Date of Award

Spring 1974

Document Type

Dissertation - Restricted

Degree Name

Doctor of Philosophy (PhD)




A Model for Quality Assurance in Nursing was developed and selected components of the model were tested in this study, Quality assurance was defined as activities done to determine the extent to which a phenomenon fulfills certain values and activities done to assure changes in practice which will fulfill the highest level of values. Based upon a critical review of the literature and an examination of existing theoretical frameworks, the Model for Quality Assurance in Nursing includes the following components: 1) Formation of values, 2) Establishment of optimal outcome, structure, and process standards and criteria for nursing care, 3) Assessment of the degree of discrepancy between the standards and criteria and the current level of nursing practice, 4) Selection and implementation of an appropriate alternative action for changing nursing practice, and 5) Improvement of nursing care. Following the development of the model, two specific model components were selected for further study. These components were the establishment of optimal outcome criteria and the assessment of the degree of discrepancy between the criteria and the current level of nursing practice. A group of five peer registered nurses, Pediatric Nurse Practitioners, from a variety of organizational settings, established a set of 45 outcome criteria for a specific patient population--well three month old infants who had been seen by a Pediatric Nurse Practitioner since birth. Using the set of outcome criteria, the five nurses who wrote the criteria and additional five peer Pediatric Nurse Practitioners reviewed 25 selected records of the target patient population. The review resulted in a statistically significant agreement on 34 of the 45 criteria. The 25 patient records, however, contained insufficient evidence of achievement on 28 of the 45 criteria. Therefore, there was a wide gulf between the established outcome criteria and the documentation or recording of these outcomes in the records. Each record was also given a subjective rating by each reviewer. A higher subjective rating directly correlated with the objective rating on the achievement of the greater number of outcome criteria as reflected in the records. Peer registered nurses who wrote the criteria and those who did not write the criteria gave the records similar ratings...



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