University of Wollongong Research Online University of Wollongong Thesis Collection 1954-2016 University of Wollongong Thesis Collections 2015 Measuring the quality and safety outcomes of nursing practice Jenny Sim University of Wollongong, [email protected] Follow this and additional works at: https://ro.uow.edu.au/theses University of Wollongong Copyright Warning You may print or download ONE copy of this document for the purpose of your own research or study. The University does not authorise you to copy, communicate or otherwise make available electronically to any other person any copyright material contained on this site. You are reminded of the following: This work is copyright. Apart from any use permitted under the Copyright Act 1968, no part of this work may be reproduced by any process, nor may any other exclusive right be exercised, without the permission of the author. Copyright owners are entitled to take legal action against persons who infringe their copyright. A reproduction of material that is protected by copyright may be a copyright infringement. A court may impose penalties and award damages in relation to offences and infringements relating to copyright material. Higher penalties may apply, and higher damages may be awarded, for offences and infringements involving the conversion of material into digital or electronic form. Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong. Recommended Citation Sim, Jenny, Measuring the quality and safety outcomes of nursing practice, Doctor of Philosophy thesis, School of Nursing, University of Wollongong, 2015. https://ro.uow.edu.au/theses/4716 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: [email protected] Measuring the quality and safety outcomes of nursing practice A thesis submitted in fulfilment of the requirements for the award of the degree Doctor of Philosophy from University of Wollongong by Jenny Louise Sim RN, BAppSc (Nurs), Grad Dip Clinical Nursing, Grad Dip Bus Admin, MACN School of Nursing 2015 i ABSTRACT Background Measuring the impact of nursing care on patient outcomes is a complex task. Nurses make up a large proportion of the healthcare workforce and interact with patients in almost every aspect of a person’s healthcare experience. Despite the large volume of research that examines nursing care and patient outcomes, there has been no agreement on what should be measured and no consensus on how the broad actions of nurses should be evaluated. The purpose of this research was to identify how nursing’s contribution to patient outcomes could best be measured. The research aims were to: identify / develop a conceptual framework that describes nursing outcomes from a holistic perspective; and identify a set of indicators that could be used to measure the quality and safety of nursing practice from the perspective of the person receiving nursing care. Methods This research used a multi-phase, mixed methods design with three distinct phases. Phase 1 of the research used qualitative interviews and analysis of the published literature to identify the important concepts for measuring nursing practice. Phase 2 used a modified Delphi survey to gain consensus agreement from practicing nurses in Australia on the most important concepts for measuring the outcomes of nursing practice. Phase 3 used a template analysis of the published literature to identify how each of the concepts identified in Phase 2 of the research had been measured. This enabled a systematic analysis of the published literature on nursing-sensitive indicators and nursing-sensitive outcomes to be undertaken. At the end of this research a conceptual framework and indicator set for measuring the quality and safety outcomes of nursing care has been proposed. ii Findings Each phase of the research has built on findings from the previous phase. A conceptual framework has been developed that describes the important concepts that can be used to measure nursing care in a comprehensive way. There are seven elements in this conceptual framework and they are: Care and Caring; Communication; Coordination and Collaboration; Safety; Patient Characteristics; Organisational Environment: and Nurses Work Environment. An indicator set for measuring the quality and safety outcomes of nursing care has also been proposed. This indicator set identified structure, process and outcome measures for the seven elements within the conceptual framework. Data for the indicator set can be obtained from organisational data, processes of care, safety indicators, and from three periodic surveys (Nursing Work Index – Revised; Caring Assessment Tool; and the Picker Institute Patient Experience Survey). Through collection of this data at unit level a comprehensive evaluation of nursing care and the impact it has on patient outcomes can be undertaken. Conclusion This research makes an original contribution to knowledge in that it has: expanded on existing knowledge of how the outcomes of nursing care can be conceptualised; and identified a method for measuring the unique contribution of nurses and nursing care to patient outcomes. The conceptual framework and indicator set developed within this research can be used to articulate and measure the contribution that nurses make to patient outcomes. The conceptual framework and indicator set enables individual nurses, units and organisations to be more accountable for the care they provide to patients. The indicator set has the potential to assist organisations to monitor and improve nursing care by measuring the quality and safety of the care that is provided to patients in a comprehensive way. iii CERTIFICATION I, Jenny Louise Sim, declare that this thesis, submitted in partial fulfilment of the requirements for the award of Doctor of Philosophy, in the School of Nursing, University of Wollongong, is wholly my own work unless otherwise referenced or acknowledged. The document has not been submitted for qualifications at any other academic institution. Jenny Louse Sim 10th July 2015 iv ACKNOWLEDGEMENTS I would like to thank my research supervisors, Professor Patrick Crookes and Professor Kenneth Walsh for sharing their expertise with me and helping me to grow both as a person and as a researcher. Your encouragement, enduring support, intellectual guidance and your patience have been pivotal in the process of completing this PhD. I will be forever grateful. I also wish to thank the organisations that have been involved in this research. The University of Wollongong, the South Eastern Sydney Illawarra Area Health Services (now known as the South Eastern Sydney Local Health District and the Illawarra Shoalhaven Local Health District) and Ramsay Healthcare have all been involved in differing ways throughout this project. Thank you for your contributions and for making this research possible. I particularly want to thank the University of Wollongong for supporting me with an Equity Fellowship which came at a pivotal time during data collection and analysis. There are many individuals I wish to thank. Firstly to all the participants within the research, thank you for answering my questions and assisting me to understand your point of view. It has been a privilege to meet you and learn from you during this research. To my colleagues both in the health system and in academia, thank you for your encouragement, support and for motivating me to get this project completed. Within my family there are also a number of special people I need to thank. I especially thank my husband, Dave. Your love and your belief in me have always been unwavering. It makes everything seem possible (including ascending the tallest peaks). To my sisters Tracy and Karen and my brother David: thank you for always believing in me. To my mother, Valda, and my father, Robert, thank you for providing me with the skills and motivation to be independent. To my children, Jack, Daniel and Max: you have never known a mother who was not busy and trying to achieve a large number of things at once. I hope this provides a role model that helps you to understand that you can achieve anything if you set your mind to it. v DEDICATION I dedicate this thesis to my three children: Jack, Daniel and Max. You are my inspiration and my passion. Your love, curiosity, sense of wonder and your happy spirits are the true inspiration for so many achievements and this is just one of them. I hope that you will grow up with a love of learning that enables you to shine and share your knowledge and enthusiasm with the world. Each and every one of you are truly amazing and my gift (with my husband, Dave) to humanity. I love you very much. This thesis is also dedicated to my sister, Tracy, who during the writing up of this thesis has battled with and is now losing her fight with breast cancer. Your positivity, love of life and the humanity of your spirit will always live in side of me. You inspire me in so many ways. You will be forever loved and sorely missed. vi TABLE OF CONTENTS ABSTRACT ...................................................................................................................... ii CERTIFICATION ........................................................................................................... iv ACKNOWLEDGEMENTS .............................................................................................