title: The Development and Validation of Haemodialysis Nurse Sensitive Indicators
Creators: name: McIntyre, David P
Publisher: name: Griffith University
Year: 2024
Subjects: subject: chronic kidney disease
subject: haemodialysis
subject: nursing
subject: benchmarking

description: Background Nurse sensitive indicators (NSIs) are a way to measure the quality of care that nurses provide. The current indicators tend to measure hospital (ward-based) nursing care, although many indicators are not suitable for other settings or highly specialised areas of nursing. Prior to this research, there were no NSIs that were specific to haemodialysis nursing. Aims This study comprises two stages. Stage one aimed to identify nursing interventions that were suitable and relevant to the development of structural, process, and outcome haemodialysis NSIs. Stage two sought to develop an audit tool to measure the indicators, and then to test the tool for its validity and feasibility. Methods Stage one used a Delphi technique to attain consensus from an expert panel of nurses drawn from the membership of the Renal Society of Australasia. The panel rated the importance and frequency of NSIs using online surveys. Qualitative feedback was also sought. Results of each round shaped subsequent rounds. Consensus was set at ≥ 70.0%. Stage two involved the creation of the McIntyre Audit Tool (MAT), which was then tested for face and content validity. A panel of expert haemodialysis nurses (n = 13) participated in two online brainstorming sessions to confirm face validity of the original MAT-26. A modified version of the MAT was then tested for content validity to assess item clarity, relevance, appropriateness, and ambiguity. Content analysis was used for face validity data. Scale content validity index average (S-CVI/Ave), overall scale content validity index (S-CVI), and item content validity index (I-CVI) were calculated with I-CVI scores ≥ 0.78 considered acceptable. Feasibility testing involved the recruitment of nurses (n = 30) from five in-centre and satellite haemodialysis units across metropolitan and regional Queensland. Audits of the haemodialysis NSI were completed for each shift over a one-week period. In addition, four questions sought information about how long and difficult the audit was, whether it was feasible to complete, and would they complete the MAT-20 if it was introduced. A descriptive analysis was then performed. Results Stage one included 38 participants with a mean age of 47 years (SD 8.86), median haemodialysis nursing experience was 17 years (IQR 8.5-22) and 89% had attained a specialist renal qualification. Round one assessed the suitability of 38 potential NSIs. Those failing to achieve consensus were retested and removed after round two (n = 12). Round three assessed a modified list of 26 NSIs with all achieving consensus. The fourth round sought qualitative feedback on the NSIs with all achieving agreement. Stage two validity testing involved an initial group of 13 expert nurses to test face validity with 10 nurses going on to complete overall validity testing. The average clinical experience of the nurses was 20.3 years (SD 6.46, range 10-33). All 26 haemodialysis NSIs achieved item content validity indices ranging from 0.825 to 1.00 with scale content validity index average of 0.910. Six indicators were then removed following a review of feedback from the expert panel of nurses. The final version of the audit tool had an excellent average scale content validity index of 0.924. Stage two feasibility testing included 30 nurses, who returned a total of 97 audits of the haemodialysis NSIs using the MAT. There was an equal number of nurses (n = 15) recruited from both sites. The response rate varied between the two sites with greater than two thirds of audits (n = 38, 68%) returned at site one. Most nurses (n = 24, 80%) completed a short feasibility questionnaire, and a majority (n = 19, 79%) indicated that they could complete the audit in five minutes or less. Nearly all nurses (n = 23, 96%) found the MAT easy to complete. Most nurses (n = 20, 83%) could complete the MAT during a normal working shift and would be happy to complete the MAT if it was introduced (n = 19, 79%). Conclusion Haemodialysis NSIs offer a rigorous method of measuring nursing processes and care that can contribute to improving the continuity and quality in patient care. This research makes an original and significant contribution to the identification and understanding of NSIs applicable in a haemodialysis environment. There is also a critical distinction between what is and what is not an NSI, as haemodialysis nurses have been relying on haematological and biochemical markers to assess nursing care. The MAT provides nurses with a valid and simple tool to measure the quality of care being provided in specialist haemodialysis clinical settings. The application of the MAT in clinical practice has the potential to facilitate improvements in patient safety and quality care to improve patient outcomes.