Skip to main content
Download PDF

Construction of a sensitive index system for nursing quality in the perioperative period of liver transplantation based on the Three-Dimensional Quality Structure theory

BMC Health Services Research volume 25, Article number: 510 (2025) Cite this article

Abstract

Objective

Based on the “Three-Dimensional Quality Structure” theory, a sensitive index system of nursing quality during the perioperative period of liver transplantation patients was constructed.

Methods

Through a comprehensive literature review and rigorous application of the Delphi method, a panel of 27 experts completed three rounds of effective letter consultation to obtain expert consensus opinions. The contents of indicators were determined based on this process, and the analytic hierarchy process was employed to confirm the weightage assigned to each indicator. Consequently, we established a sensitive index system of nursing quality during the perioperative period of liver transplantation patients.

Results

The effective recovery rates of the questionnaires in the three rounds of expert consultation reached 96.6%, 100% and 96.4%, respectively, and the proportions of experts who gave opinions were 55%, 25% and 12%,respectively, indicating a high degree of expert authority. The expert authority coefficients were calculated to be 0.899, 0.895 and 0.909,respectively, indicating a high degree of expert authority. In the third round, Kendall’s coordination coefficients for primary, secondary, and tertiary indicators were determined to be 0.340, 0.379, and 0.402 (P < 0.001), indicating that expert opinions tended to be consistent. Finally, We established a comprehensive sensitivity quality index system comprising 3 first-level indexes,11 s-level indexes, and 60 third-level indexes specifically designed for liver transplantation patients during the perioperative period.

Conclusion

The sensitive index system of perioperative nursing quality for liver transplantation patients can provide a theoretical basis for nursing staff to construct precise individualized nursing models.

Peer Review reports

Introduction

The fundamental treatment for end-stage liver disease is liver transplantation [1]. However, liver transplantation is a complex operation with great difficulties and high professionalism in nursing. Any adverse event occurring in any link of perioperative nursing will affect patient safety. The Chinese Expert Consensus on Perioperative Management of Liver Transplantation for Liver Failure (2021 Edition) provides reference opinions and guidance for the standardization and normalization of perioperative management of liver transplantation [2]. How to efficiently implement nursing measures, promote the improvement of nursing quality, and conduct comprehensive, scientific and effective evaluations is the problem currently faced by nursing managers. Constructing nursing quality evaluation indicators can quantitatively measure nursing quality and is an important means of effectively evaluating nursing quality and conducting nursing quality management [3,4,5]. However, currently, during the perioperative period of patients, there is not a complete, objective and scientific set of nursing quality sensitivity indicators in China to effectively evaluate the nursing quality of liver transplantation patients.To achieve real-time monitoring, rapid feedback, and timely optimization of the quality of clinical nursing work in liver transplantation, it is necessary to construct a complete, objective, and scientific nursing quality sensitivity indicator system. This study takes the “Three-Dimensional Quality Structure” theory as a framework, and uses literature analysis, the Delphi method and the analytic hierarchy process to construct a nursing quality sensitivity indicator system for the perioperative period of liver transplantation, so as to provide a basis for objectively evaluating the nursing quality and safety of patients.

The “Three-Dimensional Quality Structure” theory was put forward by American scholar Doabedian [6]. It divides nursing quality into structural quality, process quality and outcome quality. The structural quality is mainly used to evaluate the basic conditions for carrying out nursing work, the process quality is mainly employed to assess the process of nursing activities, and the outcome quality indicators are primarily utilized to evaluate the nursing effect. The evaluation approach that combines these three aspects can reflect the quality of nursing services in a more comprehensive manner. The nursing quality sensitive indicators constructed based on this theory have been applied to postoperative patients in fields like lung cancer [7] and esophageal cancer [8] in China, and good results have been achieved.

Method

Set up a research group

The research team has been established, with its members including specialist nurses, head nurses, department directors, directors of the Nursing Quality Control Center and researchers. Their main responsibilities involve determining research topics, formulating indicators, selecting experts, collating data and conducting analysis.

