Baillie Jessica, Bonner Ann, Guillouet Sonia, Mikut Cornelia, Punzalan Sally, Kaczmarek Anna, Wenzyl Lawrence Climaco, Finderup Jeanette
School of Healthcare Sciences, Cardiff University, Cardiff, UK.
School of Nursing and Midwifery, Griffith University, Australia and Aarhus University, Gold Coast, Denmark.
J Ren Care. 2025 Mar;51(1):e70008. doi: 10.1111/jorc.70008.
Nursing sensitive indicators are a way of measuring aspects of patient care that are most affected by the actions of the nurse. Despite the existence of nursing sensitive indicators, these are largely not suitable to measure peritoneal dialysis nursing practice.
This project aimed to co-develop a set of peritoneal dialysis nursing-sensitive indicators.
Informed by the Donabedian quality framework (structure, process, outcome), a multinational co-production consensus design was used.
First, an expert panel of seven professionals proposed potential indicators from clinical expertise and examining peer-reviewed articles and clinical guidelines. Next, the expert panel undertook a consensus building process involving face-to-face meetings and online discussion to refine the indicators. Lastly indicator confirmation was undertaken using a 5-point rating scale involving delegates at a major conference.
The initial indicator proposal, based on evidence and clinical experience, identified 65 potential indicators (20 structural, 22 process and 23 outcome). The consensus process involved discussion and negotiation to reduce the potential indicators to 28 (eight structural, 12 process and eight outcome). Confirmation involved 25 nurses with all 28 indicators supported (all > 3.5/5). Indicators highly supported were patient satisfaction, fluid balance assessment, peritoneal dialysis catheter exit-site, clinical signs measurement, peritonitis investigation, peritoneal dialysis catheter complications referral and infection rates.
Following further validity, reliability and feasibility testing, these nursing sensitive indicators can be used to measure the quality of peritoneal dialysis nursing care provided for patients and families.
护理敏感指标是衡量受护士行为影响最大的患者护理方面的一种方式。尽管存在护理敏感指标，但这些指标在很大程度上并不适用于衡量腹膜透析护理实践。
本项目旨在共同制定一套腹膜透析护理敏感指标。
以唐纳贝迪安质量框架（结构、过程、结果）为指导，采用跨国联合生产共识设计。
首先，由七名专业人员组成的专家小组根据临床专业知识、查阅同行评审文章和临床指南提出潜在指标。接下来，专家小组开展了一个共识构建过程，包括面对面会议和在线讨论，以完善指标。最后，在一次大型会议上，使用5分制评分量表对代表们进行指标确认。
基于证据和临床经验的初始指标提案确定了65个潜在指标（20个结构指标、22个过程指标和23个结果指标）。共识过程涉及讨论和协商，将潜在指标减少到28个（8个结构指标、12个过程指标和8个结果指标）。确认过程涉及25名护士，所有28个指标均得到支持（均>3.5/5）。得到高度支持的指标包括患者满意度、液体平衡评估、腹膜透析导管出口部位、临床体征测量、腹膜炎调查、腹膜透析导管并发症转诊和感染率。
经过进一步的有效性、可靠性和可行性测试后，这些护理敏感指标可用于衡量为患者及其家庭提供的腹膜透析护理质量。
