THE LIVED MEANING OF QUALITY NURSING CARE FOR PRACTICING NURSES (Under t

151 Pages·2008·5.1 MB·English

ABSTRACT

Linda Maas Burhans. WHAT IS GOOD NURSING CARE? THE LIVED
MEANING OF QUALITY NURSING CARE FOR PRACTICING NURSES (Under
the direction of Dr. Martha R. Alligood) College of Nursing, May, 2008.

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.
WHAT IS GOOD NURSING CARE? THE LIVED MEANING OF QUALITY
NURSING CARE FOR PRACTICING NURSES

A Dissertation
Presented to
The Faculty of the College of Nursing

East Carolina University

In Partial Fulfillment
of the Requirements for the Degree
Doctor of Philosophy

by
Linda Maas Burhans

May, 2008
©Copyright
Linda Maas Burhans
WHAT IS GOOD NURSING CARE? THE LIVED MEANING OF QUALITY

NURSING CARE FOR PRACTICING NURSES

by
Linda Maas Burhans

APPROVED BY:
DIRECTOR OF DISSERTATION______________________________________
Martha R. Alligood

COMMITTEE MEMBER_____________________________________________
Marie E. Pokorny

COMMITTEE MEMBER_____________________________________________
Elaine S. Scott

COMMITTEE MEMBER_____________________________________________
Cheryl B. Jones

DEAN OF THE GRADUATE SCHOOL
______________________________________________
Patrick J. Pellicane
ACKNOWLEDGEMENTS
First and foremost, I am thankful for the love and unfailing support of my
husband, Jim, and my daughter, Stacey. They consistently raise me up. I could
not succeed without their encouragement and belief in me.
I am indebted to my advisor and committee chair, Dr. Martha Alligood who
supported, challenged, and befriended me as I made this scholarly journey. The
time and commitment of my committee members, Dr. Marie Pokorny, Dr. Elaine
Scott, and Dr. Cheryl Jones are deeply appreciated.
I am grateful for the love and patience of my brothers, sister, sister-in-law,
and other family members who tolerated my inattention to normal family activities
and cheered me on when I became discouraged. My parents, with me now only
in spirit, inspire me daily as they did in life. I am thankful for the values they
instilled in me through their love and sacrifices.
The encouragement and support of my colleagues, classmates, and
friends throughout these years of class days, study, and research will never be
forgotten.
Above all, I thank God. He/She replenishes my soul.
This study was funded in part by a grant from the East Carolina Center for

Nursing Leadership (ECCNL).
TABLE OF CONTENTS

LIST OF FIGURES......................................................................................... viii

CHAPTER ONE: INTRODUCTION................................................................ 1

Definitions............................................................................................ 6

Statement of the Problem.................................................................... 7

Purpose................................................................................................ 13

Research Question.............................................................................. 14

Theoretical and Philosophical Perspective.......................................... 15

Delimitations........................................................................................ 17

Limitations............................................................................................ 18

Significance of the Proposed Study..................................................... 18

Summary.............................................................................................. 20

CHAPTER TWO: REVIEW OF THE LITERATURE....................................... 22

Purpose................................................................................................ 22

Interdisciplinary Healthcare Quality..................................................... 22

Quality Nursing Care............................................................................ 26

Definitions of Nursing Care Quality and Excellence............................ 29

Representation and Evaluation of Quality Nursing Care..................... 34

Nurses’ Meanings or Perceptions of Quality Nursing Care.................. 40

Proposed Research Study................................................................... 44

Conclusion........................................................................................... 45
CHAPTER THREE: METHOD....................................................................... 48

Philosophy and Study Design.............................................................. 48

Researcher Qualifications.................................................................... 52

Study Population.................................................................................. 54

Study Sample Selection....................................................................... 54

Study Methods..................................................................................... 59

Ethical Considerations......................................................................... 62

Data Analysis and Interpretation.......................................................... 64

Data Validity and Trustworthiness....................................................... 65

CHAPTER FOUR: FINDINGS........................................................................ 69

Turning to the Phenomenon................................................................ 69

Investigating the Lived Experience...................................................... 73

Reflecting on the Essential Themes.................................................... 83

Describing the Phenomenon................................................................ 95

Maintaining a Nursing Relation to the Phenomenon............................ 100

Balancing the Parts and the Whole...................................................... 103

CHAPTER FIVE: REFLECTIONS ON THE FINDINGS................................. 106

Reflection on Preconceptions and Biases........................................... 107

Reflection on Existing Literature and Practice..................................... 110

Reflection on Utilization of the Method................................................ 115

Reflection on Integration of the Findings............................................. 116
Application to Nursing Practice, Education, and Research.................. 117

Suggestions for Future Inquiries.......................................................... 120

Conclusions......................................................................................... 123

REFERENCES............................................................................................... 125

APPENDIX A: ADVERTISING FLYER.......................................................... 136

APPENDIX B: CONSENT DOCUMENT........................................................ 137

APPENDIX C: DEMOGRAPHIC QUESTIONS AND INTERVIEW GUIDE.... 139

APPENDIX D: INSTITUTIONAL REVIEW BOARD APPROVAL LETTER.... 142
LIST OF FIGURES

1. The iterative reflective analysis process................................................... 75