Quality in Nursing : A Simple Question with Difficult Answer

Some of the simplest questions have the most difficult answers. ‘What is quality?’ ranks with the most difficult of them. Quality in other professions may be linked to tangible physical properties; however, in patient care quality is intangible. As said by Kitchenham, “Quality is hard to define, impossible to measure, easy to recognize.” According to Peter F. Drucker, “Quality in a product or service is not what the provider puts in. It is what the customer gets out.” As the largest group of healthcare professionals, nurses contribute in positive and negative ways to the healthcare quality problem. Nurses have intimate knowledge of patient needs and the continuous interactions nurses maintain with the patients and their families uniquely position them to positively influence their hospital experiences and resultant outcomes. The fact is the nurses play a central role in ensuring the quality of hospital care. While few reports were found in the professional literature regarding poor nursing quality; perceptions in decline of quality and understanding of quality among hospital nurses and patients have risen in recent years.

Nurses now understand the reasons behind the unsatisfactory quality care of patients. Coupled with the shortage of nurses, the view persists that professional nurses are less involved in direct care of patients but rather seen occupied with administering medications or supervising. Trained nurse peer reviewers used a quality rating scale based on the nursing process to evaluate the overall quality of nursing care. Findings revealed that systematic variation in nursing care were linked to hospital type and geography. With the current approach of assigning some clinical responsibilities to unlicensed assistive personal, the nursing shortage and higher acuity in hospitals, one would suspect that these problems persist and may be even worse. Some of the nursing sensitive indicators of quality care given by American Nurses Association include:

• Nursing hours
• Nosocomial infections
• Nurse satisfaction
• Patient injuries
• Mixed staff
• Patient satisfaction

It is important to recognize some of the primary characteristics of quality:

• Quality is not absolute: it cannot be measure upon a quantifiable scale.
• Quality is multidimensional: it has many contributing factors. It is not easily summarized.
• Quality is subject to constraints: it refers to any critical resources such as people, tools and time. The availability and demand of a resource will become critical to overall quality.
• Quality is about acceptable compromises: in the quality criteria, some may be sacrificed and others may be well accepted.
• Quality criteria are not independent: the quality criteria interact with each other causing conflicts.
• Quality changes over time.

There are various opportunities to enhance the quality of patient care. Strengthening the nursing workforce through education, continuing education in information technology and research skills, migrating away from fact based learning to value based learning will effectively add to proportion of more educated nurses. Frequent opportunities for critical reflection will enhance self awareness and contribute to more caring practice.

( Joanne Duffy, 2003 )