〇招聘講演 The Guest Lecture 〇 - 日本看護研究学会

◆ 招聘講演丁h e G u e s t L e c t u r e ◆
“
Trends and lssues of Qualitative(Evaluative)
Research of Nursing in the United States''
Faye G.Abdellah
RN,Ed D,Sc D,FAAN /Former Deputy
Surgeon General U S Public Health.Service
(transcribed by Noreen Murata)
Thank you Dr Tajima Also want to
thank Professor Miyazaki, v′
that you will have a little better understand―
ho has beey very
helpful in inviting me to this 」 apanese Society
of Nursing Research 」
ust very happy tO be
ing about Qualitative Research Also,a little
about the historical development of Quality
Research, some measures or suggested ap―
here and to share with you this aftern00n
proaches to measuring Quality,the definition,
Because l wanted very much to have a chance
and most important, I think the most impOr―
to really be with yOu and share more tirne
tant message l have for you this afternoon is
with you, as probably been mentioned, after
the phrase called Outcomes lvleasurement
By Outcomes S/1easurement really l mean
the meeting a complete copy of my paper
with the figures and references will be avail―
the effect Of v′
hat v′e do upon our patients or
able So just relax and don't take any notes
clients M″e use the term patient― client inter―
and you'1l have that available as well as op―
changeably because some of our clients are in
pOrtunity for some questions
the home,in the community (And they are
not) ・…I M′
ant you to think about our poten―
I'm very much interested in this topic
of quality care and quality research And this
tial group as being not only in the hospital
afternoon, I would like to take you on a iou■
but in the home, ambulatory care, in the
ney which l believe will move us, move nurs―
comrnunity
ing And I'In very proud to be a nurse as wё
ll
As this group is primarily interested in
as a research scientist But rm always a nurse
Research, there are many steps that need to
And l wanted to share with you opportunities
be taken l want to share with you 、 rhat kinds
that we hav6 befOre us to move into the 21st
of data we need in relatiOn to Qualitative
century And when l received the invitation to
Research l will share 、 /ith you also a new
be 、′
ith you l knew no better country where
agency that we have in the Public Health Ser―
you could ready tO move in that direction
vice and sOme of the potential layer and the
I M/ill briefly talk about why the interest number of nurses who are working in that
in Qualitative Research We very commonly
agency I'd like to give you a couple of ex―
hear about Quantitative Research but I'm talk―amples Of how Qualitatiave Research can be
ing abOut Qualitative Research And l hope
applied tO nursing education, to the clinical
日本看護研究学会雑誌 Vol.15 No.3 1992
“
Trends and lssues of Qualitative(Evaluative) Research of Nursing in the United States''
setting, and some of the data needed there
to the development of the patient classiflcation
And tO just finish up with a suggested moni―
system, particularly in relation to the elderly
toring and evaluation process (So that'sv/hat
So sornetimes,you will find that Quality Of
we have before us this afternoon)
Care is Out of reach But we can at least diflne
Now, the quest for Quality is ongoing
v′
hat would be from a professional standpoint,
a n d t h e r e i s a c o m m i t m e n t t o Q u a l i t y i n tw oh a―t i s n e e d e d f o r c a r e
day's(competitive)envirOnment The patients
really see Quality of Care They don't call it
“
Quality Of Care'' What they call it would be
they're “satisfied with care", “my nurse is
concerned about me"
They are concerned with
what will happen to them so that Quality of
Care tO them means satisfaction and getting
out of the hospita1 0r getting back to the
FIGURE
QUALITY OF CARE
ELEMENTS
O APPROPRIATE
THE RIGHT CARE PROVIDED IN THE
RIGHT PLACE
O EFFICIENT
community
To us,if we were looking at Quality Of
Care as a researcher, we want to look at the
outcomes in terms of our plan of care fOr
that individual What our goals are and as
health professionals we would be more con―
cerned with health promotion and disease
CARE PROVIDED IN THE RIGHT WAY
AT THE RIGHT TIME
O EFFECTIVE
CARE THAT IS PROVIDED APPROPRI
ATELY AND EFFICIENTLY AND
ACHIEVES THE RIGHT OUTCOMES
prevention The patient may be less so, but
our emphasis 、
/ould be much broader in terms
of our goal
There are really three elements of Quality
of Care to simplify it We need to say “
Now the challenge to provide Quality
Is
the care appropriate and the right care, the
of Care¨ ・
it's not iust clinical expertise And
right place, the right setting for that care?"
it is difficult to measure Quality Of Care We
Is it efficient?Care provided in the right way
also, in order to convey to health policy
and in the right time, and effective
makers the importance of Quality Of Care, we
There are three key v/ords:Appropriate,
need to link cost to this M/hat does it cost?