Constructing the nursing quality sensitivity indicator system for the perioperative period of liver transplantation

In this paper, “Three-Dimensional Quality Structure” theory, “liver transplantation”, “perioperative period”, “nursing”, “system construction”, “nursing quality sensitivity indicators”, “quality evaluation/quality improvement/quality management” were used as the search terms. The search was conducted in Chinese databases (such as CNKI, Wanfang Data, and VIP Information) as well as in English databases (such as PubMed, Sciencedirect, Springer, and CINAHL). The search time limit was from the establishment of each database to February 28, 2024.

After the research group sorted, screened and discussed the literature, a draft of the nursing quality sensitivity indicator system for the perioperative period of liver transplantation patients based on the Three-Dimensional Quality Structure theory was formed. Five experts were invited to participate in the pre-mail consultation. The selection criteria for the inclusion of these experts were as follows: the age range was 40.8 ± 2.9 years old, all of them had senior professional titles, possessed a bachelor’s degree or above, and had been actively engaged in liver transplantation nursing for more than ten years. After integrating the experts’ opinions, a formal mail questionnaire was compiled. This questionnaire consisted of three parts: (1) The expert mail questionnaire, which used the Likert 5-level scoring method to evaluate the importance of the indicators. (2) General information about the experts, including their professional titles, ages, education levels, and years of working experience. (3) The basis for expert judgment and their familiarity with the indicator questionnaire.

Determine the expert for correspondence consultation

A total of 27 experts in China from tertiary hospitals and universities were selected.The pre-set inclusion criteria were as follows: (1) medical or nursing education experts from universities who willingly accepted letter inquiries and committed to continuous participation in the project. (2) possessing higher professional and technical titles. (3) having more than 10 years of experience in liver transplantation nursing or being spe cialist nurses in liver transplantation. (4) holding a Bach elor’s degree or higher.

Implement expert letter consultation

Our study carried out three rounds of expert consultation from September to November 2023. The paper or electronic questionnaires were distributed by the same researcher to experts, and the interval between each round of sur vey was two weeks. Likert 5-point scoring method was also used to evaluate the importance of each item. The questionnaire was equipped with a modification column for experts to propose modification, addition and deletion. After three rounds of letter consultation, the expert opinions were basically reached. According to the expertopinions, the indicators were included to meet the criteria of the mean value of importance assignment ≥ 3.50 and the coefficient of variation < 0.25 [9].

After the collective review of the research team, the nursing quality sensitivity indicator system for the perioperative period of liver transplantation patients was confirmed.

Data processing

Using SPSS 22.0 statistical software, data entry, analysis, and finalization were conducted. Count data were pre sented as frequency and percentage. Measurement data were expressed as mean ± standard deviation and coeffi cient of variation. The recovery rate of questionnaires and the submission rate of opinions served as indicators for expert positivity coefficient determination. The authority coefficient (Cr) of experts was calculated using the judg ment coefficient (Ca) and familiarity coefficient (Cs). The degree of agreement among expert opinions was assessed through the coefficient of variation and Kendall coordi nation coefficient W.

Results

Expert situation

The experts were respectively from 25 tertiary grade-A hospitals in 9 cities including Qingdao, Jinan, Heze, Shanghai, Changchun, Chongqing, Nanchang, Xi’an and Fuzhou, as well as 2 institutions of higher education. Among them, there were 14 liver transplant specialist nurses (51.9%), 8 liver transplant nursing managers (30.0%), 3 liver transplant physician experts (11.1%) and 2 liver transplant nursing education experts (7.4%). The average age of this group of experts was 42.8 ± 6.2 years old. Their working years in liver transplantation were 12.2 ± 4.4 years, and all of them had senior professional titles. In terms of educational background, there were 18 experts with a bachelor’s degree (66.7%), 6 with a master’s degree (22.2%) and 3 with a doctor’s degree (11.1%).

