Sheehan Rosemarie, Ryder Mary, Brenner Maria
School of Nursing and Midwifery Health Systems, University College Dublin, Ireland.
Int J Nurs Stud Adv. 2024 Nov 29;8:100275. doi: 10.1016/j.ijnsa.2024.100275. eCollection 2025 Jun.
This paper highlights the need for nursing-sensitive indicators tailored to children and young people with complex and integrated care needs. While nursing plays a pivotal role in influencing care quality for this population, current measures predominantly focus on adult populations, creating gaps that hinder the evaluation of nursing contributions across diverse settings such as acute, community, and home care. We examine the importance of quality care measurement for children and young people with complex and integrated care needs and highlight deficiencies in international measurement systems. The discussion highlights the multidimensional care needs of this vulnerable population and advocates for nursing-sensitive indicators that capture broader outcomes including physical health, functional outcomes, family experience, and family well-being. Also highlighted is, the weak evidence linking process indicators to improved patient outcomes, a focus on negative outcomes, such as mortality, and the lack of theoretical foundations for nursing-sensitive indicators. There is a lack of consensus on what components to measure, definitions of indicators, and appropriate methodologies for the development of nursing sensitive indicators. Donabedian's (1988) structures, processes, and outcomes framework is discussed as well as an overview of adaptations used to improve the quality of indicator sets in a variety of settings. By situating the discussion within the context of children's and young people's nursing, this paper aims to direct future research towards the development of comprehensive indicators that capture the full contribution of nursing to the care of children and young people with complex and integrated care needs. Ultimately, this paper advocates for a standardised, holistic approach to nursing-sensitive indicators for this vulnerable population to improve care quality and overall health and wellbeing for children, young people, and their families.
本文强调了针对有复杂综合护理需求的儿童和青少年制定护理敏感指标的必要性。虽然护理在影响这一人群的护理质量方面发挥着关键作用，但目前的措施主要侧重于成年人群体，从而产生了差距，阻碍了在急性、社区和家庭护理等不同环境中对护理贡献的评估。我们研究了针对有复杂综合护理需求的儿童和青少年进行优质护理测量的重要性，并突出了国际测量系统中的不足之处。讨论突出了这一弱势群体的多维度护理需求，并倡导采用护理敏感指标，以涵盖更广泛的结果，包括身体健康、功能结果、家庭体验和家庭福祉。还强调了将过程指标与改善患者结果联系起来的证据不足、对死亡率等负面结果的关注，以及护理敏感指标缺乏理论基础。在测量哪些组成部分、指标的定义以及开发护理敏感指标的适当方法方面缺乏共识。文中讨论了唐纳贝迪安（1988年）的结构、过程和结果框架，以及为提高各种环境下指标集质量而采用的适应性概述。通过将讨论置于儿童和青少年护理的背景下，本文旨在引导未来的研究朝着开发全面指标的方向发展，这些指标能够充分体现护理对有复杂综合护理需求的儿童和青少年护理的贡献。最终，本文倡导为这一弱势群体采用标准化、整体化的护理敏感指标方法，以提高儿童、青少年及其家庭的护理质量和整体健康与福祉。
