Quality of care assessed: using the Senior Monitor index in three wards for the elderly before and after a change to primary nursing

Abstract

Assessments of quality of care using Senior Monitor in three matched wards for elderly patients were carried out on three occasions. The first assessment was carried out in June 1987 as a trial of the measurement tool. The instrument allows for a maximum score of 100. All three wards scored above 60, with two wards scoring above 70. Primary nursing was introduced in one of the wards in January 1988 and the assessment was repeated in June 1988. All ward scores were above 70, with one ward, not the primary nursing ward, scoring above 80. A third assessment was carried out in June 1989. Again, all three wards scored above 70 but this time the primary nursing ward scored 86; the highest ward score of the series. The results for the sub-sections of the assessment are explored in the paper and issues about validity, reliability and inter-rater reliability are discussed. It is argued that Senior Monitor is a useful tool for assessing changes in the quality of care delivered to patients in wards for the elderly but that its full value only becomes apparent with repetition over an extended time period. It may be less appropriate for assessing the impact of a change in the organization of care, not because of any inherent fault in the test but because the very process of using it makes staff look at their practice more critically. It is this critical re-appraisal rather than the change in organization per se which stimulates the improvement in the quality of care.

Effects of resident‐oriented care on quality of care, wellbeing and satisfaction with care

“…A number of studies examined the effects of a patient‐oriented care model on dimensions of quality of care. Several studies demonstrated a significantly higher quality of care as a consequence of Primary Nursing (9–14). Kaban and Thompson (15) reported a significant improvement regarding the continuity of care, attention and time spent on patients and the number of fault reports after the introduction of Primary Nursing.…”

“…However, only in four studies (2, 12, 16, 17), was a (quasi)experimental design [pretest(s), post‐test(s) with nonequivalent groups] used. The other studies made use of post‐test(s) only with nonequivalent groups (10), one group pretest(s), post‐test(s) (9, 11), and one group post‐test(s) only/correlational (13, 14).…”

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

“…The provision of quality patient care is a priority in all health care institutions ( Erith‐Toth & Spencer 1991). Formal definitions of what constitutes quality are numerous ( Ambler Peters 1991), as are the approaches used to assess the quality of patient care ( Harvey 1991, MacGuire 1991). Although much has been written about the phenomenon of quality care, significant variations exist in its interpretation and use, ‘Unaware or undeterred by the conceptual confusion, quality care continues to be assured, controlled, evaluated and managed in the Health Service today’ ( Attree 1993 p. 355).…”

“…Quality nursing care has been studied from various perspective’s using different methods. Quantitative studies focusing on the measurement of the quality of nursing care have highlighted the difficulties experienced with defining and measuring quality ( Kitson 1986, Larson 1986, Pearson et al 1989, MacGuire 1991, Gilloran et al 1993). These difficulties may in part, be due to a basic lack of clarity as to what constitutes quality nursing care.…”

Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses

“…1991, Lepola 1997). Research with older patients has tended to concentrate on acute hospital wards (MacGuire & Botting 1990, MacGuire 1991), but long‐term care has been largely neglected. Although the staff perspective is predominant (Sellick et al .…”