Efficient, and Effective2)The last one, effective,
And One of the most difficult challenges l had
is another way of saying Outcome lvleasures
while working in the Federal Government was
Sometimes as researchers we ca11 0utcOme
`effect varia―
Measures `dependent variables'一―
to define Quality of Care in terms of a cOst
that cOuld be provided (This is difficult to
achieve especially when there is pressure to
contr01 00stsl))
bles' And that is where the term comes from
`Effective' meaning `the impact of what we
do upon nursing practice'
As nurses, v/e want the best fOr our
patients or clients But very often that's nOt
vre v′。uld all agree that patients are
entitled to (expect)safe, Good― Quality of Care
available So l define Quality of Care as `that
And v′ e need to build in safeguards withOut
care which is needed' and nO mο re The criti―
feeling pressured to fol10M/ this We need to
¨
cal v′
Ord is `need' And after l define rneed'・
be flexible though, to accomlnodate this care
it was the effort to define `need' that led｀
me
and there are some limitatiOns Particularly
日本看護研究学会雑誌 Vol.15 No_3 1992
“
Trends and lssues Of Qualitative(Evaluative)Research of Nursing in the United States"
if we get carried away with this area of Out―
at least one approach So if we have to cut
com es, that 、/e might become too rigid So
down on services, at least we can emphasize
we need to keep in mind to be flexible in
what is ilnportant and set some standards
providing
for health care
By flexible, I mean meeting the
individual needs of patients in different settings
Now recent studies have demonstrated,
・
…SO We need to do that
and again in the United States, that about 35%
WHY SO MUCH INTEREST IN QUALITA―
of all surgical deaths and 50% of pos,operative
TIVE(E∨ ALUA丁 !VE)RESEARCH?
cOmplicatiOns can be prevented (and 359イ
Nov′ v′
hy is there so much interest in
Qualitative Research? And if you read the
Nurses, I feel, and l say this with great
literature, it's not iuSt in the health area. It's
confidence, provide an essential resOurce to
also in the area of education, engineering,
health care to maintain and provide Quality
technology, and in this wonderful cOuntry of
of Care in a cOst effective v′
ay ln the United
e refer tO nursing as `the caring pro―
yours You have really pioneered in Quality
States, v′
Control in Qualitative Research
fession' Nov/some physicians are not happy
And every
other cOuntry, including the United States, we
with us doing that But we feel that nursing
learn from you So there are a lot of princi―
is `the caring profession' and our American
ples there that can be adapted to health care
pushed to really be concerned about Quality
Care'
dollars, 600 or 700 billiOn this year (about
12%Of the GNP)700 billion American dol
up from that as researchers there is a v′
HISTORiCAL OVERVIEW OF QUALi丁
abOut 260 1nillion people, 37 million people
SURANCE
still have no health care nOr access to care
h。lo
Y AS´
QUAL!TY ASSURANCE THE‐
ORISTS IN THE MEDICAL AND NURSiNG
Now, we're very cOncerned about this because
F!ELDS:
of the 37 milllon, about 13 million of those
A brief note about the history of Quality
And so there's something wrong
of Care Actually there are, over a span of 25
lf we
years, two physicians who have provided us
spend more money than any other country in
with ilnportant definitions, important guide‐
the v′
orld but we still have 37 milllon people
without access to health care So there is・
e know that just
lines and two nurses
…
One physician was Dr Lawrence ヽ
Veed,
in Massachusetts, who developed the very
familiar Problem Oriented N/1edical Record
(for fel10w physicians and their students).
system isn't the ansv″er
So we are looking fOr a way to better
That was in the 1960's I've also accused him
e can get out of this dilemma
understand hov′ v′
and still protect that patient And that's why
M′
e are moving with more emphasis into
Qualitative Research
rord And picking
nities for nursing research abound
in the world And yet of our population of
putting more dollars, more yen, into the
`Care' being the key 、
science of care being developed with opportu‐
lars, which is mOre than any other country
because of this concern v′
Nurses Association, introduced just this last
une, a health care plan called a `Core Of
」
of Care because M′ e spend more Arnerican
are children
apan
Nurses Association, comparable to your 」
For us in the United States,we have been
with our health care delivery system
of
all hospital admissions are unnecessary)
of stealing the plan from the 21 nursing prob_
lems, which was essentially a Problern Ori―
ented Record approach for nursing But we're
We feel that that is
goOd friends The Problem Oriented Record
日本看護研究学会雑誌 Vol.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States''
linked medical diagnosis from treatment to
the Diagnostic Related Groups and that is
Outcomes That v′ ord again `OutcOmes'
maybe familiar to many of you The tragedy
Later, I had the privilege, Or actually, of that, and l hope you can learn from our
it was about the same time in the 1960's,
mistakes,there was some 467 diagnoses which
developing the 21 nursing problems Another
were identified but there was not a nursing
physician, Dr
component
Avedis Donabedian, provided
us with some helpful language to give us a
related
to
these
Diagnositc
Related GrOups(DRGs)And since 1981,
model so we could understand what 、 ′
e mean
problems have been created because nursing
when we talk about Qualiけ Care He developed
component has not been defined And the rea―
a structure for us with emphasis on process
son it was nOt defined ―
and the Outcome Dr NOrma Lang, a nurse,
come lVIeasures
I'rn sure you're familiar v/ith some of her
we don't have Out―
You see, this is so critical for us and I
work, v′ ho pioneered in developing what we
again… ・
it's almost too late but it is never too
