Developing metrics for nursing quality of care for low- and middle-income countries: a scoping review linked to stakeholder engagement

Abstract

Background: The use of appropriate and relevant nurse-sensitive indicators provides an opportunity to demonstrate the unique contributions of nurses to patient outcomes. The aim of this work was to develop relevant metrics to assess the quality of nursing care in low-and middle-income countries (LMICs) where they are scarce. Main body: We conducted a scoping review using EMBASE, CINAHL and MEDLINE databases of studies published in English focused on quality nursing care and with identified measurement methods. Indicators identified were reviewed by a diverse panel of nursing stakeholders in Kenya to develop a contextually appropriate set of nursesensitive indicators for Kenyan hospitals specific to the five major inpatient disciplines. We extracted data on study characteristics, nursing indicators reported, location and the tools used. A total of 23 articles quantifying the quality of nursing care services met the inclusion criteria. All studies identified were from high-income countries. Pooled together, 159 indicators were reported in the reviewed studies with 25 identified as the most commonly reported. Through the stakeholder consultative process, 52 nurse-sensitive indicators were recommended for Kenyan hospitals. Conclusions: Although nurse-sensitive indicators are increasingly used in high-income countries to improve quality of care, there is a wide heterogeneity in the way indicators are defined and interpreted. Whilst some indicators were regarded as useful by a Kenyan expert panel, contextual differences prompted them to recommend additional new indicators to improve the evaluations of nursing care provision in Kenyan hospitals and potentially similar LMIC settings. Taken forward through implementation, refinement and adaptation, the proposed indicators could be more standardised and may provide a common base to establish national or regional professional learning networks with the common goal of achieving high-quality care through quality improvement and learning.

Optimizing the contributions of nursing and midwifery workforces: #Protect, #Invest, #Together

“…Several papers, notably reviews, provide an evidence-based underpinning for the third area of action: to strengthen nurse leadership to ensure that nurses have an influential role in health policy formulation and decision-making, and contribute to the effectiveness of health and social care systems. These include a scoping review to develop metrics for nursing quality of care for low- and middle-income countries, in order to better demonstrate impact [ 13 ], a report on the introduction and extension of nurse prescribing of medicines in 13 European countries, which highlights policy engagement to support advanced practice [ 14 ], and a scoping review of the policy implications, positive and negative, of Caribbean nurse migration [ 15 ], and a review highlighting the use of advanced practice nurses as a strategy to enable more equitable access to health care in the countries of the Western Pacific Region [ 16 ].…”

Revisión sistemática sobre implementación de indicadores de calidad de la atención

“…En el estudio realizado por Aljuaid et al los indicadores de enfermería fueron: seguridad del paciente, efectividad clínica, efectividad centrado en el paciente y oportunos. Para la implementación de los indicadores plantean la necesidad de mejorar la calidad de la atención a través de mejora continua al personal de salud, relacionado a las áreas de seguridad del paciente, eficacia clínica y centrado en el paciente (Aljuaid et al, 2016); las propuesta de indicadores estandarizados que requieren ser validados para su implementación con el fin de identificar brechas, intervenir específicamente para mejorar la calidad de la atención, la inversión y los mecanismos de gobernanza y rendición de cuentas que contribuyan a mejorar la calidad de los sistemas de salud (Gathara et al, 2020).…”

“…Haciéndose necesario mejorar los mecanismos de registro y el procesamiento de los datos (Saturno-Hernández & Martínez-Nicolás, 2017). Así como el uso del término indicador fue utilizado para nombrar los procesos básicamente referidos a la prescripción de medicamentos; pareciéndose más a estandarizar una guía o protocolo de atención (Foy et al, 2020), por lo tanto existe heterogeneidad en la forma de definir e interpretar los indicadores, se encuentran indicadores que se clasifican según el marco de acuerdo al modelo de calidad de la atención de Donabedian (estructura, proceso y resultado) así como otros vinculados a clasificaciones o dominios de calidad (perspectiva del paciente, seguridad, eficacia y compasión en la atención de enfermería) (Gathara et al, 2020).…”

Indicators of Good Nursing Practices for Vulnerable Groups in Primary Health Care: A Scoping Review

“…Finally, it is considered that valuing the Nursing work process involves measures of actions and quality of the care offered to the users-measures that will unveil problems associated with the scarcity of workforce and with the possibility of improving care ( 33 ) .…”