Patients' perspectives on quality of nursing care : exploring the relationship between process and outcome

This study investigated quality of nursing care from the perspective of patients. Twelve adult subjects who had been hospitalized for treatment of a medical or surgical problem completed in depth interviews, Cantril ladder questions, and a demographic data form. Field notes were maintained. The number of interviews per subject ranged from two to four, and occurred over four months. Sampling was theoretically guided. Subjects' ages ranged from 29 to 84 years, and education levels from 8th grade to PhD. Five men and seven women participated. Interviews were audiotaped, transcribed and analyzed for recurrent themes. Qualitative data were organized using the Ethnograph computer program. Quantitative data were analyzed using descriptive statistics, frequency distributions, and a Spearman Rho correlation coefficient. For the subjects, becoming sick or being injured, going to hospital, and receiving treatment, thrust them into a world characterized by intensity. Patient intensity comprised experiences of emotion, body, control, and time. If nursing care eased patients' intensity, care was labeled high quality. Conversely, when patients' intensity increased, care was labeled low quality. High quality nursing care comprised the factors competence, coaching, connection and immediacy. Low quality nursing care comprised the factors incompetence, not informing, detachment, and not being there. Ongoing outcomes of nursing care comprised the themes of patient intensity and physical recovery. Overall outcomes of hospitalization, included the themes of physical status and evaluation of care. Patient intensity and physical recovery were interrelated. Nursing care impacted all outcomes, but the impact on patient intensity was described most frequently. If care was evaluated as low quality, patients described a lingering negative response. Patients described numerous factors as contributing to their overall care outcomes. The quantitative data supported the qualitative findings. Further qualitative research investigating patients' perspectives on process and outcome relationships may explicate the pattern which emerged