Development of a quality evaluation index system for graded exercise rehabilitation nursing in patients undergoing cardiac surgery: a delphi and analytic hierarchy process study

Graded exercise rehabilitation is an important component of recovery after cardiac surgery, but nursing quality assessment in this area remains insufficiently standardized. Existing evaluation systems seldom integrate structure, process, and outcome indicators that reflect the specific demands of postoperative graded exercise rehabilitation. To develop a quality evaluation index system for graded exercise rehabilitation nursing among patients undergoing cardiac surgery. A preliminary indicator pool was developed through literature review, semi-structured interviews, clinical expert discussion, and the Structure-Process-Outcome model. The indicators were then refined through two rounds of Delphi consultation with a multidisciplinary expert panel. Expert participation, authority, rating dispersion, Kendall’s W, content validity, and analytic hierarchy process weights were analyzed. After two Delphi rounds, the final system included 3 first-level indicators, 13 s-level indicators, and 87 third-level indicators. Expert response rates were 14/15 (93.3%) and 15/15 (100.0%), showing high participation. The minimum I-CVI was 0.733, and S-CVI/Ave was 0.946. The first-level AHP weights were 0.281 for structure, 0.309 for process, and 0.410 for outcome. The index system offers a structured framework for assessing and improving the quality of graded exercise rehabilitation nursing after cardiac surgery. Further multicenter validation is needed before it can be recommended for routine clinical use.