Clinical Connections: Identifying validated nursing quality indicators for the intensive care unit: an integrative review

Abstract

SUMMARY Background: Quality indicators (QIs) play an important role in evaluating quality improvement initiatives. A generally accepted set of QIs specific to the nursing care in the intensive care unit (ICU) is not available. Aim: To identify QIs associated with nursing care for adult ICU in the literature. The methodological quality of QIs was assessed and associated variables of quality and quantity of nursing care were also identified. Methods: We employed an integrative literature review. A focused search of electronic databases was applied. Inclusion and exclusion criteria were used for the selection of relevant articles. Quality assessment of the included studies was based on the guidance document of domains and elements suggested by the Agency of Health Care Research and Quality. QIs’ methodological quality was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. Results: The review identified 13 studies and 45 QIs associated with nursing care in the ICU. The set of QIs assessed in each study, the type of nurse staffing measure as well as morbidity and mortality rates varied considerably. Findings suggest that quality and quantity of nursing care are strongly associated with higher rates of adverse events, mortality, infections and complications in adult ICUs. Methodological quality of the QIs also differed considerably. Higher AIRE scores, indicating higher scientific evidence of methodological quality, can be used to select evidence-based and valid QIs. Conclusions: A number of QIs quantifying nursing care in the ICU have been identified. These QIs could be combined to form a tool which would allow to the quantification and assessment of the quality of ICU nursing care provided in a regular basis.