What Is Good Nursing Care? The Lived Meaning of Quality Nursing Care for Practicing Nurses

Abstract

Healthcare quality in the United States of America (USA) is the subject of intense criticism. Although quality nursing care is vital to patient outcomes and safety, meaningful quality improvements have been disturbingly slow and incremental. Practicing nurses are rarely involved in developing improvement programs and their definitions of quality nursing care have not been known. The lived meaning of quality nursing care for practicing nurses was unknown and not addressed in the literature. A premise of this study was that effective efforts to improve quality nursing care must be meaningful and relevant to nurses. It was proposed that uncovering the lived meaning of quality nursing care would facilitate development of effective improvement approaches. The purpose of this study was to uncover the lived meaning of quality nursing care for nurses practicing in acute care hospitals. This lived meaning was revealed through analysis of practicing nurse interviews using van Manen's (1990) hermeneutic phenomenology, a research approach designed to explore and uncover the lived meaning of pragmatic experiences. The research question asked: "What is the lived meaning of quality nursing care for practicing nurses in the USA?" Participants were 12 nurses practicing on medical or surgical adult units at general or intermediate levels of care within acute care hospitals who participated in semi-structured interviews. Emerging themes were discovered through empirical and reflective analysis of audiotapes and transcripts. The lived meaning of quality nursing care for practicing nurses was meeting human needs through caring, empathetic, respectful interactions within which responsibility, intentionality, and advocacy form an essential, integral foundation. The lived experience of quality nursing care resided within nurse-patient interactions. The lived meaning of quality nursing care for these practicing nurses was within the art of nursing rather than the science of nursing. Practicing nurses, managers, administrators, educators, researchers, and policy makers may use these findings to further define the discipline of nursing and to facilitate practice changes, driving improvements in the quality of nursing care. Future studies based on this understanding of the lived meaning of quality nursing care could begin to address this focus in an effort to improve quality patient care.