Measuring patients' perceptions of nursing care.

Each year pain disables approximately 50 million Americans. This study determined the relationships among pain management and patients' and nurses' perceptions of quality nursing care. This study was a secondary analysis of data for 91 patients, with additional data collected. How patients perceive their nursing care may correlate with how well their pain is managed.

The changing role of the consumer in health care quality.

Traditionally, health care quality has been provider defined and focused, even though consumers define and evaluate health care quality. And, there is no relationship between consumer and provider perceptions of quality. Importantly, consumers use their evaluations when they decide to sue, recommend or return for services, and comply with treatment regimens. This article examines the changing role of the consumer in health care quality, explicates the need for a change in the health care paradigm, and suggests strategies for increasing patient participation in health care planning and quality assessment.

Emerging model of quality.

A theoretical model of quality, based on an organismic worldview, provides a framework for understanding health care quality. This retroductively developed model incorporates ethical and economic concepts: value, beneficence, prudence, and justice. The model supports viewing patients and families as equal partners with providers in defining, evaluating, and achieving health care quality. Further model development can generate mid-range theories useful for improving quality in an ethical and economic manner.

Progressive systemic sclerosis: Part 1--The disease and medical management.

The incidence of scleroderma is approximately 700,000 people in the United States. Pathologic changes occur in a variety of body systems and can alter lifestyle, especially for people with diffuse scleroderma. Information from clinical practice and research concerning the nature, incidence, pathophysiology, complications, and medical management is discussed. Although there is no known cure for scleroderma, life expectancy has improved as management of renal hypertensive crisis and renal failure has improved.

Relationships among educational material readability, client literacy, perceived beneficence, and perceived quality.

Illiteracy remains a pervasive problem that compromises quality health care, limits understanding of health information, and potentially leads to poor health outcomes. This study demonstrated that participants' measured reading level was significantly lower than both their stated years of education and readability of an educational pamphlet. A positive relationship was identified between measured reading level and pamphlet helpfulness (client-perceived beneficence). Participants perceived care quality as good to very good. Quality client education requires use of either educational materials appropriate for the measured reading level of clients or alternatives to written material.

Women's perceptions of quality and benefits of postpartum care.

Increased competition in the United States has led to increased interest in women's perceptions of their obstetric experience. Family-centered postpartum care (FCPPC) was originated to improve women's perceptions of care quality. This study examined differences in and the hypothesized relationship between quality and beneficence in a group receiving traditional postpartum care (TPPC) and a group receiving FCPPC in a safety-net hospital in West Tennessee. Both groups had high mean quality and beneficence scores; however, the FCPPC group's scores were significantly higher than those of the TPPC group. There was a relationship between quality and beneficence for the combined sample. The findings suggest that nurses should incorporate FCPPC approaches as a means of improving perceived quality and benefits.

A simultaneous analysis of nursing care quality and cost.

The simultaneous evaluation of quality and the cost of health care can provide information that is useful for guiding quality improvement activities while minimizing or reducing cost. Despite the evidence of concern for health care costs, a long history of concern for health care quality, and numerous efforts to evaluate the quality and cost of health care simultaneously, current methods have been relatively ineffective in decreasing or containing costs. Simultaneous monitoring of cost and quality indicators can be used to compare differences between the cost of prevention and the cost of failure and can be utilized to determine areas where failure costs can be decreased.

Defining patient-perceived quality of nursing care.

Many patient satisfaction instruments are not based on patient perceptions, theoretically limiting their validity. This qualitative study identified good nursing care from the patient's perspective, using a convenience sample of 199 hospitalized adult patients in a public hospital in South Central United States. Content analysis yielded five themes: providing for my needs, treating me pleasantly, caring about me, being competent, and providing prompt care. Similarities and differences were found between these themes and themes identified in other qualitative studies, as well as instruments, for which item generation was based upon qualitative patient data. Implications for providers, administrators, and researchers are discussed.

A model for change to evidence-based practice.