call a common definition, common data to be
late in a way・ ¨but 、′
e need to move ahead
collected, data―set…・
this nationally recognized
on that Qualitative Research is theoretically
for the development of practice standards
based on (phenOmenology)culture, the sym‐
Dr
Lang's work has been reflected in Canada and
bolic interaction of our history,of our values5)
v′
orldwide 3)
I was reminded of this yesterday aFter―
Donabedian continued his work and
noon when l had the privilege and wonderful
pushed On for a better definition of Quality
visit to your national history museum and
assessment and certainly we, to him, we owe
institute at Chiba, which is the whOle history
our basic vocabulary in that area
of the」 apanese culture Of the skills,the atti―
(Dona―
bedian has pointed out that advances in the
tudes, and achievements over thousands Of
early 1930s and in the mid 1950s ln the 1960s,
years The basis is already there for Qualita_
Donabedian established the basic vocabulary
tive
and cOncepts we noM′
represent of the supreme ability in defining
use in discussing qua―
lity of care4))
Research
and
certainly
archeologists
Qualitative Research in that category
Now the increased interest in Quality
〕
ヾo、/ what made that national history
today stems from this (continued)rapid rise
museum an institute at Chiba so exciting to
of health care costs ヽVe're “hitting the roof"
me v′as to see several rooms devoted to data
in Our cOuntry on costs and we don't have
collectiOn ― maps, r00ting, development of
any national health insurance Ⅵ /e have nation― tools, some medicinal things, and sο
forth
al health obiectiVes with a national agenda
Data, v′e cannot get at Outcomes with data
But we don't know how to getfrOm Y to Z
collection And when l speak of data collectiOn
We have set some goals but we have major
we rnust have again two componentt of uniform
health prOblems For example, in the devel―
definitiOn and agreement upon what data we
oped countries we have the highest percentage
will collect Those two are very essential
of infant mOrtality rate per 100,000 Which is
(Data collection techniques in qualitative
disgraceful!
research includes observing, listening, and
We have also looked at different ways
interviewing The ski1l of 「
Bracketing」
of cOntaining cost ln 1981 there was an ap―
alsO essential which requires the researcher
proach of prospective payment intrOduced called
to suspend a prior assumption to understand
日本看護研究学会雑誌 Vol.15 No 3 1992
is
“
Trends and lssues Of Qualitative(Evaluative)Research of Nursing in the United States"
the experience of the participants6))
Quality Assurance is an assessment of
tO Quality Care We speak of one which is
`Implicit Review' which is iudgemental ―
the care the patient receives and usually in_
bringing together experts and utilizing their
volves measuring or monitoring areas of care
judgement We use this a great deal in what
that are exarnined including medical care,
we call `Consensus Conferences', where we
nursing care, and the envirOnment, we musn't
have a controversial issue We bring together
forget that, and the efficiency of that care
experts in the field and they agree upon this
TWO METHODS OF MEASUREMENT TO
at the moment is the best approach or treat―
MON!丁 OR QUALITY:
ment in relation to whatever the condition is
The other is `Explicit Review' which is much
more rigid in terms of lists of criteria and
DEFINITION OF TERMS(7)
established in advance of care I'1l speak a
little rnore about that in a bit
QUALITY CONTROL:
So the Quality Assurance program in―
MONITORING OF A PROCESS TO ASSURE
THAT THE QUALITY OF THE RESULTS
clude both methods A/1ost Quality Assurance
prOgrams measure three general categories :
ARE CONSISTENT
structure, prOcess, and outcome
QUALITY ASSURANCE:
DEFINIT10N OF QUALITY CARE AND HOW
QUALITY CONTROL OF THE ENTIRE OPE―
RAT10N SO THAT RESULTS ARE RELIABLE
THREE CATEGORIES ARE MEASURED :
STRUCTURE,PROCESS,AND OUTCOME
!T CAN BE MEASURED:
Now to define Quality Of Care requires
a deflnition of the attributes of care provided
as well as the criteria of what cOnstitutes
QUALITY ASSESSMENT:
PROCESS IN WHICH STANDARDS OF QUAL―
ITY ARE, ESTABLISHED BY PROCESS OF
good care And activities can be divided into
technical care//science as well as prevention
and management of care
CONSENSUS
And it's interesting as the American
Nurses Association introduced its new core
So here we have suggested again the
plan of care there was great emphasis upon
little specific emphasis on v′
h at we really
managed care Where the nurse would have
mean and define in terms of Quality Care
the total management of the care of that
V′
e speak about Quality Control, moni―
patient or family
But also emphasize the
toring our process to assist the quality of the
social―
psych01ogical aspects of that care as
results The key word, most important word
it affected that individua13) Again the three
t h e r e , i s ` c o n s i s t e n t ' Q u a l iAサ
ssurance,Qual
approaches(to assessment of quality are pro―
ity COntr01 of the entire operation, looking
posed)
at again this structure of process and out―
come So there you have the key word and
that would be`reliable' Quality Assessment,
the last one, the key thing there would be
process Of `consensus' agreed upon by the
majority
There are two methods of measurement
日本看護研究学会雑誌 Vol.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States"
FiGURE
FIGURE
MEASUREMENT OF QUALITY OF CARE
EXAMPLES OF CLINICAL INDICATORS
TO MEASURE QUALITY OF CARE
O STRUCTURE:ORGANIZAT10N AND FINANC‐
ING OF CARE
O PROCESS:
NURSING
TECHNICAL ASPECTS OF
O PHYSICAL ASSESSMENT/NURSING HISTORY
CARE INTERPERSONAL
INCLUDES ALL BODY SYSTEヽ
ASPECTS OF CARE
TIFIES HEALTH CARE NEEDS
0 0UTOCOME: IMPACT OF PRACTICE ON
lS AND IDEN‐
O VITAL SIGNS WITHIN NORMAL LIMITS
PATIENT/CLIENT
MONITOR VITAL SIGNS EVERY 15 MINUTES
POSTOPERATIVE.
