Construction of orthopedic specialty nursing quality standards based on sensitive indicators

This study aims to systematically construct a scientific, structured, and clinically applicable system of sensitive quality indicators for orthopedic specialty nursing to provide standardized and quantifiable tools for precise management, evaluation, and continuous improvement of orthopedic nursing quality. A multi-method design integrating evidence-based research, empirical analysis, and expert consensus was adopted. First, based on the structure-process-outcome theoretical model, a systematic evidence synthesis was conducted on domestic and international orthopedic nursing quality literature from the past fifteen years to develop an initial indicator pool. Subsequently, multicenter on-site clinical observations were conducted in 3 tertiary hospitals, and semi-structured interviews were performed with 32 key stakeholders, including physicians, nurses, rehabilitation therapists, and patients, to supplement perspectives from clinical practice and patient experience. On this basis, 2 rounds of rigorous Delphi expert consultation (25 experts) were carried out for indicator screening and revision, followed by determination of the relative weights of each indicator level using the analytic hierarchy process (AHP). Through systematic evidence synthesis, an initial pool of 138 indicators was established, covering the 3 domains of structure, process, and outcome. After 2 rounds of Delphi consultation (expert response rates of 92% and 100%, respectively), expert opinion demonstrated significant coordination (second-round Kendall W = 0.412, P <.001). The final orthopedic specialty nursing quality evaluation framework consisted of 12 primary dimensions and 68 secondary indicators. AHP weight analysis further revealed the relative importance of each dimension, among which "functional rehabilitation management" (14.7%), "Complication Outcomes" (13.9%), and "Nurse Competency Assurance" (12.5%) were identified as the 3 core dimensions with the highest weights. This study successfully developed a sensitive orthopedic specialty nursing quality indicator system grounded in the structure-process-outcome model, with both scientific rigor and clinical applicability. The system features comprehensive indicators, clear logic, and reasonable weighting, providing essential tools for standardized measurement and quantitative evaluation of orthopedic nursing quality, as well as important references for precise interventions and continuous improvement in clinical nursing quality management.