Geriatric nursing-sensitive indicators, a framework for delivering quality nursing care for the older person: A scoping review

Objective: This thesis aims to explore the concept of geriatric nursing-sensitive indicators (NSIs), which are used to measure care for the older population. Introduction: By the year 2050, the global number of older people is predicted to double, creating fiscal and practice challenges for nursing. Nursing is the largest workforce in the health sector and is best placed to influence the quality of care received by the older person as system demand increases. Geriatric NSIs provide the opportunity to describe this influence, as they reflect the quality and effectiveness of geriatric nurses when caring for the older person. Methods: Due to the broad nature of the research topic, a scoping review was considered appropriate. The methods were based on those of the Joanna Briggs Institute, which were in turn informed by Arksey and O’Malley. In addition, a group of context experts were utilised to ensure the conduct of the review was meaningful for clinical staff and policy makers. This thesis outlines the results of a scoping review prepared as a manuscript for publication. The manuscript presented for publication is positioned in chapter four as a continuation of the thesis that outlines the methods and results of the scoping review. Results: The scoping review was completed, and a manuscript was prepared and submitted for publication. Many indicators were identified that described the nursing care of the older person. In line with the methodology, these were mapped in a variety of ways including Donabedian’s Domains and Fundamentals of Care that are existing taxonomies and Specificity which was a novel approach. It was apparent that there was a great deal of inconsistency in the description of the indicators but grouping of indicators through commonality and classification simplified indicator descriptions. Conclusions: The scoping review identified that concepts associated with geriatric nursing sensitive indicators are complex, and that extracted indicators did not comprehensively reflect contemporary geriatric nursing care. The complexities identified in the scoping review included issues such as lack of indicator definition and consistency, relationships between indicators, methodology for risk adjustment of patient outcomes and performance measurement of indicators. Contemporary nursing issues were not comprehensively reflected in the extracted indicators. Additional indicators are required to address issues such as the consumer perspective of geriatric nursing care, nursing hospital avoidance strategies and case management of inpatients. The achievements of this project extended beyond the mere conduct of a review and subsequent reporting of results. The project provided an opportunity for the lead reviewer to immerse themselves and learn the methodology of a scoping review. In addition, the decision to present the thesis in this form also provided the experience of submitting a manuscript for publication.Thesis (MClinSc) -- University of Adelaide, Adelaide Nursing School, 202