Framework for Nursing Quality Assessment in Tracheotomy Dysphagia Following Craniocerebral Trauma Using the Structure-Process-Outcome Model.

Aim: This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the 'structure-process-outcome' model.

Design: A Delphi survey.

Methods: The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts.

Results: The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90-5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators.

Conclusion: The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes.

Implication For The Profession And Patient Care: This study develops targeted NSQIs to improve dysphagia management in ABI patients' posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training.

Patient Or Public Contribution: Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.