Degree of expert activeness

The recovery rates of the three rounds of correspondence questionnaires were 96.6%, 100% and 96.4% respectively. Moreover, experts put forward constructive suggestions in each round, suggesting that the experts were highly motivated, as shown in Table 1.

Table 1 The degree of expert activeness
Full size table

Degree of expert authority

As shown in Table 2, three rounds of correspondence of expert authority coefficient (Cr) > 0.80 [10]. This suggests that the study possesses a significant level of expert authority and yields credible research findings.

Table 2 Expert authority degree
Full size table

Expert opinion coordination degree

The Kendall coordination coefficient W ranges from 0 to 1, and the greater the W, the better the degree of expert coordination [11]. As shown in Table 3, the significance test of the coordination coefficient of the three rounds of letter consultation in our study showed statistical signifi cance, indicating that the expert opinions were coordi nated and reliable.

Table 3 Expert opinion coordination degree and significance test
Full size table

Screening and modification of indicators

The first round of expert letter consultation revised the indicators

Index

Reason for revision

Delete pointer

 

The pass rate of intraoperative hemodynamic monitoring

Led by anesthesiologist, nursing influence factors are small

The qualified rate was evaluated by cold ischemia time of donor liver

It is dominated by doctors, and the nursing influence factors are small

Increase index

 

Early exercise assessment accurate rate of attainment

Nursing leadership

Implementation rate of early activity measures

Nursing leadership

Early activity implementation rate

Nursing leadership

Modified index

 

Accurate compliance rate of preoperative nutritional risk assessment

Because the nutritional status of the patient is dynamic and the condition is constantly changing, only attention is paid to the failure before surgery, and the accurate compliance rate of nutritional risk assessment is changed

Accurate compliance rate of immunosuppressant dose assessment

The drugs used in liver transplantation patients are complex and varied, and immunosuppressants are only one of the drugs to be managed. Therefore, experts suggest that the “accurate compliance rate of immunosuppressive dose evaluation”, “compliance rate of standardized management measures” and “compliance rate of patients’ knowledge of immunosuppressive drugs” should be changed to “correct compliance rate of drug safety management evaluation”, “Compliance rate of drug safety standardized management measures” and “compliance rate of drug safety management knowledge” respectively.

Standard implementation rate of immunosuppressant management measures

Patients’ knowledge of immunosuppressive drugs was known to meet the standard rate

The second round of expert letter consultation revised the indicators

During the second round of expert letter consultation, the indicator system was optimized and improved. Three tertiary indicators were added, namely “the compliance rate of writing patient follow-up records”, “the compliance rate of establishing multidisciplinary teams”, and “the compliance rate of health education norms for specialized nursing knowledge”. These additions aimed to measure various dimensions of nursing quality in a more comprehensive and precise manner, further strengthening the scientificity and practicability of the indicator system.

The third round of expert letter consultation revised the indicators

During the third round of expert letter consultation, particular attention was paid to the meticulous revision of the indicator “job satisfaction”. It was divided into two aspects: “patient satisfaction with nursing work” and “attending physician satisfaction with nursing work”. After in-depth discussions, the experts unanimously believed that evaluating nursing work from the perspectives of different groups could reflect the actual effectiveness of nursing work more objectively and comprehensively. This, in turn, provides more targeted and reliable bases for improving nursing quality and vigorously promotes the development of the entire indicator system towards a more complete and reasonable direction.

Expert letter inquiry results

Expert letter inquiry results After three rounds of expert consultation and group dis cussion, 3 first-level indicators, 11 s-level indicators and 60 third-level indicators were finally established. The ana lytic hierarchy process was used to determine the weight and combined weight of each index, as shown in Table 4.

