Nurse-Driven Quality Indicators for Neonatal Intensive Care: A Delphi Consensus on Family-Integrated Priorities in...

Area of Science:

• Neonatal Nursing
• Healthcare Quality Improvement
• Evidence-Based Practice

Background:

• Nursing-sensitive quality indicators (NSQIs) are vital for assessing neonatal care quality across multiple dimensions.
• Existing NSQI frameworks often lack clinical utility and fail to incorporate modern priorities like family-centered care.
• The 2017 Chinese NSQI set, while practical, is outdated regarding global advancements in neonatal care.

Purpose of the Study:

• To establish a novel, nurse-driven NSQI framework specifically for neonatal intensive care units (NICUs).
• To integrate international evidence with current clinical needs in neonatal nursing.
• To create a practical tool for evaluating and enhancing the quality of neonatal care.

Main Methods:

• A three-phase study involving literature synthesis, expert panel review, and a two-round e-Delphi survey.
• Identification of potential NSQIs through international database searches.
• Assessment of indicators by 32 experts using 9-point scales, with consensus defined by median score ≥7 and disagreement index <1.

Main Results:

• High response rates (96.8%, 100%) and expert reliability (Cr = 0.855-0.865) were achieved in the Delphi rounds.
• Iterative screening led to the exclusion of 13 indicators due to low feasibility or relevance.
• Nine neonatal intensive care unit (NICU) indicators were validated with strong expert agreement.

Conclusions:

• This research presents China's inaugural nurse-driven NSQI framework for NICUs, featuring 9 evidence-based indicators.
• The framework aligns Chinese care priorities with clinical realities, shifting evaluation towards actionable practice.
• These indicators facilitate efficient NICU quality management, particularly in resource-limited settings, by focusing on high-impact nursing actions.