Nursing Accountability and Nurse Sensitive Outcomes: A Qualitative Focus Group Study With Nurses and Patients

Achoimre

ABSTRACT Aim To explore nursing accountability in relation to nurse sensitive outcomes (NSOs) from nurses' and patients' perspectives. Design Qualitative descriptive study. Methods Five focus groups were conducted (November–December 2024) at a university medical centre: four with nurses from different divisions and one with patients. Discussions were guided by empathy mapping and questions addressing five NSOs (pressure ulcers, delirium, catheter‐associated urinary tract infections, line infections, fall incidents). The Fundamentals of Care (FOC) Framework informed the analysis of empathy‐map data, while inductive analysis was applied to responses related to the NSOs. Results Nurses and patients identified elements of nursing accountability, although their perspectives sometimes diverged. Nearly all FOC elements were represented in focus groups. For nurses, accountability emerged as a complex, layered concept. Across NSOs, implementation of interventions, especially for fall incidents, was emphasised. For pressure ulcers, prevention and recognition are key, while delirium was mainly seen as a medical accountability. Conclusion NSOs provide measurable indicators of nursing accountability; however, current quantifications do not fully capture the complexity of nursing practice. Nurses emphasised accountability for their professional actions, including preventive care, while recognising patient outcomes may still be unfavourable. Although NSOs conceptually allow for a broader view, their present operationalisation supports only partial representation of accountability distribution and outcome evaluation. This underscores the need for broader approaches to evaluating nursing accountability. Implications for the Profession and/or Patient Care Strengthening nursing accountability requires professional autonomy in multidisciplinary decision‐making. It also requires access to NSO data, the ability to interpret these data, and opportunities to act on influencing factors. Supporting reflective practice and constructive use of outcomes data are equally important. Future research should refine NSOs to better capture nursing contributions without narrowing the scope of the nursing profession. Impact This study highlights the multifaceted nature of nursing accountability as perceived by nurses and patients, providing insights into the potential and limitations of nurse sensitive outcomes. Reporting Method Standards for reporting qualitative research (SRQR). Patient or Public Contribution This study did not include patient or public involvement in its design, conduct, or reporting.