DOCUMENTAT10N IS REQUIRED IN ALL QUALITY ASSU膵
O LAB WORK WITHIN NORMAL LIMITS
OR REFERRD TO PHYSICIAN
ANCE PROGRAMS ACTIVE PARTICIPAT10N OF THE CARE
CIVERS IS ALSO REQUIRED HEALTH CARE PROVIDERS
O PATIENT MEETS DISCHARGE CRITERIA
PER POLICY
SELECT ASPECTS OF CARE THAT ARE IMPORTANT AND
NEED TO BE MONITORED THESE ASPECTS ARE KNOWN
O DOCUMENTAT10N PER PROCEDURE
AS ・ NDICATORS OF OUALITY・
O PERIOPERATIVE TEACHING AND DIS―
WHICH ARE REVIEWED
CHARGE PLANNING IMPLEMENTED
TO DETERMINE WHETHER THE STANDARD OF CARE IS
BEING MET
O SAFE AND ASEPTIC ENVIRONMENT PRO‐
VIDED
As you see, these components 、 vill appear
over and over again―
―structure, process and
O SPONGE NEEDLE,BLADE,INSTRUMENT
COUNTS CORRECT
outcome9)Again, our key v/ord, and that is
O SURGICAL PROCEDURES PERFORMED IN
、″
here 、ハ
re are the weakest at the moment ithe
ACCORDANCE TO INSTITUT10N CRITERIA
Outcome
ln a1l of this,just as at the museum I
visited yesterday, a1l of the artifacts and all
of the history presented there v′
O ALL EQUIPMENT AND SUPPLIES PREPARED
TO PREVENT UNNECESSARY DELAYS IN
SURGERY
ould have little
O NURSING CARE PLAN FORMULATED TO
meaning 、 ′
ithout documentation So in Order
MEET THE CHANGING NEEDS OF THE
to really move and get into this are of Out―
PATIENT
comes, we need to obtain documentation
ヽ
Ve need one thing also l hope you'1l re―
O NO VERBALIZED DISSATISFACT10N FROM
PATIENT/FAヽ
IILY
mernber, that we need to involve the consumers
of care in obtaining thls documentation、
Very
often we make serious mistakes in Our country
in not involving consumers of care, 、
/ho are
very knoM′ ledgeable today about their health
SO uRCE:
FOWLER, ME (1990) TRENDS OUALITY ASSURANCE:
DEFINIT10N AND IMPORTANCE PLASTIC SURGICAL
NURSING,SUMMER.lo(2)196
needs and who really want tO have a say in
their health care
Figure
4 gives you a fev′
examples of
clinical indicators tO measure Quality Of Care
NOM′, I put these up here because they'd be
famlliar to you All v′ e've tried to do here is
to give some order to them To bring them
日本看護研究学会雑誌 V01.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States"
into some grouping But many of these are
WHEN AND HOW TO CONTACT STAFF
familiar to you and already been involved
IN CASE OF PROBLEM OR EMERGENCY
So there's nothing new So you shouldn't be
Ⅳ HEALTH PROMOTION
afraid or cOncerned about clinical indicators
A PATIENT WILL DEMONSTRATE UNDER―
Of Quality of Care See this is essential to get
STANDING OF BREAST SELF―
to Outcome WIeasures And l won't go through
a1l of these
EXAMI
NATION
But you're farniliar with the
B PATIENT WILL IDENTIFY WARNING
physical assessment, patient needs, and so
SIGNS OF CANCER
forth These are quite familiar
C PATIENT WILL KEEP SCHEDULED
FOLLOW―
UP APPOINTMENTS
FIGURE 5
V PATIENT COUNSELING
EXAMPLES OF PATIENT OUTCOME INDICATORS
A PATIENT WILL IDENTIFY HOSPITAL
IN AMBULATORY CARE SETTINGS
AND COMMUNITY RESOURCES
I NURSING PROCESS
B PATIENT WILL STATE REALISTIC OR
A THE PATIENT EXPRESSES SATISFAC―
T10N WITH NURSING CARE
ACCOMPLISHABLE GOALS
C PATIENT WILL COMPLY WITH RECOM_
B THE PATIENT DEMONSTRATES RESO‐
LUTION OF COMPLAINT OR PROBLEM
Ⅱ USE OF STANDARD CARE PLANS
MENDATIONS AND INSTRUCT10NS
Ⅵ PATIENT SAFETY
A PATIENTS WILL BE FREE FROM IN」
A THE PATIENT DEMONSTRATES AGREE‐
MENT WITH PLAN OF CARE
U―
RIES OR FALLS
B PATIENTS WILL RECEIVE CORRECT
B ALL PREOPERATIVE AMBULATORY
SURGERY PATIENTS WILL DEMON―
DRUG AND DOSAGE
C PATIENTS WILL NOT SHOW SIGNS OF
STRATE REDUCED ANXIETY AFTER
INFILTRATION OR EXTRAVASAT10N
FROM A CHEMOTHERAPY DRUG
C SEDATED PATIENTS ヽ
ハ
′
ILL BE MONI
TORED ACCORDING TO CLINIC STAN―
SO uRCE:
DARD OPERATING PROCEDURE
GATES, R A AND PRZYKUCKL」
I PATIENT EDUCAT10N
M (1989) IMPROVING
PRACTICE IN AMBULATORY CARE i DEVELOPMENT OF
A THE PATIENT OR CARE GIVER VERB―
ALIZES UNDERSTANDING OF DIAG―
AN AMBULATORY NURSlNG OA PROGRAM JOURNAL
OF NURSING OUALITY ASSURANCE′
3(4)
NOSIS AND OPT10NS FOR THERAPY
CONSISTENT WITH THEIR INTELLEC―
TUAL AND EMOTIONAL STATE
B
THE PATIENT OR CAREGIVER IDEN―
TIFIES SIGNS/SYMPTOMS TO REPORT
I hear examples of outcome indicators
in ambulatory care settings Again, familiar
to you so you should feel very comfortable
about understanding this