Table 4 Expert letter inquiry results on the sensitive indicators of perioperative nursing quality for liver transplantation patients
Full size table

Discussion

Scientific and reliability analysis of index construction

Through literature review and clinical research, this study constructed the nursing quality sensitivity indicator system for the perioperative period of liver transplantation by applying three rounds of Delphi method correspondence consultation based on the “Three-Dimensional Quality Structure” theory. This study has provided a solid theoretical basis for the perioperative nursing services of patients and has a relatively strong scientific basis. The effective recovery rates of the three rounds of questionnaires were 96.6%, 100.0% and 96.4% respectively, which indicates that the experts had good participation and attention. In the Delphi consultation method, it is appropriate to have 15 to 50 experts [12]. A questionnaire recovery rate of 50% is sufficient for analysis and reporting, while a recovery rate of 70% is regarded as an excellent proportion [13]. The authority coefficients of the three rounds of consultation were 0.899, 0.895 and 0.909 respectively, meaning that the experts were familiar with the content of this field and had a relatively strong judgment basis. The acceptable value of the expert authority coefficient is Cr ≥ 0.7 [14]. The Kendall coordination coefficients of the first-level, second-level and third-level indicators obtained through expert consultation were 0.340, 0.379 and 0.402 respectively. The mean of each indicator was ≥ 3.50, and the coefficient of variation was < 0.25, which means that the expert opinions tended to be unified and the reliability was good.

Index construction can be comprehensive and targeted environment field

In the structural indicators, considering that the nursing of liver transplant patients is characterized by strong specialized operations, complex management, strict environmental requirements and frequent emergencies, an evaluation indicator system is established from five dimensions: human resource allocation ratio, medical resource allocation, training and assessment, environmental monitoring, and systems and norms. Among all the second-level indicators, the compliance rate of systems and norms has the highest weight, reaching 0.0668. Comprehensive systems and norms are undoubtedly the foundation and guarantee for improving the quality of perioperative nursing care for liver transplant patients [15]. In clinical practice, it is advisable to formulate a standardized work manual for liver transplant wards, and continuously promote its update and revision, effectively implement relevant systems and processes, accurately locate problem links, and lay a solid foundation for nursing management. In terms of the third-level indicators, the intact and compliance rates of instruments, drugs, goods and emergency supplies were all rated 5 points by all experts, which fully demonstrates the high degree of consensus among experts on the importance of these three indicators. After all, perfect hardware facilities are a key prerequisite for ensuring the quality and safety of nursing care [16]. In addition, only by continuously optimizing the human resource structure, strengthening the standardization of operational skills and continuously monitoring the operating environment can the ward nursing quality work be promoted to a new height, which is also precisely in line with the requirements of the expert consensus on the evaluation criteria for human organ donation and transplantation technology in the grade hospital evaluation [17].

Process indicators are not only the core elements of nursing quality but also the crucial hubs for monitoring outcome indicators [18]. Based on the key aspects and difficulties in the ward management of liver transplant patients, four second-level rating indicators, namely nursing assessment, specialized nursing, specialized indicators, and nursing follow-up, have been established. The 28 third-level evaluation indicators it encompasses can comprehensively reflect the quality level of the nursing process, and this result is basically in line with the research findings of Lu Fangyan [19]. Among the second-level indicators, the top three are nursing assessment, specialized nursing, and specialized indicators, which precisely demonstrate the key points of nursing work in liver transplant wards and are highly consistent with the nursing work content stipulated in the “Technical Operation Specification for Liver Transplant Nursing” [20]. As for the third-level indicators, those with relatively high weights include early mobilization, sedation and cough suppression, drug safety management, and nutritional risk. Research shows [21] that timely exercise training after liver transplantation plays a significant role in accelerating the recovery process of patients. Domestic research by Zheng CX [22] and other scholars also incorporated the implementation rate of early mobilization into the sensitivity indicator system of perioperative nursing quality for liver transplantation, which coincides with the results of this study. Appropriate postoperative sedation and analgesia measures [23] and a reasonable nutritional feeding plan [24] are important links in promoting patients to start activities as early as possible and achieve rapid recovery. In addition, improper drug management and fluid management are also common causes of postoperative complications and abnormal liver function, which is corroborated by the research conclusions of Tian M [25] and Carrier [26]. Therefore, how to construct a closed-loop management system for each key point through the cycle mode of assessment, nursing, monitoring, tracking, and then assessment is an important issue that requires continuous attention and efforts to solve in future ward work.

