Measuring the outcomes of nursing practice: A Delphi study

Aim: To develop nursing-sensitive patient indicators to measure the outcomes of nursing practice.

Background: Nurses play an important role in the health care system yet there is no consensus on how the impact of nursing work should be evaluated. Limited research has previously examined the views of clinical nurses on the important concepts for measuring nursing practice.

Design: A four-round modified Delphi survey sought opinions from patients and nurses about the relevant concepts and their relative priority as indicators of quality nursing practice.

Method: Round 1 comprised semi-structured interviews with patients and nurses to identify key concepts. Nurses were then asked to participate in three rounds of Delphi survey to identify and rate key concepts from which indicators were developed. Thematic analysis and descriptive statistics were used to analyse the data.

Results: By the end of Round 4, the process had generated 103 concepts and participants had agreed on 8 overarching constructs, namely: care and caring; communication; coordination and collaboration; safety; patient characteristics; workload; Nurses work environment; and organisational characteristics.

Conclusions: Consensus was achieved between nurses on the most important concepts which can provide the basis for measuring the quality and safety of nursing practice in a comprehensive and holistic way.

Relevance to clinical practice: The identification of concepts that patients and nurses consider important for measuring nursing practice will guide the development of methods for evaluating nursing in the future. Ensuring that nursing practice is rigorously evaluated has the potential to identify opportunities to improve nursing quality, patient safety and improve health outcomes.