The components of hospital quality: a nursing perspective

Spirituality as a universal concept: Student experience of learning about spirituality through the medium of art

Precise definitions of spirituality can be elusive (McSherry, 2000). This factor together with the increasing class sizes for undergraduate nursing students render the teaching and learning of spirituality in nursing a challenge for both lecturers and students alike (McSherry, 2000). This paper reports on the design, delivery and evaluation of an innovative spirituality program for second year nursing students attending a Bachelor of Science degree at a university in the Republic of Ireland. This teaching program was introduced in 2005 to enhance nursing students' engagement with the concept of spirituality. The program consisted of a series of lectures on the topic, followed by a visit to the National Gallery of Ireland. The latter involved a structured visit, whereby the students (n=100) were divided into ten small groups and asked to wander through a section of the gallery and choose a piece of art work that they perceived to be spiritual in nature. Students were then asked to write their subjective impressions and reasons for their choice of painting. A list of themes related to spirituality was provided to the students as a prompt. Students later visited the paintings with both a lecturer and an art gallery guide and their chosen paintings were discussed within the group. Later that day, purposive sampling was used, whereby a selection of nursing students participating in the Gallery visit (n=21) partook in four recorded focus group interviews following the Gallery visit. Themes emerging from the interviews pertained to the universal and individual nature of spirituality. In keeping with Mc Sherry's (2000:27) definition of spirituality as a "universal concept relevant to all individuals", students in the study revealed their surprise at the uniqueness of their colleague's interpretations. The teaching methodology offered them an opportunity to reflect upon their own understandings and develop a deeper awareness of the meaning of spirituality. It also allowed many of them to understand how spirituality transcends traditional religions and permitted many of them to verbalize their feelings on spirituality for the first time.

A discipline-specific determination of high quality nursing care

AIM

The purpose of this study is to establish a framework for defining quality of care based in nursing's unique body of knowledge through identification of nursing actions associated with high quality care.

RATIONALE

Nurses are legally liable and morally responsible for the quality of the care they provide to patients. Yet the meaning of 'high quality nursing care' remains ambiguous mainly because models used to define it are borrowed from other disciplines.

DESIGN

Two frameworks, quality and nursing knowledge, guided the selection and review of this literature review. The third framework of learning domains, an educational theory, assisted in organizing the data gathered from the literature.

FINDINGS

Attributes of high quality nursing care as perceived by both patients and nurses are described. Despite a professed philosophy of holism and humanism, nursing relies heavily on the industrially derived structure-process-outcome model with current emphasis on outcomes.

CONCLUSIONS

Patient outcomes are the product of the service nurses deliver and are appropriate as defining criteria only when care is being evaluated from the patient's perspective. Defining quality from the nursing profession's frame of reference focuses on evaluating the services provided; that is, nursing actions and behaviours, linked to the use of nursing knowledge. High quality nursing equates with competence in the cognitive, affective, and psychomotor domains.

Cost, quality, and satisfaction with hospice after-hours care

Three hundred seventy-three patients enrolled in a health maintenance organization's hospice program were given two different models of after-hours nursing care, one using nurse employees and the other using contract nurses. Statistically significant differences were found between the two groups in cost, in quality of nursing care, and in patient/family satisfaction. Cost of hospital days for the organization was less when patients received after-hours care from nurse employees of the organization, and quality of documentation was better. More patients who received care from nurse employees were satisfied with nurses' arrival time and understanding of problems as well as with the service, information, courtesy, follow-up, and respect which patients received during their hospice stay.

A tentative model for developing strategic and clinical nursing quality indicators: postoperative pain management

The purpose of the study was to evaluate the usefulness of a tentative model, based on important aspects of surgical nursing care, for designing strategic and clinical quality indicators. Objective postoperative pain management was chosen for the model because it is a priority area in surgical nursing care. Items within a questionnaire were designed by using the tentative model as a base and by means of a literature review. The questionnaire, directed to clinical nurses (n = 233), was compiled to establish the validity and the usefulness of the indicators. Fourteen items were assessed as essential for achieving high quality outcomes in postoperative pain management (11 as realistic to carry out, and 13 as possible for nurses to influence) with mean scores > or = 4 (on a 5-point scale). The conclusion reached was that the tentative model combined with a literature search was found to be effective for designing items that might be useful as strategic and clinical indicators of quality in postoperative pain management.

The use of focus group methodology--with selected examples from sexual health research

This paper describes in detail the use of the focus group approach in research. The following issues are discussed: when, why and how focus group methods are used, their advantages and disadvantages and how data are analysed. Selected examples from four research studies on sexual health using this methodology are reported together with some of the problems experienced with their use. The importance of using focus groups in qualitative research is addressed and an argument is suggested for their more general use.

Important aspects of nursing care in surgical wards as expressed by nurses

The aim of this study was to find out clinical nurses' perceptions of important aspects of nursing care that might have an impact on quality of care in surgical wards. A qualitative approach using focus group interviews was used. The data analysis revealed 15 categories of important aspects of care which could be condensed into two dimensions, here called 'prerequisites' (i.e., staffing, routines and attitudes) and 'elements of performance' (i.e., detecting and acting on signs and symptoms and acting on behalf of the patients). These aspects could be a starting point for developing quality indicators. Carper's four fundamental patterns of knowing were used to make a theoretical interpretation, and three of them were identified.

Quality indicators in clinical nursing: a review of the literature

The purpose of the present study was, by means of a literature review, to describe and analyse the characteristics of clinical indicators used to assess and promote quality improvement in nursing care. It was found that a generally accepted definition of a clinical indicator is a 'quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities'. By the seriousness of the event and the degree to which it can be avoided, clinical indicators are described as sentinel event or rate-based indicators. They can measure structure, process or outcome of care. Authors have had different approaches in focus when selecting and developing indicators viz. specific aspects of care/nursing diagnosis, medical diagnosis, generic aspects of care and clinical areas. These different points of departure were influenced by research knowledge, theories/frameworks, or by the opinions of patients or staff. The threshold of an indicator is essential when measuring the quality of care as it describes a critical level between what is considered good or not. Thresholds should be dynamic, realistic, and improve over time. However, the literature on how to establish specific thresholds is limited. The review has also revealed that there is an uncertainty regarding the use of terms such as indicators, standards, norm, criteria and aspects of care.