PURPOSE: To describe a model that guides nurses and other healthcare professionals through a systematic process for the change to evidence-based practice. The tremendous increases in clinical research and accessibility to research findings have prepared the way for the paradigm shift from traditional and intuition-driven practice to evidence-based practice. Although several models have emerged to guide practitioners in research utilization, practitioners continue to have difficulty synthesizing empirical and contextual evidence and integrating evidence-based changes into practice. ORGANIZING FRAMEWORK: The model is based on theoretical and research literature related to evidence-based practice, research utilization, standardized language, and change theory. In this model, practitioners are guided through the entire process of developing and integrating an evidence-based practice change. The model supports evidence-based practice changes derived from a combination of quantitative and qualitative data, clinical expertise, and contextual evidence. METHODS: The model was developed using sources identified on searches of Medline, CINAHL, and systematic reviews available on the Internet. Review topics were focused on evidence-based medicine and nursing, research utilization, and change process. Other sources included clinical expertise and quality-improvement information. CONCLUSIONS: Practitioners need skills and resources to appraise, synthesize, and diffuse the best evidence into practice. Patient outcomes must reflect discipline-specific and interdisciplinary accountabilities. Collaboration between researchers and practitioners within and among disciplines will enhance the diffusion of evidence-based practice innovations.

Patient satisfaction with nurse practitioner care in primary care.

This quantitative, descriptive pilot study assessed patient satisfaction with care provided by four nurse practitioners using a modified version of the Di Tomasso-Willard Patient Satisfaction Questionnaire. Results indicated high satisfaction with care in all groups, but there were differences among the groups on 26 percent of the items and on three of the five subscales. The implication is that nurse practitioners need to identify and improve those dimensions of care for which patients are less satisfied.

The lived experience of patient prudence in health care.

The purpose of this phenomenological study was to describe the lived experience of patient prudence in health care. Prudence has previously been defined as good judgement in setting realistic personal goals and using personal resources to achieve those goals. Audiotaped interviews were conducted with 10 hospitalized adults for whom health care providers had previously recommended life style changes for health reasons. Data were analysed using Colaizzi's method. Seventy-seven significant statements were identified and, from their formulated meanings, seven themes emerged that were integrated into a description of the fundamental structure of prudence. From the patient perspective, prudence in health care is a dynamic phenomenon that involves achieving well-being and self-perpetuation within the context of the patient's world of competing values and is experienced with emotions that range from harmony to fear and depression.

Predictors of patient-perceived quality.

Larrabee's model of quality proposes a relationship between quality and value. This study tested the relationship by identifying predictors of patient-perceived quality for nursing care. Data were obtained from interviews and records of 199 adult patients. Candidate predictors of patient-perceived quality included patient goal achievement, nurse-perceived quality, and nurse goal achievement. Candidate predictors also included seven demographic, seven financial, six illness, and six hospital variables. Predictors of both patient-perceived quality global and patient-perceived quality total were pain severity on exit interview, clinic referral, unit, and patient goal achievement. Medicare nonrecipient was a predictor of patient-perceived quality global. Worry score on admission was a predictor of patient-perceived quality total. The results support the relationship between quality and value and between quality and beneficence postulated by Larrabee's model of quality. Additional investigation of these relationships in other populations and using other operationalizations of the model concepts is needed to provide further support for the model. This model is potentially useful for investigating quality in diverse cultures because the operationalization of the model concepts can be designed to reflect local, regional, or national values.

Progressive systemic sclerosis: Part 2--Nursing management.

Multiple body systems can be affected by scleroderma. Satisfactory coping and life-style alterations will depend on numerous factors, including the nature and extent of organ involvement, individual coping style, and health professional services provided. Because of the low incidence of this disease, nurses may have little knowledge about the nursing management. Because of the nature of the disease's complications, the nephrology or dialysis nurse may care for more scleroderma patients than other hospital nurses.

Evaluation of documentation before and after implementation of a nursing information system in an acute care hospital.

Economic pressures on healthcare systems have intensified the necessity of demonstrating the unique contribution of nursing care to patient outcomes. The use of nursing information systems (NIS) has increased completeness of some nursing documentation elements. This study's purpose was to evaluate differences in documentation completeness of nurse assessments of patient outcomes (NASSESS), achievement of patient outcomes (NGOAL), nursing interventions done (NQUAL), and routine assessments before and after implementation of an NIS in a 100-bed urban university hospital in west Tennessee and before and after retraining in NIS use and care planning. NIS implementation did not improve documentation within the first six months. However, retraining and continued NIS use did significantly improve NASSESS, NGOAL, NQUAL, and blood pressure documentation 18 months postimplementation. Nurses must evaluate documentation completeness before and periodically after NIS implementation, using results to improve patient record data validity for patient care decisions, quality improvement, and research.