Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has had significant negative effects on health and wellbeing in all countries worldwide. However, as we reflect back on the past 12 months, it is clear that we have a new appreciation of the contributions made by the health and social care workforce. In the 2020 International Year of the Nurse and Midwife, the COVID-19 pandemic served to raise public awareness of the complexity involved every day in nursing and midwifery practice. The pandemic also reinforced the importance of focusing on the delivery of high-quality patient-centred care, regardless of the constraints imposed by external factors. The findings presented in this paper detail the development of nursing metrics for acute care in order to help make visible the often unseen, or invisible, contributions made by nurses. The authors hope that the impact of having quality care process nursing metrics that ultimately define patient experience would go some way to unpacking the nurse’s actual contribution to care. The authors of this study used a modified Delphi design to achieve consensus on the components of an Acute Quality Care Process Metrics system for use in Ireland, funded by the Office of Nursing and Midwifery Services Department. Establishing agreed standards of nursing care for acute care metrics, with corresponding quality indicators, was undertaken in order to make the provision of such care uniquely attainable and measurable, as well as enabling policy standards to be developed to maintain such nursing standards. Two exploration and two evaluation phases with an expert panel of registered nurses with an extended personal experience in an acute clinical speciality, followed by face-to-face working group meetings and a final consensus panel meeting led to a final set of 11 quality care process nursing metrics and 53 associated indicators for acute care. The authors hope that these will be used to quantify the contributions made by nurses to high-quality care, whilst qualifying these against evidence-based standards that have the patient at the centre of care. The paper includes a great deal of detail about the Delphi process, which will help replication to determine if these metrics have greater generalisability, beyond that of the landscape of healthcare in Ireland. However, this paper will be seen, by some, to be quite controversial since the decision was taken to exclude ‘patient experience’ and ‘patient engagement’ as quality care process metrics, due to the difficulties of measuring these at the bedside. Furthermore, the authors acknowledge the forthcoming challenge of implementing the metrics. In 2021, Kitson et al. argued that nurses, and other healthcare professions, must factor in sufficient time to establish and nurture the relationships with their patients who often have complex fundamental care needs. Future care systems need to embrace more humane and safe ways to care. Consequently these acute care metrics and others, such as the Fundamentals of Care Framework (Kitson, 2018), that now exist, must be implemented and evaluated to determine if they really do make a positive difference to patients’ experiences, and enhance care systems.