Indicators of quality in nursing care--an alternative approach.

Indicators of quality of nursing care were developed from a conceptual framework for geriatric nursing based on the twin concepts of care and having a positive attitude to the health and welfare of old people. These primary concepts were further developed using structural aids, in particular the theoretical guidelines for practice disciplines propounded by Dickoff et al. From this, a measure, called the Therapeutic Nursing Function (TNF) Indicator, was devised which attempted to identify those ward sisters who provided more patient-centred or therapeutic nursing care from ward sisters who gave routine-centred or non-therapeutic nursing care. The TNF Indicator, based on the conceptual framework, comprised a list of statements to which ward sisters responded. The scaling system divided responses into more--or fewer--therapeutic nursing responses. A stratified random sample of 25 ward sisters was used in the study and from this the characteristics of ward sisters in the upper and lower range of the scale were compared. Distinct variations were noted between groups in relation to demographic information, perception of geriatric nursing, use of nursing information, management approach and the ward sisters' concept of rehabilitation. A further instrument, the Therapeutic Nursing Function Matrix, attempted to measure the quality of care patients were receiving on geriatric wards. Nurse-patient interaction on a ward where the ward sister had a high TNF Indicator score was compared to a ward where the ward sister had a low score. The results showed that quality of care seemed to be related more to the orientation and perception of the ward sister than to any number of extraneous variables such as medical and paramedical input, ward facilities and ancillary staff support.