Progressing Quality Care Process Metrics for Public Health Nursing: Viewed Through the Lens of a Modified Delphi Approach

Background: Nursing plays a central role in facilitating care in the community setting, yet there is no consensus of public health nurses contribution to care and how to measure what hidden or explicit things they do to provide high quality and safe care. A modified Delphi approach with an expert panel was established with the purpose of identifying quality care process metrics for public health nursing care and respective indicators that could measure their unique and multidimensional contribution to care. This modified Delphi study integrated a four round survey of 218 nurses, face-to-face meetings with a patient representative and key stakeholder holders within public health nursing services with a final consensus meeting inclusive of a panel of 29 expert nurses in the community setting. Results: Delphi rounds 1-4 led to a consensus on fourteen quality care process nursing metrics and sixty-nine associated indicators incorporating expert panellists' suggestions for the community care setting. Notwithstanding the rating of ‘critical' in the Delphi rounds, in depth discussions were conducted on all proposed metrics and indicators at the final consensus meeting and in particular emphasizing the key role performed by public health nurses in the context of ‘Maternal Health', ‘Care Plan Development and Evaluation' and ‘Health Promotion'. Conclusion: This paper describes through the lens of public health nursing the development of a set of 14 quality care metrics using a modified Delphi technique aligned with a set of 69 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that public health nurses' unique and multidimensional contribution to patientcentered care is measurable in the community setting.