Identifying and prioritizing key risk factors in internet-based shared nursing services from the nurses' perspective: a hybrid multi-criteria decision-making approach

Home visiting programs are constrained by nursing shortages and limited coverage. Internet-based shared nursing services in China offer a potential solution but introduce multidimensional risks that have not been systematically examined from the perspective of shared nurses, the primary stakeholders in service safety. This study aimed to identify and prioritize key risk factors from the nurses' perspective to facilitate targeted risk management strategies.

A purposive sample of 30 shared nurses from a tertiary general hospital in Zhejiang Province, China, completed a survey in March 2026 based on the Internet-based Risk Factor (IBRF) Scale for Shared Nursing Services. Within a hybrid multi-criteria decision-making model, consistent fuzzy preference relations (CFPR) were used to assign weights to the risk factors, and importance-performance analysis (IPA) was applied to identify management gaps and prioritize interventions.

At the dimension level, nurses' clinical core competence (C5), patient/family risk assessment (C1), and nurses' service-related experience (C4) had the highest weights. At the item level, the top five risk factors were the establishment of trust with patients/families (C13), the fulfillment of expected service outcomes (C14), the adequacy of systematic home-care training (C43), proficiency in clinical problem-solving and emergency handling (C54), and the ability to remain calm in difficult situations (C55). IPA identified patient/family courtesy (C11), educational background (C12), and the establishment of trust (C13) as high-importance-low-performance priorities.

Based on data from a single tertiary hospital, this study provides a systematic framework for prioritizing risk factors in shared nursing services. Concrete strategies-such as communication training modules for nurses, platform-based risk alert systems, age-tailored public education, and nurse protection mechanisms- may reduce nurses' perceived risks; however, multicenter validation is warranted.