comprising 3 primary indicators and 16 secondary indicators for hemodialysis vascular access nursing quality assessment was drafted and submitted for expert consultation.

“A preliminary questionnaire comprising 3 primary indicators and 16 secondary indicators for hemodialysis vascular access nursing quality assessment was drafted and submitted for expert consultation.”

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

In the first round, 11 experts proposed modifications to the secondary indicators.

“In the first round, 11 experts proposed modifications to the secondary indicators.”

May combine two claims.

Among the secondary indicators, the nurse-to-patient ratio ranked first (0.3498), followed by establishment of a vascular access monitoring team (0.1925), and pass rate of vascular access nursing training assessment (0.1059).

“Among the secondary indicators, the nurse-to-patient ratio ranked first (0.3498), followed by establishment of a vascular access monitoring team (0.1925), and pass rate of vascular access nursing training assessment (0.1059).”

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

One new indicator was added: 'correct disinfection rate for catheter interface.'

“One new indicator was added: “correct disinfection rate for catheter interface.””

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

The literature search retrieved 2,423 articles.

“A total of 2,423 articles were retrieved.”

May combine two claims.

Among the three primary indicators, the structural indicator had the highest weight (0.6483), followed by the outcome indicator (0.2297), while the process indicator had the lowest weight (0.1220).

“Among the three primary indicators, the structural indicator had the highest weight (0.6483), followed by the outcome indicator (0.2297), while the process indicator had the lowest weight (0.1220).”

May combine two claims.

The mean-score change rate of all retained indicators between the two rounds was less than 5%, and the coefficient of variation for each indicator decreased to below 0.25 in the second round, indicating that expert opinions had stabilized.

“To assess consensus stability, we compared the mean importance scores of all retained indicators between the two rounds, the mean-score change rate was less than 5%, and the coefficient of variation for each indicator decreased to below 0.25 in the second round, indicating that expert opinions had stabilized.”

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

During the second round of correspondence, experts proposed modifying 'incidence of arteriovenous fistula puncture bleeding/hematoma' to 'incidence of arteriovenous fistula puncture injury.'

“During the second round of correspondence, 16 experts re-evaluated the adjusted indicator system, proposing to modify the “incidence of arteriovenous fistula puncture bleeding/hematoma” to “incidence of arteriovenous fistula puncture injury.””

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

The expert panel included 5 males and 11 females; their average age was 41.74 ± 5.86 years, and their average years of work experience was 21.38 ± 7.50 years.

“Among the 16 experts who completed both rounds of correspondence, 5 were males and 11 were females; their average age was 41.74 ± 5.86 years, and their average years of work experience was 21.38 ± 7.50 years.”

May combine two claims.

The mean importance scores of all indicators were >3.5, with a coefficient of variation <0.25, indicating that a consensus was reached.

“The results revealed that the mean importance scores of all the indicators were >3.5, with a coefficient of variation < 0.25, indicating that a consensus was reached.”

May combine two claims.

Following semistructured expert interviews, 2 indicators were removed, 2 indicators were merged into 'correct execution of hand hygiene rate,' and 1 new indicator was added.

“Following the semistructured expert interviews, 2 indicators (“composition ratio of hemodialysis nurses” and “arteriovenous fistula mapping rate”) were removed, while 2 indicators (“correct hand hygiene rate” and “hand hygiene compliance rate”) were merged into “correct execution of hand hygiene rate.” Additionally, 1 new indicator (“establishment of a vascular access monitoring team”) was added.”

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

Two indicators were revised: 'incidence of arteriovenous fistula thrombosis' was changed to 'incidence of arteriovenous fistula aneurysms,' and 'physical examination execution rate for arteriovenous fistula' was revised to 'correct execution rate of physical examination for arteriovenous fistula.'

“Two indicators were revised: “incidence of arteriovenous fistula thrombosis” was changed to “incidence of arteriovenous fistula aneurysms,” and “physical examination execution rate for arteriovenous fistula” was revised to “correct execution rate of physical examination for arteriovenous fistula.”

May combine two claims.

The two rounds of expert inquiries involved the same panel of experts, with Cs = 0.894, Ca = 0.913, and Cr = 0.904.

“In this study, the two rounds of expert inquiries involved the same panel of experts, with Cs = 0.894, Ca = 0.913, and Cr = 0.904.”

