Measuring Quality of Care: A Rasch Validity Analysis of the Good Nursing Care Scale

Introduction and Systematic Review of the Good Nursing Care Scale

AIM(S)

To provide an introduction to the Good Nursing Care Scale (GNCS) and systematically review the application of the scale in health research.

DESIGN

Systematic review.

METHODS

Empirical studies published in English or Finnish in peer-reviewed journals or as a summary of a PhD thesis where the scale was used for data collection amongst patients were included. Analysis was made by using descriptive statistics, narrative analysis, and evaluation of psychometric properties.

DATA SOURCES

PubMed, CINAHL, Cochrane, and Scopus in October 2023.

RESULTS

A total of 26 full-text studies and summaries of PhD theses were included in the review. The GNCS has been developed systematically, and the theoretical structure has remained stable. The studies indicate a high level of patient-centered quality of nursing care. Validity and reliability evaluation and reporting were systematic in the studies and mainly indicate sufficient level. Variations between countries are not large, supporting the international use of the GNCS.

CONCLUSIONS

Patient-centered quality of nursing care is predominantly at high levels. However, systematic evaluation is needed to provide longitudinal data. For that purpose, the GNCS is one potential instrument.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Support for the use of existing, tested instruments is encouraged to provide critical ideas for the future needs of nurse practitioners, managers, teachers and researchers.

IMPACT

This paper impacts researchers interested in systematic evaluation of the patient-centered quality of nursing care and for practitioners taking care of patients. For researchers, it introduces a relevant instrument, the GNCS, for analysing the quality or for comparing the quality with other instruments. For practitioners, it produces evidence of the usability of the GNCS.

REPORTING METHOD

PRISMA guided the systematic review, and the COSMIN guideline was used for quality appraisal of included studies.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public contribution.

Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach

Background

Nursing workload and its effects on the quality of nursing care is a major concern for nurse managers. Factors which mediate the relationship between workload and the quality of nursing care have not been extensively studied. This study aimed to investigate the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and quality of nursing care.

Methods

In this cross-sectional study, 311 nurses from four different hospitals in center of Iran were selected by convenience sampling method. Six self-reported questionnaires were completed by the nurses. The data were analyzed by SPSS version 16. Structural equation modeling was used to determine the relationships between the components using Stata 14 software.

Results

Except direct and mutual relationship between workload and quality of nursing care (P ≥ 0.05), the relationship between other variables was statistically significant (P < 0.05). The hypothesized model fitted the empirical data and confirmed the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and the quality of nursing care (TLI, CFI > 0.9 and RMSEA < 0.08 and χ²/df < 3).

Conclusion

Workload affects the quality of the provided nursing care by affecting implicit rationing of nursing care, job satisfaction and emotional exhaustion. Nurse managers need to acknowledge the importance of quality of nursing care and its related factors. Regular supervision of these factors and provision of best related strategies, will ultimately lead to improve the quality of nursing care.

The use and quality of reporting of Rasch analysis in nursing research: A methodological scoping review

BACKGROUND

Rasch analysis is widely used in the life sciences. Rasch analysis is a mathematical and probabilistic model based on the assumption that the probability of passing a single item is governed by a person's ability and the difficulty of the item. However, its use in nursing science remains unclear.

AIM

To (i) describe the use of Rasch analysis in nursing research and (ii) determine the quality of reporting in nursing studies using Rasch models.

METHODS

A methodological scoping review of literature was conducted. The systematic electronic literature search was initially conducted on 1 February 2020 and updated on 16 April 2021 from PubMed/Medline and CINAHL databases. The search was limited to covering the timeframe from the earliest literature available until 31 December 2020. The search terms used were Rasch, IRT, item response theory, and nursing. The search was limited to the English language and title/abstract level. The analysis included quantification and content analysis.

RESULTS

In total, 388 hits were identified. Following a two-phase retrieval process, 88 articles were included in the final analysis. Rasch analysis was used to test the psychometric properties of the newly developed instrument, and validate or test a short version of the existing instrument. The reporting of Rasch analysis demonstrated large variability in quality. Rating scale functioning, internal scale validity using goodness-of-fit statistics, and unidimensionality were the most frequently reported outcomes.

CONCLUSION

The use of Rasch analysis in nursing science was found to be unsystematic. Rasch analysis could provide new possibilities for investigating measurement properties. However, robust, comprehensive, and precise reporting of the methodological choices and results of Rasch analysis is needed. Furthermore, the use of Rasch analysis in nursing science is encouraged.

WHAT IS ALREADY KNOWN

WHAT THIS PAPER ADDS.

The Relationship Between Nursing Care Delivery Models, Emotional Exhaustion, and Quality of Nursing Care Among Jordanian Registered Nurses

Background

Inappropriately selected models of nursing care delivery and emotional exhaustion of nurses at work not only affect the nurses’ health, but also the health of their patients.

Purpose

To examine the relationship between nursing care delivery models, nurses’ emotional exhaustion, and quality of nursing care.

Methods

A cross-sectional survey that used a convenience sampling technique was employed. A total of 160 participants completed the study. Participants provided information about nursing care delivery models, nurses, emotional exhaustion, and quality of nursing care.

Results

Participants had a moderate level of emotional exhaustion. No statistically significant difference in the scores of quality of nursing care and emotional exhaustion were found according to the type of care delivery model (P > .05). Emotional exhaustion was significantly and negatively correlated with the (nursing staff characteristics) subscale of quality of nursing care (r = −.183, P = .021). There was a significant difference in emotional exhaustion in regard to shift duty, marital status, education level, years of experience, salary, and working area). Only marital status significantly predicted emotional exhaustion (t = 2.57, B = −8.98, P = .011).

Conclusions

Quality of nursing care was associated with nurses’ emotional exhaustion rather than models of nursing care delivery. As nurses’ emotional exhaustion could negatively affect the quality of nursing care, addressing the emotional exhaustion of nurses is important to improve patient outcomes.

A Concept Analysis of Quality Nursing Care

PURPOSE

This study aimed to perform a concept analysis of quality nursing care.

METHODS

Walker and Avant's concept analysis method was used to carry out this study.

RESULTS

The defining attributes identified were as follows: caring, the nurse-patient relationship, and patient needs. Antecedents included patient characteristics, individual factors (age, education, knowledge, competence, and experience), job position, and environmental factors. The consequences of quality nursing care have significant influence on both patients and nurses.

CONCLUSION

The findings can aid researchers in obtaining a better understanding of quality nursing care, and stakeholders can consider the factors related to quality nursing care and its consequences to improve the nursing process.

Development and psychometric evaluation of a quality nursing care scale from nurses' perspective

Aim

To develop and evaluate psychometric property of quality nursing care scale (QNCS) from nurses’ perspective in the Chinese context.

Design

A cross‐sectional survey design.

Methods

This study was conducted in two phases. In Phase I, literature review and interviews were conducted to develop the items. In Phase II, content validity was evaluated by five experts. Construct validity was tested through exploratory factor analysis (EFA) among 302 nurses and confirmatory factor analysis (CFA) among 510 nurses from October 2014 to January 2015. Additionally, internal consistency reliability was tested.

Results

The EFA extracted six factors including staff characteristics, task‐oriented activities, human‐oriented activities, physical environment, patient outcomes and precondition. All six factors accounted for 74.78% of the total variance to explain quality nursing care. The modified measurement model of the final version of QNCS was supported by the CFA with 48 items in six dimensions. The internal consistency reliability of final QNCS was acceptable.