Nursing-sensitive indicators: a concept analysis

J Adv Nurs. 2014 Nov;70(11):2469-82. doi: 10.1111/jan.12503. Epub 2014 Aug 12.


Aim: To report a concept analysis of nursing-sensitive indicators within the applied context of the acute care setting.

Background: The concept of 'nursing sensitive indicators' is valuable to elaborate nursing care performance. The conceptual foundation, theoretical role, meaning, use and interpretation of the concept tend to differ. The elusiveness of the concept and the ambiguity of its attributes may have hindered research efforts to advance its application in practice.

Design: Concept analysis.

Data sources: Using 'clinical indicators' or 'quality of nursing care' as subject headings and incorporating keyword combinations of 'acute care' and 'nurs*', CINAHL and MEDLINE with full text in EBSCOhost databases were searched for English language journal articles published between 2000-2012. Only primary research articles were selected.

Methods: A hybrid approach was undertaken, incorporating traditional strategies as per Walker and Avant and a conceptual matrix based on Holzemer's Outcomes Model for Health Care Research.

Results: The analysis revealed two main attributes of nursing-sensitive indicators. Structural attributes related to health service operation included: hours of nursing care per patient day, nurse staffing. Outcome attributes related to patient care included: the prevalence of pressure ulcer, falls and falls with injury, nosocomial selective infection and patient/family satisfaction with nursing care.

Conclusion: This concept analysis may be used as a basis to advance understandings of the theoretical structures that underpin both research and practical application of quality dimensions of nursing care performance.

Keywords: acute care; concept analysis; nursing performance measurement; nursing-sensitive indicators; quality of nursing care.

MeSH terms

  • Concept Formation
  • Humans
  • Nursing Process*