You have the nursing process The pa―
TO HEALTH CARE TEAM
THE PATIENT OR CAREGIVER DEMON―
STRATES UNDERSTANDING OF CLINIC
OPERAT10N, FUNCTIONS OF PERSON―
NEL, APPOINTMENT SYSTEM, AND
tient expresses satisfaction with nursing care,
which is very ilnportant As you can see the
patient satisfaction is very irnportant Use of
standard care plans ― there is a lot of change
in relation to standard care plans And you'11
日本看護研究学会雑誌 Vol.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States"
find that there's rnore focus on certain aspects you measure that?
of that And the figure is continued up there
l won't take tirne to go into all of that
l do wantto mentiOn one category here:
Health Promotion
I never forget ―
I just love teaching
students and l spent about 5 years at Yale
l do feel we don't put
University teaching undergraduate students
abOut principles of nursing And I'1l never
enough emphasis on Health PrOmotion and
forget 127 1 was a very young instructor at
disease prevention And in any standard of
the time and l was very proud to be able to
care, any plan that you develop, you need to
do this But when l did some extensive graduate
include that Mre know frOm some early Surgeon
、/ork in physiology and some of the sciences,
General's repOrts that have been involved in
I realized everything l taught was wrong And
that there are many conditions v′hich we our―
l spent the rest of my career really trying to
selves have control over That v′
e can do som←
undo those and challenge those principles
thing about
Because v′
e didn't have Outcome Measures
For example, alcohol consumption,
You see, if v′
e had Outcome トノ
Ieasures,
smoking, weight gain, blood pressure, you
I wOuldn't have fallen into that trap But I
know, many conditions that we really can dO
、
vasn't alone
something about And Health Promotion, of
who also fell into that
course, is very key And as l mentioned ear―
There were many colleagues
Now the ideal measurement of Quality
lier, this is sOmething 、ァ
hich a standard care
is M″
hat we call the patient's quality of life,
plan needs to address and the patient may
v′
hich might be quite different than our per―
not be as excited about getting invOlved in that ception for that patient
OUTCOMES 一
MEASUREMENT 一
THE KEY
丁0 0 U A L I T A 丁￨ ∨E R E S E A R C H :
lt's irnportant, /here
、
monies for health
are very tight, because we need to think about
Let me move on quickly because 、 re want
the patient and the Quality Of Life in terms
t o ¨・
I w a n t n o w t o t a l k a b o u t t h i s w o r d ` O u t ― Of whO will get the most for the dollar The
comes Measurement' It's the key to Qualitative
Federal Government or the State, the local
Research lt's the Key
government providing some of that, the pa―
―
About 30 years ago, I 、 ras chastised for tient whO gets that care, or we as providers―
using the term `nursing diagnosis'
Today,
health care providers
it's quite common in the States v′here vre talk
ヽ Vhat assurance we
have that those Outcome lvleasures are really
about nursing intervention, nursing diagnOsis
viewed in a way that we will get, as we say
related to that Outcomes Measures refer tO
colloquially, the
“ biggest bang for the buck"
any measurement system used tO uncover Or
Data Needed;
identify the health outcome or treatment for
that patient or client
Now data As l mentioned, this 、 vhole
problem of Quality is hindered because Of the
Currently, for many years with emphasis
lack of documentation and data. And I'd like
On Quantitative Research,we really didn't move to talk a little about that
too far because the Qualitative
Research
The crucial need is for reliable and use―
relied pretty heavily on mortality, morbidity
ful data There is heavy reliance on quantita―
data, but not really on the tough ansv′ ers
tive data and not on the qualitative lt's dif_
Sirnply put, `what is the impact of what we
ficult tO measure Qualitative data ln fact,
do as nurses upon the patient' And hov′
do
v/hen we publish this 3rd edition of our bOok
日本看護研究学会雑誌 Vol.15 No.3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States"
(and I'm nOt selling this book, this is a cere― I didn't go up and say “ Well, I need so many
