{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T20:13:54Z","timestamp":1784232834928,"version":"3.55.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The aim of this study was to develop a set of quality indicators for hemodialysis vascular access nursing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A two-round Delphi study was conducted from August to September 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Based on the Donabedian structure\u2013process\u2013outcome theory model, this study retrieved, evaluated, and synthesized the best evidence on quality indicators for hemodialysis vascular access nursing. A questionnaire was developed through evidence-based analysis and semistructured interviews. An indicator system was established using the Delphi method, and an analytic hierarchy process (AHP) was employed to determine the weights of each indicator. A total of 16 experts from 14 hospitals across nine provinces in China completed two rounds of Delphi surveys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After two rounds of consultation, the experts reached a consensus on the definitions of the indicators, calculation formulas, and data collection methods. They established a quality indicator system for hemodialysis vascular access nursing, which includes 3 primary indicators and 15 secondary indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The developed nursing quality-sensitive indicator system for hemodialysis vascular access was constructed through a rigorous Delphi process and aligns with the practical features of hemodialysis vascular access nursing management. It may serve as a reference basis for evaluating the quality of vascular access nursing, pending further clinical validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the profession and patient care<\/jats:title>\n                    <jats:p>This framework offers a structured approach to monitoring vascular access nursing quality. Its potential to reduce complications and improve patient outcomes requires confirmation through future clinical implementation studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>The indicators identified in this study are highly consistent with those in clinical practice, demonstrating sensitivity and practicality. The hemodialysis centers of relevant medical institutions may consider using this quality indicator system for routine data collection. Its utility for quality improvement should be further evaluated in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting method<\/jats:title>\n                    <jats:p>This study was reported in line with the Conducting and Reporting of Delphi studies (CREDE) guidance on Delphi studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1858484","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T05:33:30Z","timestamp":1783920810000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Construction of nursing-sensitive quality indicators for hemodialysis vascular access: a Delphi study"],"prefix":"10.3389","volume":"14","author":[{"given":"Yingjun","family":"Zhang","sequence":"first","affiliation":[{"name":"Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"He","sequence":"additional","affiliation":[{"name":"Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikai","family":"Tang","sequence":"additional","affiliation":[{"name":"Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueshan","family":"Gao","sequence":"additional","affiliation":[{"name":"Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Chen","sequence":"additional","affiliation":[{"name":"Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Shi","sequence":"additional","affiliation":[{"name":"Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Chen","sequence":"additional","affiliation":[{"name":"Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University\/West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2461","DOI":"10.1016\/S0140-6736(25)01853-7","article-title":"Global, regional, and national burden of chronic kidney disease in adults, 1990\u20132023, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023","volume":"406","author":"GBD","year":"2025","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1378","DOI":"10.1016\/S2214-109X(25)00198-6","article-title":"Global, regional, and national prevalence of kidney failure with replacement therapy and associated aetiologies, 1990\u20132023: a systematic analysis for the Global Burden of Disease Study 2023","volume":"13","author":"GBD","year":"2025","journal-title":"Lancet Glob Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1186\/s12882-021-02458-z","article-title":"Cannulation technique and complications in arteriovenous fistulas: a Swedish Renal Registry-based cohort study","volume":"22","author":"Staaf","year":"2021","journal-title":"BMC Nephrol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/hdi.12962","article-title":"Multiple single cannulation technique of arteriovenous fistula: a randomized controlled trial","volume":"26","author":"Peralta","year":"2022","journal-title":"Hemodial Int."},{"key":"B5","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1111\/hdi.13160","article-title":"The knowledge, attitudes, and practices of arteriovenous access assessment among hemodialysis nurses: a multicenter cross-sectional survey","volume":"28","author":"Chen","year":"2024","journal-title":"Hemodial Int."