Applying triangulation to the assessment of quality of nursing.

The claim that generic quality assessment instruments provide an objective assessment of quality of nursing care is questioned. Recent research suggests that most instruments are in need of extensive validity testing, particularly in relation to the concepts that they purport to assess. This paper outlines a research study designed to test the validity of the generic quality assessment instruments, Monitor, Senior Monitor and Qualpacs. In the absence of an independent criterion of quality against which to validate these instruments we propose a multiple triangulation research strategy in order to achieve the goals of 'confirmation' and 'completeness' within the same research design. The research incorporates approaches that purport to focus on quality of nursing care that are complementary to the generic instruments. We pay particular attention to the meanings of quality of nursing to those most closely involved and in positions of expertise--that is, nurses and patients. Comparisons between scores from the generic instruments and data generated by these complementary approaches will enable a more accurate picture of the validity of the generic instruments to emerge. The research should also increase our understanding of the meaning of quality in relation to nursing care.