Outcome indicators, as the ultimate criteria for measuring the improvement degree of nursing quality [27], cover two key indicators: the attainment rate of patients’ knowledge, attitude and practice and the attainment rate of patients’ nursing outcomes. These two indicators deeply reflect the core tenet held by the sensitive indicator system of nursing quality in liver transplant wards, that is, to fully promote the continuous optimization of nursing work quality and effectively ensure the safety of patients. It is worth noting that the tertiary indicators established under them show a high degree of consistency with the sensitive indicators set in the process indicators, and this internal relevance further strengthens the scientific and systematic nature of the entire indicator system.In addition, satisfaction occupies a pivotal position among the influencing factors of the entire nursing effect [28]. In view of this, this study incorporates three important indicators, namely, patients’ satisfaction with nursing work, patients’ and their families’ satisfaction with treatment effects, and the satisfaction of attending physicians with nursing work, into the comprehensive evaluation system of nursing quality. Through such comprehensive and detailed indicator settings, not only can the actual effectiveness of nursing work in various dimensions be more accurately reflected, but also clear and powerful direction guidance can be provided for the subsequent nursing quality improvement work, thus promoting the nursing work in liver transplant wards to move towards a more professional, efficient and humanized direction, and laying a solid foundation for the rehabilitation and health protection of patients.

Conclusion

Based on the three-dimensional quality structure theory and combined with the Delphi method, this study has successfully constructed a sensitivity index system for perioperative nursing quality of liver transplant patients. This system has laid a solid theoretical foundation for nursing staff to create a precise and individualized perioperative nursing model, effectively promoting nursing practice to move in a more scientific and efficient direction. However, due to the limitations of the researchers in terms of knowledge reserve and time and energy, the effectiveness and practicality of the currently constructed index system still need to be further optimized and adjusted during the clinical application process. Subsequently, it is necessary to continuously and deeply refine and improve the various contents of the index system to make it more in line with the actual clinical needs, thereby steadily promoting the continuous improvement of the perioperative nursing quality of liver transplant patients and providing more reliable and high-quality nursing protection for the health and well-being of patients.

Data availability

Data is provided within the manuscript file.

References

  1. Huimin Y, Jianrong L, Pinglan L, et al. Expert consensus on perioperative management of liver transplantation for adult acute-on-chronic liver failure. Organ Transplant. 2020;11(5):533–42.

    Google Scholar 

  2. Perioperative Management Group, Branch OT, Chinese Medical Association. Chinese expert consensus on perioperative management of liver transplantation for liver failure (2021 Edition). Chin J Dig Surg. 2021;20(8):835–40.

    Google Scholar 

  3. Cai Weixin Y, Zhike Z, Ran, et al. Construction and application of a multi-center stroke nursing quality control system. Chin J Nurs. 2020;55(11):1612–9.

    Google Scholar 

  4. Zhu Zhiming, Huang Lihua, Feng Zhixian, et al. Study on obstetric nursing-sensitive quality indicators using modified Delphi technique. Chin J Nurs. 2016;51(5):573–7.

    Google Scholar 

  5. Cai Libai L, Yanjin G, Yuru, et al. Establishment of a nursing quality evaluation indicator system for orthopedic rehabilitation. Chin J Nurs. 2021;56(4):508–14.

    Google Scholar 

  6. Donabedian A. Measuring the effectiveness of medical interventions: new expectations of health services research. Health Serv Res. 1966;25(15):697–708.