May combine two claims.

On the basis of the literature review and interview results and using the Donabedian three-dimensional theoretical model as a framework, a preliminary set of sensitive indicators for hemodialysis vascular access nursing was established, comprising 3 structural indicators, 7 process indicators, and 6 outcome indicators.

“On the basis of the literature review and interview results and using the Donabedian three-dimensional theoretical model as a framework, a preliminary set of sensitive indicators for hemodialysis vascular access nursing was established, comprising 3 structural indicators, 7 process indicators, and 6 outcome indicators.”

May combine two claims.

The outcome indicators included five secondary metrics, with the incidence of central venous catheter-related infections (CVCIs) (0.1049) having the highest combined weight, followed by the long-term utilization rate of arteriovenous fistulas (0.0447).

“The outcome indicators included five secondary metrics, with the incidence of central venous catheter-related infections (CVCIs) (0.1049) having the highest combined weight, followed by the long-term utilization rate of arteriovenous fistulas (0.0447).”

Probably not a substantial claim: may not pass S4 (based).

The integration of the analytic hierarchy process (AHP) reduced the subjective errors inherent in the Delphi method.

“The integration of the analytic hierarchy process (AHP) reduced the subjective errors inherent in the Delphi method.”

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

A study conducted in Mexico confirmed that targeted hand hygiene monitoring can effectively improve hand hygiene compliance, which in turn improves the performance of a series of infection control and care quality indicators.

“A study conducted in Mexico confirmed that targeted hand hygiene monitoring can effectively improve hand hygiene compliance, which in turn improves the performance of a series of infection control and care quality indicators (33).”

• cites [33] Sánchez-Carrillo, 2016, Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback, Am J Infect Control. sourceNot checked — no full text of the source

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

Rodrigues et al. reported that physical examination revealed that experienced nurses achieved greater accuracy (80%) in predicting AVF maturity.

“Rodrigues et al. (38) reported that physical examination revealed that experienced nurses achieved greater accuracy (80%) in predicting AVF maturity.”

• cites [38] Turmel-Rodrigues, 2003, Hemodialysis arteriovenous fistula maturity: US evaluation, Radiology. sourceNot checked — no full text of the source

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

The high response rate and revision suggestions reflect experts' high level of engagement in this research.

“reflecting their high level of engagement in this research”

May combine two claims.

Liu et al. reported that only 40.65% of hemodialysis units in Beijing conducted comprehensive physical examinations prior to internal fistula punctures, with 48.72% in tertiary hospitals and less than 30% in nontertiary hospitals.

“Liu et al. (40) reported that only 40.65% of hemodialysis units in Beijing conducted comprehensive physical examinations prior to internal fistula punctures, with 48.72% in tertiary hospitals and less than 30% in nontertiary hospitals.”

• cites [40] Liu, 2021, The surveillance of arteriovenous fistula dysfunction in Beijing hemodialysis centers: a cross-sectional survey, Chin Nurs Manag. sourceNot checked — no full text of the source

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

A British guideline recommended performing a physical examination before each arteriovenous fistula puncture to ensure that blood flow meets dialysis prescription requirements.

“A British guideline recommended performing a physical examination before each arteriovenous fistula puncture to ensure that blood flow meets dialysis prescription requirements (39).”

• cites [39] Aitken M Angell-Barrick N Brogan R Clinical practice recommendations for needling of arteriovenous fistulae and grafts for haemodialysis. 2018Not matched

  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).

The study was reported in line with the Conducting and Reporting of Delphi studies (CREDE) guidance.

“This study was reported in line with the Conducting and Reporting of Delphi studies (CREDE) guidance on Delphi studies.”

• Also stated in: § Design · plain

  “This study was reported in line with the Conducting and Reporting of Delphi studies (CREDE) guidance, as shown in Supplementary Table S1.”

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

A Cr > 0.9 indicates a high level of expert authority.

“A value of Cr > 0.9 indicates a high level of expert authority.”

May combine two claims.

Structural indicators held the greatest weight, indicating that they serve as the foundation for ensuring the quality of vascular access care for hemodialysis patients.

“In this study, structural indicators held the greatest weight, indicating that they serve as the foundation for ensuring the quality of vascular access care for hemodialysis patients.”