monial b00k), we've put our emphasis there
more hundreds of nurses, so many hundreds
On Quantitative― not as much on Qualitative
of physicians, dentists lt's the number game
So now I'm involved in moving in the other
is a trap
direction TOwards Qualitative Research And
So what l did was to turn that around
the most important method in relation to
and point Out that the problems in relation
Qualitative Research is to obtain that data
to fetal alcoholism(this is where the mother
through clinical trials
who drinks even one coctail can damage her
And you say “
iuSt fOr drugs"
Oh, clinical trials! That's
very serious problern among American lndians
Not so Not so The only
way we can really document ―
I shouldn't
say the only way but most effective way to
document Outcome ヽ
fetus), the prOblems of diabetes, which is a
leasures, is through clinical
and Native Alaskans, alcoholisnl, dental care
So what l did was to move away from numbers
and talk about results, outcomes, documented
trials where you introduce an intervention,
it What would happen if this care was not
you measure that, you deflne it, you quantify
provided to this population? Diabetes, alco―
it
holism, drug abuse, a1l of that So that the
And now as nurse researchers, it's not
totally easy, but we have more access to pati―
health policy makers, not interested in num―
ents and clients for research which makes this
bers, or nursing theory lt doesn't mean that
possible so that we, again, need to remember
we need that but we need to publish and
to involve the consumer
communicate that theory in a way that policy
Every advisory committee l appoint I
always・ ¨we'd make sure l had a consumer
represented on that group
makers can understand and say “
I knoM′ what you mean¨
Oh yeah,
・
that's important…
understand that l understand about diabetes
Now another lesson I've learned in my
l understand about teeth falling out l under―
many years in the bureaucracy of the Federal
stand about mothers who drink alcohol and
Government is the need to translate research
the fetal alcoholism"
findings in a way that policy makers can
understand what you're saying
That is why it's so important those of
you nurse researchers who publish, to translate
l fight all the tilne with nurse theorists
because they say “
・
I
I'm a nurse theorist Don't
bother me I'm nOt going tO translate this"
what you do in terms of the policy maker can
understand what you say
W e a l s o ¨・
the Data that we need We need
If you don't translate yOur nurse theory or
involvement of the family and caregivers
your findings into ways in which a policy
could go on and on but time is running out
maker, the decisiOn maker, can understand
and this you'1l find in the paper l list really
that ― ― you're wasting your time
Because
I
almOst 2 pages of kind of data that we need
today cost drives Quality of Care, rationing
to collect The assurance that there's a true
of care, 、 /hat care will be provided There's
commitment at a1l levels of care
Now ever since Florence Nightingale¨・
I
no way you can escape it
l learned this lesson l used to have to
was reading this morning with the iet lag…・
defend the health budget befOre Congress for
I had a manuscript to review on Florence
the American lndian and the Alaskan Natives
Nightingale And even in her time she was
And l learned that before going to Congress
talking about Quality of Care and would you
日本看護研究学会雑誌 Vol.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States"
believe it, OutcOme A/1easures? She 、 ′
as one
my best ideas for research from the bedside
of Our first health statisticians in the world
nurse or the nurse in the home So you don't
And she again was looking at Outcome S/1eas―
haveto have a PhD,well we need all the PhDs,
ures
but you do need to have an inquiring mind
She didn't call it that
She called it
Standards Of Practice
about what is the research question What is
Our American Nurses Association issued
Vhat is this patient saying to you?
ilnportant? ヽ
a social policy statement in 1980 with the
A/1eans listening to that patient And you can
(four)characteristics of nursing(:phenomena,
pick up some fantastic research ideas!
