Development of a quality indicator set for the responsibility-based holistic nursing model: a Delphi study based on the donabedian framework

Background: The responsibility-based holistic nursing model is widely implemented in Chinese hospitals. However, a structured quality indicator set for assessing this model is still absent. We aim to develop a standardized quality indicator set, thereby providing a reference for the further implementation of this methodology. Methods: Using the "structure-process-outcome" quality framework as a theoretical foundation, evaluation indicators for the responsibility-based holistic nursing model were constructed through a literature review and semi-structured interviews with nursing staff. A two-round Delphi survey was performed with 18 nursing experts to determine content validity and achieve consensus. Indicator weights were calculated using the normalized mean importance score method. The final indicator set comprised 3 primary indicators, 12 secondary indicators, and 50 tertiary indicators. Conclusion: This study established a preliminary quality indicator set for the responsibility-based holistic nursing model based on the Donabedian framework. Developed with moderate expert consensus, the indicator set offers a reference for evaluating nursing quality in hospitals. However, its practical applicability remains to be validated through clinical practice.