All ETDs from UAB

Advisory Committee Chair

Wendy Landier

Advisory Committee Members

Sara W Day

Nataliya Ivankova

Adelais Markaki

Patricia A Patrician

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


Although nursing sensitive indicators (NSIs) have been developed to measure factors influencing nursing care quality and patient outcomes in general and in select specialty areas, a core set of NSIs for international pediatric oncology nursing practice does not exist. Quality nursing care delivery in pediatric oncology is essential to achieving optimal patient outcomes and closing the 50% survival gap between high-income and low- and middle-income countries. To enhance global childhood cancer outcomes influenced by nursing, this dissertation research was conducted with the purpose of developing a preliminary core set of NSIs for international pediatric oncology nursing that is important, actionable, and feasible to measure across varied resource settings and countries. Donabedian’s Quality-of-Care Framework and the Compassionate Collaborative Care Framework conceptually guided this study. A multiphase sequential mixed methods research design intersected with a classical Delphi method was utilized. Through an open-ended initial Delphi survey, responses from an international panel of 122 expert pediatric oncology nurses from 43 countries were coded and categorized through descriptive content analysis into 32 potential NSIs/Constructs. These items were then integrated in a second round of the Delphi survey, in which 91 panelists from 38 countries selected 10 NSIs/Constructs for inclusion in the core set, ranked by order of importance. The top 10 NSIs/Constructs by mean-importance scores were integrated into the final Delphi survey round, in which 85 panelists from 38 countries ranked these top 10 NSIs/Constructs by order of importance and then rated each for actionability and feasibility of measurement. The top 10 NSIs/Constructs identified by the expert panelists through the Delphi survey process in order of importance included: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. These findings provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement and benchmarking and will inform future studies to finalize a core set of NSIs for pediatric oncology nursing internationally.

Included in

Nursing Commons



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