Journal of nursing management · 2026
Improving Nursing Quality Through On-Site Supervision: A Process Management Intervention Guided by the Structure-Process-Outcome Model.
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Li Min, Li Yueqin, Fan Maoqing, Cui Liping
Аннотация
AIM(S): To develop and evaluate an Structure-Process-Outcome (SPO) model-based on-site supervision program for nursing process management, and to assess its impact on nursing compliance, competency, patient satisfaction, and adverse events.
BACKGROUND: The SPO model provides a comprehensive framework for evaluating healthcare quality, yet its translation into practical on-site nursing supervision tools remains limited. Nursing quality assessments frequently emphasize retrospective outcome indicators while offering limited insight into real-time procedural adherence.
METHOD(S): A pre-post quasi-experiment was conducted in a tertiary hospital (January 2024-December 2025), comparing outcomes between independent annual cohorts of nurses (2024 vs. 2025) within the same wards. Participants were not individually matched across the two phases. The intervention included a "1 + 1 + X" supervision team (Structure), formative evaluation with a "Ten Knowledges" checklist (Process), and a closed-loop feedback mechanism. Data were collected from nurses (n = 194) and patients (n = 155) and analyzed using t-tests and chi-square tests.
RESULTS: Nursing compliance (aseptic technique: 91.86% vs. 83.80%), skill scores (93.65 ± 2.28 vs. 91.80 ± 3.76), and patient satisfaction (97.44 ± 3.93 vs. 95.86 ± 5.26) improved significantly (p < 0.05). The annual number of documented nursing-related adverse events decreased from 559 in 2024 to 398 in 2025 (presented as raw counts without adjustment for total procedures).
CONCLUSION(S): The SPO-based program was associated with improvements in nursing quality and patient safety indicators, suggesting a replicable strategy for nurse managers.
IMPLICATIONS FOR NURSING MANAGEMENT: This program offers nurse managers a structured, theory-driven framework for on-site supervision that can be adapted across similar clinical settings. By strengthening procedural compliance, clinical competency, and patient-centered care, the approach provides a practical strategy for improving nursing quality and patient safety within existing resource constraints.
BACKGROUND: The SPO model provides a comprehensive framework for evaluating healthcare quality, yet its translation into practical on-site nursing supervision tools remains limited. Nursing quality assessments frequently emphasize retrospective outcome indicators while offering limited insight into real-time procedural adherence.
METHOD(S): A pre-post quasi-experiment was conducted in a tertiary hospital (January 2024-December 2025), comparing outcomes between independent annual cohorts of nurses (2024 vs. 2025) within the same wards. Participants were not individually matched across the two phases. The intervention included a "1 + 1 + X" supervision team (Structure), formative evaluation with a "Ten Knowledges" checklist (Process), and a closed-loop feedback mechanism. Data were collected from nurses (n = 194) and patients (n = 155) and analyzed using t-tests and chi-square tests.
RESULTS: Nursing compliance (aseptic technique: 91.86% vs. 83.80%), skill scores (93.65 ± 2.28 vs. 91.80 ± 3.76), and patient satisfaction (97.44 ± 3.93 vs. 95.86 ± 5.26) improved significantly (p < 0.05). The annual number of documented nursing-related adverse events decreased from 559 in 2024 to 398 in 2025 (presented as raw counts without adjustment for total procedures).
CONCLUSION(S): The SPO-based program was associated with improvements in nursing quality and patient safety indicators, suggesting a replicable strategy for nurse managers.
IMPLICATIONS FOR NURSING MANAGEMENT: This program offers nurse managers a structured, theory-driven framework for on-site supervision that can be adapted across similar clinical settings. By strengthening procedural compliance, clinical competency, and patient-centered care, the approach provides a practical strategy for improving nursing quality and patient safety within existing resource constraints.