Perceived Care Quality of Frontline Clinical Nurses in China and Its Predictors: A Mixed-Methods Study

To identify predictors of nurses' perceived care quality, explore their understanding of high-quality care and propose improvement strategies to inform clinical practice.

A mixed-methods design, integrating quantitative data analysis and qualitative in-depth individual interviews.

Quantitative analysis used cross-sectional data from the 2017 Chinese Nursing Work Environment Survey (C-NWES). Chi-square tests and logistic regression were used to examine how demographic characteristics, work environment and occupational burnout predicted perceptions of care quality at hospital and unit levels. Qualitatively, 42 frontline nurses were interviewed in 2024 to explore their perceptions of care quality, predicting factors and improvement strategies in a post-pandemic context. Thematic analysis was applied to code and synthesise the interview data.

Quantitative analysis revealed that gender, education, workload, experience, work environment and burnout had differing impacts on nurses' care quality perceptions at hospital and unit levels. In-depth individual interviews revealed that nurses perceive high-quality care as patient-centred, predicted by factors such as human resources, occupational burnout, patient and family cooperation at the unit level and environmental and policies factors at the hospital level. Unit-level strategies included improving communication, team collaboration and leadership support, while hospital-level recommendations focused on welfare benefits, continuing education, flexible scheduling and resource optimisation. Through the mutual validation of quantitative analysis and in-depth interviews, this study revealed the multidimensional understanding and key predictors of care quality among frontline clinical nurses in China.

Work environment, occupational burnout and demographic factors significantly impact nurses' perceived care quality, highlighting the need for targeted organisational improvements at both unit and hospital levels to enhance care quality.

The findings highlight the importance of organisational interventions. Nursing managers should promote a positive work environment and mitigate burnout. Future research should develop testing models to explore the relationship between work environment and perceived care quality and validate their effectiveness.

No patient or public contribution.