Grappling With The Measurement Of Quality Care: Exploring Nursing Care And Its Impact On Patient Outcomes

2.50
Hdl Handle:
http://hdl.handle.net/10755/166041
Category:
Abstract
Type:
Presentation
Title:
Grappling With The Measurement Of Quality Care: Exploring Nursing Care And Its Impact On Patient Outcomes
Author(s):
Lynn, Mary
Author Details:
Mary Lynn, PhD, Associate Professor, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA, email: mlynn.uncson@mhs.unc.edu
Abstract:
There are many definitions of quality care all of which have implications for how quality care should be measured. Most definitions of quality care can be summarized in one of the following statements: Care is of good quality insofar as it contributes to the patient's well-being (Ginsburg & Hammons, 1988); the balance of health benefits and harms is the essential core of quality (Donabedian, 1980); quality care lies in the concordance of behavior and professional expectations (Donabedian, 1987a)-- that is, care provided at the highest level of professional expertise, both technical and interpersonal, is also of the highest quality (Donabedian, 1980); and finally, quality consists in the ability to achieve desirable objectives using legitimate means (Donabedian, 1988). Traditional measurements do not capture the full definition of quality care. The critical question is how can we assess quality care to document whether it has been provided and what impact it has on patient outcomes? While health care issues and policy are under considerable scrutiny and debate, the effectiveness of many components of the health care system are not being assessed in terms of determining if we are achieving the desired effect -- are we doing what we should be doing on behalf of the patients we serve (Shaughnessy, et al., 1994)? The lack of effectiveness assessment stems partially from the already mentioned lack of a clear definition of effectiveness or quality care and partially from a lack of an overview of quality that identifies the essential components for the assessment. Since quality care is multi-faceted, so must be its definition and measurement. The essential concepts in defining and measuring quality nursing care are the structural context of care, the provider, patient, health state and attainable outcomes of care. When quality care can be adequately measured, we will have a means to systematically monitor its delivery in order to maintain or improve its quality. Within a multi-site study we are attempting to test measures of quality care that address aspects of this conceptualization so we can proceed to the next step --- a test of the conceptualization including all of its components. However, we have encountered a number of issues/questions that require resolution before we can proceed. These issues include: understanding how patient acuity and the complexity of nursing care relate to each other, and within that exploration, identifying how complexity of care can be accurately estimated; understanding what patients value about quality nursing care so that care is consistent with those (patient) expectations; and, exploring whether traditional structure (e.g., staff mix, turnover) and "quality" (e.g., medication errors) indicators have any relationship to the care received by the patient. As we begin to grapple with these and other measurement/substantive issues we are continuing our progress towards a multivariate system for the assessment of quality care.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Host:
Southern Nursing Research Society
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleGrappling With The Measurement Of Quality Care: Exploring Nursing Care And Its Impact On Patient Outcomesen_GB
dc.contributor.authorLynn, Maryen_US
dc.author.detailsMary Lynn, PhD, Associate Professor, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA, email: mlynn.uncson@mhs.unc.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/166041-
dc.description.abstractThere are many definitions of quality care all of which have implications for how quality care should be measured. Most definitions of quality care can be summarized in one of the following statements: Care is of good quality insofar as it contributes to the patient's well-being (Ginsburg & Hammons, 1988); the balance of health benefits and harms is the essential core of quality (Donabedian, 1980); quality care lies in the concordance of behavior and professional expectations (Donabedian, 1987a)-- that is, care provided at the highest level of professional expertise, both technical and interpersonal, is also of the highest quality (Donabedian, 1980); and finally, quality consists in the ability to achieve desirable objectives using legitimate means (Donabedian, 1988). Traditional measurements do not capture the full definition of quality care. The critical question is how can we assess quality care to document whether it has been provided and what impact it has on patient outcomes? While health care issues and policy are under considerable scrutiny and debate, the effectiveness of many components of the health care system are not being assessed in terms of determining if we are achieving the desired effect -- are we doing what we should be doing on behalf of the patients we serve (Shaughnessy, et al., 1994)? The lack of effectiveness assessment stems partially from the already mentioned lack of a clear definition of effectiveness or quality care and partially from a lack of an overview of quality that identifies the essential components for the assessment. Since quality care is multi-faceted, so must be its definition and measurement. The essential concepts in defining and measuring quality nursing care are the structural context of care, the provider, patient, health state and attainable outcomes of care. When quality care can be adequately measured, we will have a means to systematically monitor its delivery in order to maintain or improve its quality. Within a multi-site study we are attempting to test measures of quality care that address aspects of this conceptualization so we can proceed to the next step --- a test of the conceptualization including all of its components. However, we have encountered a number of issues/questions that require resolution before we can proceed. These issues include: understanding how patient acuity and the complexity of nursing care relate to each other, and within that exploration, identifying how complexity of care can be accurately estimated; understanding what patients value about quality nursing care so that care is consistent with those (patient) expectations; and, exploring whether traditional structure (e.g., staff mix, turnover) and "quality" (e.g., medication errors) indicators have any relationship to the care received by the patient. As we begin to grapple with these and other measurement/substantive issues we are continuing our progress towards a multivariate system for the assessment of quality care.en_GB
dc.date.available2011-10-27T14:39:00Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T14:39:00Z-
dc.conference.hostSouthern Nursing Research Societyen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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