Healthcare quality continues to be a subject of intense criticism and debate. Although quality nursing care is vital to patient outcomes and safety, meaningful improvements have been disturbingly slow. Analysis of quality care literature reveals that practising nurses are rarely involved in developing or de? ning improvement programs for quality nursing care. Therefore, two major study premises were that quality nursing care must be meaningful and relevant to nurses and that uncovering their meaning of quality nursing care could facilitate more effective improvement approaches.
Method. Using van Manen’s hermeneutic phenomenology, meaning was revealed through analysis of interviews to answer the research question ‘What is the lived meaning of quality nursing care for practising nurses? ’ Twelve nurses practising on medical or surgical adult units at general or intermediate levels of care within acute care hospitals in the United States of America were interviewed. Emerging themes were discovered through empirical and re? ective analysis of audiotapes and transcripts. The data were collected in 2008. Findings.
The revealed lived meaning of quality nursing care for practising nurses was meeting human needs through caring, empathetic, respectful interactions within which responsibility, intentionality and advocacy form an essential, integral foundation. Conclusion. Nurse managers could develop strategies that support nurses better in identifying and delivering quality nursing care re? ective of responsibility, caring, intentionality, empathy, respect and advocacy. Nurse educators could modify education curricula to model and teach students the intrinsic qualities identi?
Ed within these meanings of quality nursing care. Keywords: hermeneutic phenomenology, nursing, nursing care, qualitative, quality Introduction The need to address healthcare quality improvement intensi? ed within the past decade. In 2000, the Institute of Medicine (IOM) heralded the need patient safety and quality of care in America (USA) with publication of Building a Safer Healthcare System O 2010
The Authors. Journal compilation O 2010 Blackwell Publishing Ltd for improvement in the United States of To Err Is Human: (IOM 2000). Their 1689 L. M. Burhans and M. R. Alligood documentation of 98,000 hospital deaths annually due to errors by healthcare providers sent shockwaves through professional and public arenas. In Crossing the Quality Chasm: A New Health System for the 21st Century (IOM 2001), a vision for safe, high quality care that is evidencebased, patient-centred and systems-oriented was delineated. In response to these reports, healthcare professionals were challenged to take responsibility and accountability for the quality of their practice and actively improve the quality and safety of healthcare in the USA.
In the 2004 report titled Keeping Patients Safe: Transforming the Work Environment of Nurses, the IOM validated research indicating that nursing care was directly related to improved patient outcomes and that nursing vigilance protected patients against errors (IOM 2004). Nurses, as hands-on caregivers, make major healthcare contributions by assessing, planning, and evaluating patient care needs; delivering treatments and medications; advocating for patients; and assuring their comfort. The quality of nursing care makes a vital difference in patient outcomes and safety.
Despite dissemination of numerous innovative patient safety and quality programmes in recent years, however, meaningful improvements have been disturbingly slow. Clarke and Aiken (2006) stated that: ‘There is consensus that the goal proposed by the IOM to halve the rate of medical errors within 5 years has not yet been achieved’ (p. 3). As healthcare professionals, nurses are accountable for the quality and systematic improvement of nursing practice (American Nurses Association 2004). It is notable that, with 2?
6 million nurses in the USA delivering patient care, their daily evaluation of that care is done without a shared understanding of what quality nursing care really means. The existing literature focuses primarily on measurement of nursing care quality through patient outcomes and patient satisfaction. Whereas these data provide important information, they do not address quality nursing care speci? cally. Practising nurses are often participants in studies measuring nursing care quality; however, evidence of their input into the development of measures is lacking.
Furthermore, the developers and authors of the measures are often nurse leaders, managers, educators and researchers who, by virtue of their positions, are not in practising nurse care roles. Therefore, practising nurses’ meanings of quality nursing care are not adequately represented. We reasoned that if current outcome measures and quality criteria failed to capture the heart of nursing and the meaning of quality nursing care for practising nurses, this might be contributing to the slow pace of improvement in quality 1690 nursing care. Therefore we designed a study to uncover the meaning of quality nursing care as lived, understood, and articulated by practising nurses.