• AssumptionRests on an assumption: The allocation of resources, personnel qualifications, and institutional development at the structural level directly determines the standardization of the nursing process and the safety of outcomes.
• AssumptionRests on an assumption: In institutions where structure indicators do not meet the required standards, even if high requirements are set for process indicators, it is difficult to achieve continuous quality improvement.

May combine two claims.

The experts invited to participate in this study possessed extensive theoretical knowledge and clinical practical experience, with all holding bachelor's degrees or higher and having at least 10 years of professional experience.

“The experts invited to participate in this study possessed extensive theoretical knowledge and clinical practical experience, with all holding bachelor's degrees or higher and having at least 10 years of professional experience.”

Classified as probably not a substantial claim.

The study adopted the Donabedian 'structure-process-result' three-dimensional quality framework as its theoretical basis.

“This study adopted the Donabedian “structure–process–result” three-dimensional quality framework as its theoretical basis.”

May combine two claims.

Currently, only 34.50% of hemodialysis centers in tertiary hospitals in China meet the aforementioned nurse-to-patient ratio requirement, indicating a widespread gap in the allocation of hemodialysis nursing human resources nationwide.

“Currently, only 34.50% of hemodialysis centers in tertiary hospitals in China meet the aforementioned nurse-to-patient ratio requirement (31), indicating a widespread gap in the allocation of hemodialysis nursing human resources nationwide.”

• cites [31] Liu, 2025, Current situation investigation of nursing adverse events and analysis of influencing factors related to nursing human resources in hemodialysis centers attached to class-A tertiary hospitals in China, Chin J Pract Nurs. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Incorporating the physical examination indicator into the vascular access nursing quality monitoring system can help increase hemodialysis nurses' awareness of the importance of physical examinations and promote the establishment of training systems and standardized operational checklists, thereby effectively reducing the failure rate of internal fistulas and ensuring adequate dialysis and long-

“Therefore, incorporating this indicator into the vascular access nursing quality monitoring system can help increase hemodialysis nurses‘ awareness of the importance of physical examinations and promote the establishment of training systems and standardized operational checklists, thereby effectively reducing the failure rate of internal fistulas and ensuring adequate dialysis and long-term”

• AssumptionRests on an assumption: The reasons for low physical examination rates are largely attributed to nurses' insufficient recognition of the clinical value of physical examinations, the lack of standardized operational procedures, and the absence of assessment mechanisms.

May combine two claims.

The 11 indicators identified by Gao et al. include only 3 items related to vascular access, without dimension-specific categorization.

“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.”

• cites [21] Gao, 2018, Construction of nursing-sensitive quality indicators for haemodialysis using Delphi method, J Clin Nurs. sourceNot checked — no full text of the source

May combine two claims.

A study by Moon and Jang in South Korea found that only 33% of medical staff perform standardized hand hygiene after removing gloves, indicating that insufficient hand hygiene compliance is a common problem at home and abroad.

“A study by Moon and Jang (36) in South Korea also found that only 33% of medical staff perform standardized hand hygiene after removing gloves, indicating that insufficient hand hygiene compliance is a common problem at home and abroad.”

• cites [36] Moon, 2018, The performance of healthcare-associated infection control guideline among hospital nurses: a structural equation model, Iran J Public Health.Not checked — no full text of the source

May combine two claims.

The team is mainly composed of specialized vascular access nurses, whose core responsibilities include vascular access assessment, operation quality supervision, early identification of complications, and specialized training for nursing staff.

“The team is mainly composed of specialized vascular access nurses, whose core responsibilities include vascular access assessment, operation quality supervision, early identification of complications, and specialized training for nursing staff (32).”

• cites [32] Savage, 2019, Implementation of a vascular access team to reduce central line usage and prevent central line-associated bloodstream infections, J Infus Nurs. sourceNot checked — no full text of the source

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

In both rounds, 16 questionnaires were distributed and all 16 were recovered, resulting in a 100% valid recovery rate.

“In the first round, 16 questionnaires were distributed, with all 16 completed questionnaires recovered, resulting in a 100% valid recovery rate. In the second round, 16 questionnaires were distributed, with all 16 completed questionnaires recovered, which also resulted in a 100% valid recovery rate, indicating the high level of engagement among the experts in the study.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The three dimensions of indicators support each other and jointly form a complete quality evaluation chain.

“The three dimensions of indicators support each other and jointly form a complete quality evaluation chain.”

May combine two claims.

