Abstract
AIM: This study aims to develop and validate a scientific and reliable set of nursing quality assessment indicators for orthopedic patients with pressure injuries based on the Donabedian model. The Delphi method was adopted for the selection and establishment of the indicators. DESIGN: Delphi method. METHODS: We developed an evaluation index system using a literature review and semi-structured interviews. Two rounds of Delphi surveys were conducted with 25 international experts to gather insights on indicators for orthopedic pressure injury care quality. The analytic hierarchy process was used to determine indicator weights. Consensus was defined as an average score of at least 3.5 and agreement from 75% of participants. Based on these criteria, we finalized the evaluation framework. RESULTS: The final evaluation index system for nursing quality in orthopedic pressure injury management comprises 3 first-level indicators-structural quality, process quality, and outcome quality-along with 9 second-level and 26 third-level indicators. Both rounds of expert consultation achieved a 100% effective response rate. The expert authority coefficients were 0.890 for the first round and 0.934 for the second round. In the second consultation round, Kendall's concordance coefficients for the first, second, and third-level indicators were 0.186, 0.217, and 0.115, respectively (P < 0.05). CONCLUSION: The nursing quality evaluation index system for orthopedic pressure injuries developed in this study is scientifically valid and applicable to clinical practice. It provides a standardized reference for assessing nursing quality in managing orthopedic pressure injuries. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The nursing quality evaluation index system for orthopedic pressure injuries, based on the Donabedian model, offers a structured framework for monitoring nursing quality. It standardizes nursing processes and improves resource allocation efficiency. Through outcome-based feedback, the system promotes continuous quality improvement, enhances service standardization, increases patient safety, and completes the quality management cycle. REPORTING METHOD: This study was reported by the Conducting and Reporting of Delphi Studies (CREDES) guidance. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. CLINICAL TRIAL NUMBER: Not applicable.