ORIGINAL RESEARCH article
Front. Med.
Sec. Healthcare Professions Education
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1618271
Exploring Standards for Difficult and Complex Nursing Cases in the Context of the Healthy China Strategy: A Delphi Method Study
Provisionally accepted
- 1Shenzhen Hospital, Southern Medical University, Shenzhen, China
- 2School of Nursing, Southern Medical University, Guangzhou, Guangdong Province, China
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With the ongoing implementation of the 'Healthy China 2030' national strategy, China's nursing service system is shifting from a treatment-centered model to one focused on patient-centered, life-course health management. This transformation highlights the increasing complexity of clinical nursing scenarios and underscores the urgent need for nurses to develop strong critical thinking skills. However, the lack of standardized criteria for identifying and categorizing complex cases hampers the development of effective case-based learning resources in nursing education.This study developed initial standards for difficult and complex nursing cases through a literature review and qualitative interviews. Based on these indicators, the classical Delphi method was employed to reach a consensus with 17 experts from the medical and nursing fields.After two rounds of expert consultation, final standards comprising four primary indicators and seventeen secondary indicators were established. The coefficient of variation for indicators was 0.051-0.115. The effective response rates for the two rounds of expert questionnaires were 100.0% and 94.1%, the expert authority coefficients were 0.894 and 0.916, and the Kendall's W were 0.173 and 0.311.This study establishes the first evidence-based standards for identifying difficult and complex nursing cases for educational purposes. The multidimensional framework provides a systematic approach for case selection, addressing a critical gap in nursing education resources. These standards will facilitate the development of case databases and support evidence-based strategies for enhancing nurses' critical thinking abilities across diverse clinical settings.
Keywords: Difficult and complex cases, Nursing education, Critical Thinking, Delphi study, Case-based learning
Received: 25 Apr 2025; Accepted: 19 Aug 2025.
Copyright: © 2025 Gao, Zhong, Zhang, Huang, Chen, Cai and Ren. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wei Ren, Shenzhen Hospital, Southern Medical University, Shenzhen, China
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