ArticleAdvances in neonatal care : official journal of the National Association of Neonatal Nurses2026
Nurse-Driven Quality Indicators for Neonatal Intensive Care: A Delphi Consensus on Family-Integrated Priorities in NICUs.
Article in Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Nursing-sensitive quality indicators (NSQIs) are critical for evaluating neonatal care quality across 6 dimensions: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Existing frameworks (eg, 32-58 indicator sets) lack clinical utility and fail to address emerging priorities like family-centered care and lactation support. While the 2017 Chinese NSQI set improved practicality, it no longer aligns with global advancements in family-centered care, lactation, etc. PURPOSE: This study establishes a nurse-driven NSQI framework for neonatal intensive care units (NICUs), integrating international evidence and current clinical needs.
methodsWe conducted a 3-phase study: (1) literature synthesis to identify potential NSQIs from international databases; (2) expert panel review to refine indicators through structured discussions; (3) a 2-round e-Delphi with 32 experts assessed indicators using 9-point scales. Consensus required median ≥7 and disagreement index <1.
resultsTwo Delphi rounds achieved high response rates (96.8%, 100%) and expert reliability (Cr = 0.855-0.865). Through iterative screening, 5/22 initial indicators and 8/17 revised indicators were excluded due to low feasibility/relevance (median = 1-3) and high degree of consistency (DI<1.00). Nine NICU indicators were validated with robust agreement. IMPLICATIONS FOR PRACTICE AND RESEARCH: This study establishes China's first nurse-driven NSQI framework for NICU, delivering 9 evidence-based indicators that reconcile Chinese care priorities with localized clinical realities. It shifts neonatal nursing evaluation from theoretical models to actionable practice. These indicators enable efficient NICU quality management in resource-limited settings by prioritizing high-impact nursing actions. Multinational validation and outcome-based evaluations are needed to strengthen global relevance. Future iterations will integrate advanced metrics aligned with evolving clinical standards.
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