The CRs for all pairwise comparison matrices were below 0.1 (structural indicators: CR = 0.0079; process indicators: CR = 0.0437; outcome indicators: CR = 0.0341), indicating acceptable consistency.

“The CRs for all pairwise comparison matrices were below 0.1 (structural indicators: CR = 0.0079; process indicators: CR = 0.0437; outcome indicators: CR = 0.0341), indicating acceptable consistency”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The research methodology and procedures were rigorous, and the findings are grounded in the combined input of the expert panel.

“The research methodology and procedures were rigorous, and the findings are grounded in the combined input of the expert panel.”

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

The identities and affiliations of all panel members were kept anonymous to the other experts throughout the consultation.

“Throughout the consultation, the identities and affiliations of all panel members were kept anonymous to the other experts.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Including 'the establishment of a vascular access monitoring team' as a structural indicator has clear clinical significance: it can promote the construction of a stable specialized nursing talent team in hemodialysis centers, reduce nursing quality fluctuations caused by staff turnover, and ensure patient safety from the source of management.

“including “the establishment of a vascular access monitoring team” as a structural indicator has clear clinical significance: it can promote the construction of a stable specialized nursing talent team in hemodialysis centers, reduce nursing quality fluctuations caused by staff turnover, and ensure patient safety from the source of management.”

May combine two claims.

Although the Kendall's W values were statistically significant (p < 0.05), the magnitude of these values (0.136-0.310) indicates moderate consistency.

“Although the Kendall's W values were statistically significant (p < 0.05), the magnitude of these values (0.136–0.310) indicates moderate consistency.”

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

Two research team members independently coded the interview transcripts using thematic analysis, with disagreements resolved through discussion and a third member consulted when needed.

“Two research team members independently coded the transcripts using thematic analysis. Any disagreements were resolved through discussion, with a third member consulted when needed.”

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

Caputo et al. reported that when ultrasound Doppler was used as the gold standard, physical examination showed a sensitivity of 53% for detecting early functional loss of internal fistulas, while the specificity for identifying normal arteriovenous fistulas (AVFs) reached 98%.

“Caputo et al. (37) reported that when ultrasound Doppler was used as the gold standard, physical examination showed a sensitivity of 53% for detecting early functional loss of internal fistulas, while the specificity for identifying normal arteriovenous fistulas (AVFs) reached 98%.”

• cites [37] Caputo, 2021, Arteriovenous fistula maturation: physical exam versus flow study, Ann Vasc Surg. sourceNot checked — no full text of the source

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

Each eligible article was independently evaluated by two study team members according to the Johns Hopkins Nursing Evidence-based Practice model, with disagreements resolved by a third member or collective discussion.

“Evidence evaluation was conducted according to the evidence assessment method in the Johns Hopkins Nursing Evidence-based Practice (JHNEBP) model (22). Each eligible article was independently evaluated by two study team members. In cases of disagreement, a third member was involved in the evaluation. If a consensus could not be reached, the study team conducted a collective discussion.”

• cites [22] Dang, 2021, Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and GuidelinesNot checked yet

  Not checked in the free run.

May combine two claims.

The nurse-to-patient ratio had the highest combined weight (0.3498), followed by the indicator of establishing a vascular access monitoring team, highlighting the importance of adequate nursing staffing in ensuring vascular access care quality.

“Among these, the nurse-to-patient ratio had the highest combined weight (0.3498), followed by the indicator of establishing a vascular access monitoring team, highlighting the importance of adequate nursing staffing in ensuring vascular access care quality.”

• AssumptionRests on an assumption: The nurse-to-patient ratio reflects the rationality of human resource allocation, and directly affects the timeliness and continuity of nursing practice.

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

Two research team members independently screened the titles and abstracts of all retrieved records, followed by full-text assessment against pre-specified eligibility criteria, with disagreements resolved through discussion or by consulting a third team member.

“Two research team members independently screened the titles and abstracts of all retrieved records, followed by full-text assessment against the pre-specified eligibility criteria. Disagreements were resolved through discussion or by consulting a third team member.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

The indicators identified in this study are highly consistent with those in clinical practice, demonstrating sensitivity and practicality.

“The indicators identified in this study are highly consistent with those in clinical practice, demonstrating sensitivity and practicality.”

May combine two claims.

All experts were recruited from within China, which may introduce regional and cultural biases.

