Holistic Nursing Experience of Implementing Hospital Accreditation in Iran: A Qualitative Study

Hospital Accreditation (HA) is defined as the systematic evaluation of hospitals against explicit standards. Accreditation is the most important external tool to assess healthcare quality. The purpose of HA is to improve quality and reduce medical errors in healthcare organizations by determining appropriate policies. Nursing staff play a key role in formulating and implementing policies. However, nurses face challenges in holistic nursing (HN). This study was conducted to investigate the HN experience through implementing HA in Iran from the perspective of nurses.

The design was a qualitative study.

In-depth, face-to-face, semi-structured individual interviews were conducted with 20 participants. Participants consisted of nurses involved in accreditation with at least 1 year of working experience in the hospital, selected using purposive sampling with maximum diversity. Sampling continued until data saturation was reached. Data analysis was performed through content analysis based on the Graneheim and Lundman method.

This study showed that HN is influenced by quality improvement programmes, especially accreditation. Accreditation is inherently ideal and several factors affect its accurate implementation. Obtaining more knowledge about these factors and utilizing nurses' experiences can significantly affect its better implementation and lead to comprehensive patient care. Data analysis resulted in four themes: 'structure' ('inappropriate standards', 'inappropriate assessment system', 'lack of resources', 'time constraints'), 'implementation process' ('documentation burden', 'monitoring and evaluation methods', 'team communication challenges'), 'knowledge' ('academic education gaps', 'in-service training gaps'), and 'attitude' ('superiors' views', 'nurses' views', 'value conflicts').

Twenty nurses were interviewed as healthcare providers.

The results of this study can be effective in changing the attitude of managers toward accreditation programme (AP) implementation as well as developing suitable models for accreditation. The results also clarify the challenges and benefits of accreditation implementation and its impact on HN.