Consensus on nurse-sensitive indicators for adult intensive care units in South Africa

Abstract

Background: Nurse-sensitive indicators (NSI) are tools specifically related to nursing care that can be used to measure nurses’ contribution to patients’ outcomes. NSI are important for demonstrating and evaluating quality of nursing care to ensure that patients receive efficient, effective, and safe care. In South Africa, where critical care faces challenges of resource scarcity and increased demand for Intensive Care Unit (ICU) services, there is a need to implement the use of nurse-sensitive indicators to monitor the quality of care critically ill patients receive. However, there are no published sets of nurse-sensitive indicators for adult ICUs in the country.

Objective: The study aimed to develop and reach consensus on nurse-sensitive indicators for adult ICUs in South Africa.

Methods: The study used a scoping literature review and two rounds of eDelphi technique among registered nurse specialists in critical care.

Results: Thirty-four nurse-sensitive indicators were identified from 29 studies in the scoping review. In the first eDelphi round, a panel of 32 ICU nursing experts reduced the 34 indicators to 29 and added 3 others to obtain a set of 32 indicators which were grouped into 12 categories of systems or areas of use. These were then presented to a second panel of ICU experts in the second eDelphi round. All the 32 indicators obtained agreement of at least 85% in the second eDelphi round and were finalized for possible implementation in ICU in South Africa. The 12 categories included the respiratory, cardiovascular, neurological, gastrointestinal, integumentary, and urinary tract systems. Others were infection control, patient safety, nursing processes, workload, training and experience, and institution related.

Conclusion: The study established consensus on a set of 32 nurse-sensitive indicators grouped into 12 categories suitable for use in adult ICUs in South Africa. However, there is need to establish validity, reliability, and burden of data collection by conducting pilot studies in actual ICU settings.