“Second, all experts were recruited from within China, which may introduce regional and cultural biases.”

Classified as probably not a substantial claim. May combine two claims.

Its practical operability, data accessibility, inter-rater reliability, as well as associations with clinical outcomes including vascular access-related adverse event rates and patient satisfaction, remain to be verified in further empirical studies.

“Its practical operability, data accessibility, inter-rater reliability, as well as associations with clinical outcomes including vascular access-related adverse event rates and patient satisfaction, remain to be verified in further empirical studies.”

Classified as probably not a substantial claim. May combine two claims.

If a hemodialysis center detects a higher-than-national-average incidence of catheter-related infections through routine monitoring, it can trace back to structural and process indicators to locate the root cause, develop targeted improvement strategies, and validate the improvement effect via subsequent outcome indicator data, thus forming a complete closed-loop management workflow.

“For instance, if a hemodialysis center detects a higher-than-national-average incidence of catheter-related infections through routine monitoring, it can trace back to structural and process indicators (e.g., the correct execution of hand hygiene rate, nurse-to-patient ratio) to locate the root cause, develop targeted improvement strategies, and validate the improvement effect via subsequent out”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The application of outcome indicators enables managers to accurately identify weak links in nursing quality and verify the effectiveness of quality improvement interventions.

“The application of outcome indicators enables managers to accurately identify weak links in nursing quality and verify the effectiveness of quality improvement interventions.”

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

The incidence of CRBSI has long been a core indicator highlighted in international clinical guidelines.

“Notably, the incidence of CRBSI has long been a core indicator highlighted in international clinical guidelines (45, 46).”

• cites [45] Ibeas, 2017, Spanish clinical guidelines on vascular access for haemodialysis, Nefrologia. sourceNot checked — no full text of the source
• cites [46] Lok, 2020, KDOQI Clinical Practice Guideline for vascular access: 2019 update, Am J Kidney Dis. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Since this study did not define predefined thresholds for the outcome indicators, other countries or regions can make adaptive adjustments to the indicator thresholds according to their local healthcare contexts and resource availability in subsequent clinical applications.

“Since this study did not define predefined thresholds for the outcome indicators, other countries or regions can make adaptive adjustments to the indicator thresholds according to their local healthcare contexts and resource availability in subsequent clinical applications.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Application of this system outside China will require adaptive adjustments and local validation according to regional healthcare contexts.

“Additionally, application of this system outside China will require adaptive adjustments and local validation according to regional healthcare contexts.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

This system combines standardization with a systematic methodological approach, aligns with clinical nursing practice scenarios and nursing management needs, and provides a reference for nursing managers to implement precision nursing quality control.

“This system combines standardization with a systematic methodological approach, aligns with clinical nursing practice scenarios and nursing management needs, and provides a reference for nursing managers to implement precision nursing quality control.”

May combine two claims.

This study is the first to propose separate monitoring of the three indicators (catheter exit site infections, catheter tunnel infections, and catheter-related bloodstream infections), which facilitates early clinical detection of catheter infection signs and advances the prevention of infection, thereby avoiding severe CRBSI in patients.

“This study is the first to propose separate monitoring of the three indicators, which facilitates early clinical detection of catheter infection signs and advances the prevention of infection, thereby avoiding severe CRBSI in patients.”

• AssumptionRests on an assumption: Surveillance data on exit site infections and tunnel infections remain scarce in the literature.

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

Data from the National Health care Security Network (NHSN) indicate a 2.16% CVCIs rate, with 70% of cases occurring in long-term catheterization patients.

“Data from the National Health care Security Network (NHSN) (47) indicate a 2.16% CVCIs rate, with 70% of cases occurring in long-term catheterization patients.”

• cites [47] Kumbar, 2019, Current concepts in hemodialysis vascular access infections, Adv Chronic Kidney Dis. sourceNot checked — no full text of the source

May combine two claims.

The panel excluded patients and caregivers, although this was a deliberate choice given the study's aim of constructing a clinically grounded nursing quality measurement tool, for which frontline nurses, physicians, and nursing managers are the primary knowledge holders.

“The panel also excluded patients and caregivers, although this was a deliberate choice given the study's aim of constructing a clinically grounded nursing quality measurement tool, for which frontline nurses, physicians, and nursing managers are the primary knowledge holders.”