Mary Gunther1, Martha Raile Alligood. 1. College of Nursing, University of Tennessee, Knoxville, Tennessee 37996-4180, USA. mgunther@cn.gw.utk.edu
Abstract
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.
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.