},{"key":"B6","doi-asserted-by":"publisher","first-page":"990","DOI":"10.3760\/cma.j.cn441217-20230926-00935","article-title":"Guidelines for dialysis access in China","volume":"40","year":"2024","journal-title":"Chin J Nephrol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1186\/s12882-025-04374-y","article-title":"UK Kidney Association Clinical Practice Guideline on vascular access for haemodialysis","volume":"26","author":"Aitken","year":"2025","journal-title":"BMC Nephrol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1111\/sdi.13153","article-title":"Hemodialysis vascular access coordinator: three-level model for access management","volume":"37","author":"Sousa","year":"2024","journal-title":"Semin Dial."},{"key":"B9","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1177\/11297298211001612","article-title":"Impact of a trained vascular access coordinator on a vascular access program in India","volume":"23","author":"Pundir","year":"2022","journal-title":"J Vasc Access."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1111\/jocn.12337","article-title":"Nurse-sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues","volume":"23","author":"Burston","year":"2014","journal-title":"J Clin Nurs."},{"key":"B11","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1111\/j.1553-2712.2011.01033.x","article-title":"A conceptual model for assessing quality of care for patients boarding in the emergency department: structure-process-outcome","volume":"18","author":"Liu","year":"2011","journal-title":"Acad Emerg Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"28","DOI":"10.7748\/nm.2021.e1982","article-title":"Nursing-sensitive indicators: a concept analysis","volume":"28","author":"Afaneh","year":"2021","journal-title":"Nurs Manag."},{"key":"B13","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1111\/j.1468-0009.2005.00397.x","article-title":"Evaluating the quality of medical care","volume":"83","author":"Donabedian","year":"2005","journal-title":"Milbank Q."},{"key":"B14","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1891\/1061-3749.23.3.474","article-title":"A Donabedian model of the quality of nursing care from nurses' perspectives in a Portuguese hospital: a pilot study","volume":"23","author":"Voyce","year":"2015","journal-title":"J Nurs Meas."},{"key":"B15","doi-asserted-by":"publisher","first-page":"92","DOI":"10.3870\/hlxzz.2014.09.092","article-title":"Association of quality evaluation indicators created based on the Donabedian's quality evaluation model: a literature review","volume":"29","author":"Guo","year":"2014","journal-title":"J Nurs Sci."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1002\/nop2.654","article-title":"Nursing-sensitive indicators for nursing care: a systematic review (1997\u20132017)","volume":"8","author":"Oner","year":"2021","journal-title":"Nurs Open."},{"key":"B17","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1111\/jnu.12798","article-title":"Establishing nursing-sensitive quality indicators for pediatric oncology: an international mixed methods Delphi study","volume":"55","author":"Sullivan","year":"2023","journal-title":"J Nurs Scholarsh."},{"key":"B18","doi-asserted-by":"publisher","first-page":"4736","DOI":"10.1111\/jan.16266","article-title":"Construction of nursing-sensitive quality indicators for acute poisoning in emergency departments: an e-Delphi study","volume":"80","author":"Li","year":"2024","journal-title":"J Adv Nurs."},{"key":"B19","doi-asserted-by":"publisher","first-page":"7937","DOI":"10.1111\/jan.16914","article-title":"Construction of nursing-sensitive quality indicators for spine surgery under the concept of enhanced recovery after surgery","volume":"81","author":"Dong","year":"2025","journal-title":"J Adv Nurs."},{"key":"B20","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.colegn.2019.06.003","article-title":"Identifying nurse sensitive indicators specific to haemodialysis nursing: a Delphi approach","volume":"27","author":"McIntyre","year":"2020","journal-title":"Collegian."},{"key":"B21","doi-asserted-by":"publisher","first-page":"3920","DOI":"10.1111\/jocn.14607","article-title":"Construction of nursing-sensitive quality indicators for haemodialysis using Delphi method","volume":"27","author":"Gao","year":"2018","journal-title":"J Clin Nurs."},{"key":"B22","author":"Dang","year":"2021","journal-title":"Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and Guidelines"},{"key":"B23","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1186\/s12912-025-04284-2","article-title":"Construction of a core competence index system for undergraduate anesthesia nursing graduates: a Delphi and Analytic Hierarchy Process","volume":"25","author":"Yin","year":"2026","journal-title":"BMC Nurs."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e0270902","DOI":"10.1371\/journal.pone.0270902","article-title":"Construction of a competency evaluation index system for front-line nurses during the outbreak of major infectious diseases: a Delphi study","volume":"17","author":"Bai","year":"2022","journal-title":"PLoS ONE."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4081\/hls.2021.9320","article-title":"Patient perceived quality of nursing care in hemodialysis: a meta-synthesis","volume":"8","author":"Balouchi","year":"2021","journal-title":"Healthc Low Resour Settings."},{"key":"B26","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1053\/j.jrn.2018.01.014","article-title":"Structural equation modeling to explore patient to staff ratios as an explanatory factor for variation in Dialysis facility outcomes","volume":"28","author":"Hand","year":"2018","journal-title":"J Ren Nutr."},{"key":"B27","doi-asserted-by":"crossref","first-page":"274","DOI":"10.3904\/kjim.2013.28.3.274","article-title":"Current status and standards for establishment of hemodialysis units in Korea","volume":"28","author":"Lee","year":"2013","journal-title":"Korean J Intern Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"48","DOI":"10.34067\/KID.0000112019","article-title":"Global dialysis perspective: Australia","volume":"1","author":"Damasiewicz","year":"2020","journal-title":"Kidney360."