theory applicatiOn, nursing action, and evalua―
I used to teach research methods and
tiOn Of effect in relatiOn to phenomena) Six
my students were very unhappy because they
years later, the ANA Board developed a clas―
、/ould spend about 90% of their time develop―
sification Of diagnosislOl
ing statistical tables and beautiful charts and
NO、′, historically, Outcome X/1easures
color and everything And l said l don't want
are ernbedded in several classic studies Nttany
that ヽVhat l v/ant to knov′ is what is the
Of yOu you're familiar with
research question V/hat is it・that yOu really
at Bellviev′
, studied the effects on premature
、′
ant to? ヽ
Vhat are yOu asking? And l said
“
I'd rather you spend 909イ On defining the
One, HasselmeyeriD, who was a nurse
infants of a diaper role for support And we
question and 10% on the statistics" But they
k n O v ′ t h a t i n f a n t s 、/ h O h a v e s o m e k i n d o f
v′
eren't quite convinced of that
support can be quite effective
think as they groM′ 。lder they'1l realize that
Dora Schwartz10 at New York COrnell―
research nursing on the social―
psychological
aspects in relation to ambulatory patients
A/1yrtle Aydelotte131 eXamined the patient
welfare and outcome of nursing care
And
this v′as 25 years ago, beginning to emerge
Although I
that is One approach
Again because of time, I'In not going tO
go into ali the kinds of data and measure―
ments that you need They're in the paper and
you'1l find that there
l want tO move quickly now to Out―
in the literature And then l had my self in―
comes lプIeasurements related to evaluation
volved in the patient welfare and also the pa―
feel nurse researchers have the opportunity to
1つ
lD
tient satisfactioni。 1'1°
generate nev/ scientific knowledge and lmprove
The carly beginnings
of Outcome N/1easures
I
the utilization process
N o w y o u w i l l f i n d i n t h e l i t e r a t u r e ( n ov、
)
a much more interest in classificatiOn systems
in relation to Outcorne Measures
So that if you have related Outcome
ノ
ゝ
leasures of care, the next thing you need to
do is to build the classificatiOn system so yOu
AGENCY FOR HEALTH CARE POLICY AND
RESEARCH(AHCPR):
I M′
ant tO mention briefly, to me l think
is one Of the most exciting things that's
happened in our Federal Government A nev′
―is the agency for
agency has been formed ―
can group them in a way that are manageable
health care pOlicy and research (AHCPR) Irs
Qualitative Research Needed;
one of the 8 agencies of the United States
Qualitative Research We need to measure
specific aspects of care and the determinance
of satisfactiOn
Public Health Service V/e don't have a ヽ
linister
of Health in the United States
We have what v′ e call a Department of
l want tO mention here that I've gotten
Health and Human Resources The Health part
日本看護研究学会雑誌 Vol.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States"
is the public health service The Other half is
fracture, on HIヽた, on、
lyou name it There are
、′
elfare, social security So this agency is part
several of these But we feel that by developing
of Public Health Service And one of the things
these basic Standards Of practice and again
that's very exciting about it that we have a
looking at need, that this is a better approach
number of nurses on the advisory council
than saying, “ we're running Out of money・
Linda Akin is on that advisory council
and l understand she'1l be coming to visit
let's ration care", which l think is a cope― out
in terms of doing that
」apan in September Norma Lang, I mentioned
earlier, v′
ho's done a great deal of 、
′
ork on
This agency l mentioned has a number
of grants which they give tO Universities and
OutcOme lvleasures, and there's several other
there are several nursing schools applying for
nurses
that And l feel that on this horizOn, they
SO we've been very excited about this
¨
provide(s)an Opportunity for nursing tO really
agency because the agency got involved because
do some exciting research in getting Out―
the some states like Oregon and California
come Measures
said “we're going broke… ・
、
re can't cover health
A very practical part of doing this is
care…・
、/e're going to ration health care'' 一
that it v/ill lead to some decision about direct
which is very scary because who will fall below
reimbursement of care l don't knOw if that's
the net and not get care? So this agency is
an issue in 」 apan By that, I mean instead of
looking at alternative approaches to providing
the physician being paid for everything then
health care and guess what? Outcome llleasures,
the nurse not getting her share, this would
Quality of Care And I'rn excited about it be―
permit direct reimbursement for that portion
cause several of the panels inv。
l ve nurse leader
of care provided by the nurses)hospitals,
ship And nurses are key They're working,
homes, so forth The physicians don't like it
they knoM′ M′
hat the standards are, they know
but it's very exciting But again, in order to
what the data and… ・
but they do need help in
get Over that horizon, we must collect the
getting that and assessment tools
l persOnally have been involved in one
of the panels in developing Standards of Care
data about Outcome X/1easures and put a cost
factor
So that researchers need to look at cost
in relation t0 0ne area of a longterm care,
You say you're not interested in cost Only
…v′
e estimated some
interested in theory Not so Today, in this
incontinence We found・
cost data that the Federal Government, our
world, you need to look at(link cost to)that.