    Google Scholar 

  7. Wu Qiong S, Yongsheng W, Peipei, et al. Application of Delphi method in the construction of postoperative care quality index of lung tumor patients. J Adv Nurs. 2018;33(16):1449–54.

    Google Scholar 

  8. Xuemei Y, Yilan HYW, et al. Construction of nursing sensitive index system based on patient outcome of thoracic laparoscopic radical resection of esophageal cancer. J Nurs. 2018;25(04):37–42.

    Google Scholar 

  9. Wang Bin Z, Xia TH, et al. Construction of nursing-sensitive outcome indicators for elderly diabetic patients based on the Omaha system for nursing outcomes classification. Nurs Res. 2021;35(4):685–9.

    Google Scholar 

  10. Li Yanan Y, Jie W, Wenying, et al. Construction of the index system for the construction of nursing disciplines in tertiary general hospitals. Chin J Mod Nurs. 2024;30(1):82–8.

    Google Scholar 

  11. Wang B, Huang X, Liu G, Zheng T, Lin H, Qiao Y, Sun W. The sensitivity outcome index system for home care of elderly liver transplant patients was developed based on the Omaha problem classification system. BMC Med Inf Decis Mak. 2024;24(1):207.

    Article  Google Scholar 

  12. Li Yueyi C. Application status of Delphi method in nursing management. Nurs Res. 2018;32(21):3339–41.

    Google Scholar 

  13. Chang A, Gardner G, Duffield C, et al. A Delphi study to validate an advanced practice nursing tool. J Adv Nurs. 2014;66(10):2320–30.

    Article  Google Scholar 

  14. Oczkowski SJW, Au S, des Ordons AR, Gill M, Potestio ML, Smith O, Sinuff T, Stelfox HT, Fox-Robichaud. A. E. A modified Delphi process to identify clinical and research priorities in patient and family centred critical care. J Crit Care. 2017;42:243–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jcrc.2017.08.008.

    Article  PubMed  Google Scholar 

  15. Gao D, Ma L, Xi B, et al. Construction of a competency evaluation indicator system for specialist nurses in liver transplantation: A Delphi study. Brit J Hosp Med. 2024;85(10):1–17. https://doiorg.publicaciones.saludcastillayleon.es/10.12968/hmed.2024.0374.

    Article  Google Scholar 

  16. Keegan MT, Kramer DJ. Perioperative care of the liver transplant Patient. Crit Care Clin. 2016;32(3):453–73.

    Article  PubMed  Google Scholar 

  17. Organ Transplantation Branch of the Chinese Medical Association, Organ Transplantation Physicians Branch of the Chinese Medical Doctors Association. Expert consensus on evaluation criteria of human organ donation and transplantation technology in grade hospitals. Chin J Organ Transplantation. 2019;44(1):1–5.

    Google Scholar 

  18. Wang X, Li Y, Zhang Z, et al. Quality indicators for perioperative nursing care of liver transplantation recipients: A systematic review and Meta-Analysis. BMC Nurs. 2022;21(1):1–12.

    CAS  Google Scholar 

  19. Lu Fangyan, Li D, Liu Y, et al. Construction of a quality evaluation index system for perioperative nursing care of children undergoing liver transplantation. Chin J Nurs. 2022;57(6):666–73.

    Google Scholar 

  20. Society of Organ Transplantation, Chinese Medical Association. Nursing technical practice for liver transplantation. Electron J Pract Organ Transplant. 2019;7(5):331–3.

    Google Scholar 

  21. Shen Y, Chen L, Fei K, et al. Construction and application of an early activity program for patients in the intensive care unit after liver transplantation. J Nurs Sci. 2021;36(11):33–6.

    Google Scholar 

  22. Caixia Z. Construction of sensitive indicators for perioperative nursing quality of liver transplantation. Chin J Practical Nurs. 2018;34(27):2120–6.

