The delivery of quality nursing care: a grounded theory study of the nurse's perspective

This grounded theory study explored and described the delivery of quality nursing care from the perspective of nurses. Data were gathered by tape recorded interviews, published literature and some participant observation. Ten registered nurses from an acute-care public hospital located in Perth, Western Australia were interviewed. Twelve additional transcripts from interviews conducted by postgraduate students were also used. Quality nursing care was perceived to relate to the degree to which patients' physical, psychosocial, and extra care needs were met. The consequences of quality care were interpreted as 'therapeutic effectiveness', where the therapy provided by nurses was perceived to positively affect patients' healing. This was gauged by the patient's psychosocial and physical response to illness, safety, and satisfaction. Therapeutic effectiveness was facilitated by the development of positive relationships between nurses and patients, nurse's positive attributes and competent practices, as well as a functional nursing team. The problem of nurses' inability to consistently provide quality nursing care to all patients was identified. Insufficient time (caused by a lack of human and physical resources) was perceived as the main reason for this. Dissatisfaction and stress in nurses was related to this problem. To deal with this, nurses used a process named 'selective focusing'. Work was planned to most effectively utilize the time available, within the parameters of safety. Implications for nursing practice, education and management are discussed, and directions for further research are provided.