Recommendations for nursing diagnoses for burn victims undergoing prolonged field care in China: a Delphi study

Abstract

Aim To construct a nursing diagnosis index system for burn patients under prolonged field care (PFC). Design A modified Delphi study. Setting 13 class A tertiary hospitals and 2 universities. Participants Nine experts were selected for expert interview: (1) bachelor’s degree or higher; (2) ≥10 years’ experience in burn care, nursing quality management or health service management, including participation in ≥3PFC operations; (3) intermediate or higher professional title; (4) willingness to participate. 22 experts were selected for expert consultation: (1) bachelor’s degree or higher; (2) ≥3 years’ nurse management experience with theoretical expertise in burn nursing diagnosis; participation in ≥3 major non-combat military operations; (3) intermediate or higher professional title; (4) commitment to complete consultations. Interventions Including a two-stage process: (1) system construction: developed a preliminary index system using The North American Nursing Diagnosis Association international’s framework, guided by US military ‘10 PFC Core Competencies’ and UK military SHEEP VOMIT standards, via literature analysis and expert interviews. (2) Delphi refinement: conducted three Delphi rounds with 22 experts. Finalised indicators using Analytical Hierarchy Process to assign weights. Results The burn PFC nursing diagnosis index system established in this study comprises 7 primary indicators, 18 secondary indicators and 44 tertiary indicators. The valid questionnaire response rate for the expert consultation reached 100%, with an expert authority coefficient of 0.85. After three rounds of the Delphi expert consultation, Kendall’s coefficient of concordance (Kendall’s W) for indicators at all levels ranged from 0.104 to 0.305 (p<0.001), indicating a convergence of expert opinions. Regarding weight distribution, the top three weighted primary indicators were Safety/Protection, Nutrition and Elimination/Exchange. The top three weighted secondary indicators were Risk of Physical Injury, Thermoregulation and Coping Responses. The top three weighted tertiary indicators were Risk for Electrolyte Imbalance, Impaired Gas Exchange and Hyperthermia. Conclusion This systematic, scientific and rational index system provides a foundation for standardising burn PFC nursing plans, potentially enhancing care quality and efficiency in PFC settings.