    Google Scholar 

  23. Zhu Xinyan, Zhang Quyun, Shi Dongni, et al. Application effect of multidisciplinary pain management led by the anesthesia nursing team in the perioperative period of liver transplantation patients. Chin J Mod Nurs. 2022;28(32):4462–6.

    Google Scholar 

  24. Jiang Zhixiong, Ding Xiangying. Research progress on perioperative nutritional support for adult liver transplantation. Chin J Dig Surg. 2023;22(12):1426–32.

    Google Scholar 

  25. Tian Min, Wang Bo, Zhao Xue, et al. Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study, vol. 9. JMIR Medical Informatics; 2021. p. e27175.

    Google Scholar 

  26. Carrier FM, Chassé M, Wang HT, Aslanian P, Bilodeau M, Turgeon AF. Effects of perioperative fluid management on postoperative outcomes in liver transplantation: a systematic review protocol. Syst Rev. 2018;7(1):180. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13643-018-0841-3.

  27. Gao Rong F, Shengya ZJ, Lin-Jun Z. Telehealth and telemedicine in the management of adult patients after liver transplantation: A scoping Review. telemedicine journal and e-health: the official journal of the American telemedicine association. Published Online Dec. 2024;4. https://doiorg.publicaciones.saludcastillayleon.es/10.1089/tmj.2024.0359.

  28. Kula Sahin S, Bulbuloglu S. The effects of the spiritual Well-Being levels of surgical nurses on care satisfaction in liver transplant recipients after transplantation: the case of a Turkish sample. J Relig Health. 2024;63(3):1732–46. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s10943-023-01739-1.

Download references

Acknowledgements

Not applicable.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. The Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, 266000, China

    Bin Wang, Wenjuan Sun, Fengchao Liu, Taohua Zheng, Lin Quan, Guofang Liu, Hui Lin, Yue Qiao, Jinzhen Cai & Xia Huang

Authors
  1. Bin Wang
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Wenjuan Sun
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Fengchao Liu
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Taohua Zheng
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Lin Quan
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Guofang Liu
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Hui Lin
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Yue Qiao
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Jinzhen Cai
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. Xia Huang
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

Conception and design– Bin Wang, Xia Huang and Wenjuan Sun. Procurement of data– Bin Wang, Xia Huang, Guofang Liu, Lin Quan, Jinzhen Cai and Yue Qiao. Analysis of data– Bin Wang, Xia Huang, Guofang Liu and Wenjuan Sun. Drafting of the original manuscript– Bin Wang. Critical review of the original manuscript– Bin Wang, Xia Huang, Wenjuan Sun, Guofang Liu, Lin Quan, Jinzhen Cai and Fengchao Liu. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xia Huang.

Ethics declarations

Ethics approval and consent to participate

This study was submitted to the Ethics Committee of the Affiliated Hospital of Qingdao University and was verbally agreed by the Ethics Committee of the Affiliated Hospital of Qingdao University. The Ethics Committee believes that the anonymous correspondence method used in this study protects the identity of the respondents and does not involve the privacy of the respondents. At the same time, before the expert letter consultation, the respondents were informed of the research purpose and obtained their oral consent. All respondents agreed to provide data anonymously. In addition, this study does not involve human participation, human data, human tissue or case report, nor does it involve human privacy. This study does not include any studies involving humans or animals. The Ethics Committee of the Affiliated Hospital of Qingdao University considers that the construction of nursing sensitive indicators in this study conforms to the regulations of the Ethics Committee of the institution on exemption from ethical review and has been exempted. And the Ethics Committee of the Affiliated Hospital of Qingdao University approved this procedure of verbal informed consent for this study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, B., Sun, W., Liu, F. et al. Construction of a sensitive index system for nursing quality in the perioperative period of liver transplantation based on the Three-Dimensional Quality Structure theory. BMC Health Serv Res 25, 510 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12913-025-12676-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12913-025-12676-y

Keywords

BMC Health Services Research

ISSN: 1472-6963

Contact us