},{"key":"B29","year":"2023","journal-title":"Regulation of Hemodialysis Rooms in Medical Institutions"},{"key":"B30","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1046\/j.1523-1755.2003.00064.x","article-title":"Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS","volume":"64","author":"Saran","year":"2003","journal-title":"Kidney Int."},{"key":"B31","doi-asserted-by":"publisher","first-page":"275","DOI":"10.3760\/cma.j.cn211501-20240619-01603","article-title":"Current situation investigation of nursing adverse events and analysis of influencing factors related to nursing human resources in hemodialysis centers attached to class-A tertiary hospitals in China","volume":"41","author":"Liu","year":"2025","journal-title":"Chin J Pract Nurs."},{"key":"B32","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1097\/NAN.0000000000000328","article-title":"Implementation of a vascular access team to reduce central line usage and prevent central line-associated bloodstream infections","volume":"42","author":"Savage","year":"2019","journal-title":"J Infus Nurs."},{"key":"B33","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1016\/j.ajic.2016.01.040","article-title":"Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback","volume":"44","author":"S\u00e1nchez-Carrillo","year":"2016","journal-title":"Am J Infect Control."},{"key":"B34","volume-title":"Standard Operating Procedures for Blood Purification 2021","year":"2021"},{"key":"B35","doi-asserted-by":"publisher","first-page":"310","DOI":"10.3969\/j.issn.1671-4091.2023.04.014","article-title":"Investigation on the nursing operation of hemodialysis installation and pre-flush in China","volume":"22","author":"Wang","year":"2023","journal-title":"Chin J Blood Purif."},{"key":"B36","first-page":"648","article-title":"The performance of healthcare-associated infection control guideline among hospital nurses: a structural equation model","volume":"47","author":"Moon","year":"2018","journal-title":"Iran J Public Health."},{"key":"B37","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.avsg.2021.05.022","article-title":"Arteriovenous fistula maturation: physical exam versus flow study","volume":"77","author":"Caputo","year":"2021","journal-title":"Ann Vasc Surg."},{"key":"B38","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1148\/radiol.2273021730","article-title":"Hemodialysis arteriovenous fistula maturity: US evaluation","volume":"227","author":"Turmel-Rodrigues","year":"2003","journal-title":"Radiology."},{"key":"B39","unstructured":"Aitken\n              M\n            \n            \n              Angell-Barrick\n              N\n            \n            \n              Brogan\n              R\n            \n          \n          Clinical practice recommendations for needling of arteriovenous fistulae and grafts for haemodialysis.\n          \n          2018"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.3969\/j.issn.1672-1756.2021.11.012","article-title":"The surveillance of arteriovenous fistula dysfunction in Beijing hemodialysis centers: a cross-sectional survey","volume":"21","author":"Liu","year":"2021","journal-title":"Chin Nurs Manag."},{"key":"B41","first-page":"45","article-title":"Vascular access in Spain: analysis of its distribution, morbidity, and monitoring systems","volume":"21","author":"Rodr\u00edguez Hern\u00e1ndez","year":"2001","journal-title":"Nefrologia."},{"key":"B42","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1093\/joneph\/19.2.200","article-title":"Practice patterns in the management of arteriovenous fistula stenosis: a northern Italian survey","volume":"19","author":"Tessitore","year":"2006","journal-title":"J Nephrol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1016\/j.avsg.2015.02.008","article-title":"Vascular access thrombosis in France: incidence and treatment patterns","volume":"29","author":"Sadaghianloo","year":"2015","journal-title":"Ann Vasc Surg."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1093\/cid\/ciy555","article-title":"Dialysis catheter-related bloodstream infections in patients receiving hemodialysis on an emergency-only basis: a retrospective cohort analysis","volume":"68","author":"Zhang","year":"2019","journal-title":"Clin Infect Dis."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.nefro.2017.11.004","article-title":"Spanish clinical guidelines on vascular access for haemodialysis","volume":"37","author":"Ibeas","year":"2017","journal-title":"Nefrologia."},{"key":"B46","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1053\/j.ajkd.2019.12.001","article-title":"KDOQI Clinical Practice Guideline for vascular access: 2019 update","volume":"75","author":"Lok","year":"2020","journal-title":"Am J Kidney Dis."},{"key":"B47","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1053\/j.ackd.2018.10.005","article-title":"Current concepts in hemodialysis vascular access infections","volume":"26","author":"Kumbar","year":"2019","journal-title":"Adv Chronic Kidney Dis."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1858484\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T19:52:37Z","timestamp":1784231557000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1858484\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":47,"alternative-id":["10.3389\/fpubh.2026.1858484"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1858484","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]},"article-number":"1858484"}}