Abstract: Objective: To sort out the ways of nursing managers in identifying problems in the on-site supervision of nursing quality, so as to provide reference for scientific and reasonable clinical nursing quality supervision. Methods: Literature analysis, semi-structured interviews, and questionnaires were used to summarize the perspectives and ways of problems identification in the on-site supervision of nursing quality. Focus group discussions were used to form an item pool regarding the models of problems identification in nursing quality on-site supervision. The Delphi method was used and 35 experts were invited for two rounds consultation to finalized the model of problems identification in nursing quality on-site supervision. The finalized model of problems identification was preliminarily applied in practice in July 2024, and the difference in the self-efficacy of head nurses during cross-departmental quality supervision before and after the application of the model was compared. Results: The effective recovery rates of the two rounds of expert consultations were 88.6% and 93.5%, respectively. The coefficients of the degree of authority were 0.88 and 0.92, respectively. The coefficients of Kendall's concordance were 0.20 and 0.26, respectively (both P<0.05). The three perspectives of problem identification in nursing quality on-site supervision were clarified as direct acquisition, comparative discovery, and in-depth exploration. Six ways of problem identification were listening, looking, asking, checking, visiting, and tracking. The timing of applying each perspective and the specific contents of the six ways of problem identification were clarified. After the application of the model, the self-efficacy of the head nurses in problems identification was significantly higher than that before the application (P<0.001). Conclusion: The model of problems identification in on-site supervision of nursing quality is scientifically developed, reliable, and can be used as a guideline for scientific and reasonable nursing quality supervision.

Key words: nursing quality; on-site supervision; problem identification; Delphi method