While the provision of quality care to patients is clearly a professional obligation of nurses, it is considerably less clear how quality care should be evaluated, or who should be involved in the evaluation. The assertion that quality care has occurred must include data representing a variety of inputs including those of the patient, her/his health status, the nurse, the setting of the care, and the patient outcomes from the care. The primary goal of the proposed study is to further test a measure of the patient's perspective on quality nursing care to provide documentation of its utility as a quality of care measure. The long term goal of this project is to make available to acute-care setting administrators, researchers, and clinicians a measure of the patient's perspective on quality nursing care that will provide a means to assess the quality of care delivered and to identify how variations or changes in the delivery of care affect the quality of that care. The instrument to be used in this study is the Patient's Perception of Quality Scale (PPQS), a tool derived from the qualitative interviews of patients and tested using explicit instrument construction criteria. There are four aims for this study--evaluating the weighting, structure and reliability of the PPQS with a larger, more diverse sample; examining the construct validity of the scale; exploring the possibility o demographic group differences on the PPQS and, if present, developing group norms for the scale; and estimating the costs of an institution-wide patient's perception of nursing care quality assessment program using the PPQS. A descriptive design will be used to explore the reliability, validity and cost implications of the PPQS. Thirty-nine medical-surgical patient units in six institutions will serve as the settings for the study. All nurses employed on these units (n = 957) will be asked to participate in the study as will a convenience sample of 5,897 patients over the two years of data collection. Test-retest samples of half of the nurses and 10% of the patient sample will also be obtained. The patient test-retest sample will also serve as a follow-up sample used to ascertain selected validation variables. Analyses to be conducted include factor analysis, reliability estimation, correlating the PPQS subscales with measures predicted to covary with patient's perceptions of the care (e.g., compliance with and discharge care regimens), relating the PPQS scales to measures of the context of nursing, and using ANOVA to assess the ability of the PPQS to differentiate between units with more and less expert nurses. Costs of implementing an institution-wide patient satisfaction assessment program will be estimated.