government, spends 13 billion dollars a year,
It's a 、′
ay of communicating the need and
federal monies, just on the area of incontinence selling that need So that is an exciting agency
And what v/e did¨ ・
are¨・
we have a panel look―
And you'1l find more about that in the paper
ing at all the literature in relation to inconti―O U A L ! T A T I V E R E S E A R C H A P P L I E D T O
nence, all the various techniques that are avail―N ∪ R S I N G E D U C A T ! O N :
able And the panel will come up with basic
A qualitative research can be applied to
Standards Of Care that need to be provided
nursing education, to clinical settings
And these panels are interdisciplinary ―physi
nursing education, there are such things called
And
cians, pharmacists, nurses, urologist, surgeons, p e r f o r m a n c e e x a m i n a t i o n s b a c c a l a u r e a t e p r o ―
all v′
orking together v′
hich is very exciting
And there'd be various panels on hip
grams, using simulated techniques191
You
could use an interactive video201 You could
日本看護研究学会雑誌 Vol.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)
Research
of Nursing in the United States"
SUREMENT
use a set―up unit on the floor And again, you
would evaluate the whole situation using Out―
Now data care needs for quality and
corne ゝ/1easures
care monitoring and outcome measurements
Results Certainly a lot better than some
lVIc Cormick20 1ists, and I've included this in
hich
of the performance documentation which doesn't
my paper, an integrative data system v′
mean too much today But this M′
uses a predeterrnined framev7ork Of care, valid
ould really
be performance assessment right at the patient's
and reliable data sets, standardized and uni―
side And with the technology available, inter―
form data sets And these can be done for the
v/hole country You don't have to do it iust
active video, various or even simulation tech―
niques, makes a lot possible And there are…
・
for One setting You can have various sub―
I included in my reference a couple of examples
systems of business management and clinical
that you might、
management of care and identify the various
/ant to look up
QUALITATIVE RESEARCH APPL!ED TO
elements
C L I N I C A L S i t t U A 丁! O N S :
FUttURE RESEARCH AND THE CHALLENGE
In clinical situations, a v′
ritten nursing
OF THE 1990s
care plan's tO continue to be useful to teach
Now let's look at future research and
undergraduate students But are not essential
the challenge of the 1990s Certainly the 1990's
in guiding professional nursing practice nor
will seek increased emphasis on the development
assuring quality(patient)Outcomes
Of Quality Assurance systems So any research
So there is a lnovement in our country
that you do you would be one step ahead if
to move a、 ′
ay from the traditiOnal nursing
yOu focused on the Quality NIeasures, develop―
care plan v′
ith much more emphasis on look―
ment of outcome measures, to measure the
ing at 、
vhat is it that ve're
、
putting in proboress irnpact of our interventions
notes I―
Io、′can M′e avoid redundancy in recOrd―
ing? Hov′ can we look at terms of documen―
Now hospitals are iOint accrediting which
is a joint accrediting hospital associatiOn,
tation, of what's important tο the patient and
vhich is the crediting body for hospitals
、
record significant observations So that 、/e're
Again, has used the foresight to include nurses
100king at this in a different way rather than
on their accrediting body and their emphasis
iuSt in Our recording progress notes
there, interesting enough, Outcome leasures,
lν
Ve need to assure quality patient Out―
ヽ
comes by including the physician and nurse and
Quality Care And they have listed some 10
step monitoring and evaluation process20
other health disciplines in this collaborative
FIGURE 6
practice We need to make sure that services
are delivered on time, that there is a support
THE TEN‐ STEP MONITORING AND
unit, and explore ne、
v unit services
The time is long overdue for cost―effec―
EVALUAT10N PROCESS
l
ASSIGN RESPONSIBILITY FOR MONITORING
tiveness and nursing intervention and nursing
AND EVALUAT10N ACTIVITIES
diagnosis202020
Yes nursing diagnosis, nursing
2 DELINEATE THE SCOPE OF CARE PROVI DED
interventions, and related to cost, and linkage
BY THE ORGANIZAT10N
there
DAttA CARE NEEDS FOR QUALITY OF
3
1DENTIFY
THE
MOST
IMPORTANT
AS‐
PECTS OF CARE PROVIDED BY ORGANI
CARE MONITORING AND OUttCOME MEA―
日本看護研究学会雑誌 Vol.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States"
SUMMARY:
ZAT10N
4 1DENTIFY INDICATORS (AND APPRO‐
NOw in summary Because we do want
PRIATE CLINICAL CRITERIA)FOR MONI‐
to have a little time fOr questions
TORING THE IMPORTANT ASPECTS OF
The 1990's hopefully will see a much
CARE
more research of indicators and thresholds for
5 ESTABLISH THRESHOLDS FOR THE INDI_
evaluation lmportant that 、 vith all the com―
CATORS TO TRIGGER EVALUAT10N OF
puter technology, and l must confess having
THE CARE
had two secretaries for a number of years
6 MONITOR THE IMPORTANT ASPECTS OF
and then when l retired in November '89, I
CARE BY COLLECTING AND ORGANIZING
DATA FOR EACH INDICATOR
didn't have any secretary l spent two days
learningヽVORD PERFECT and DOSS So now
7 EVALUATE CARE WHEN THRESHOLDS
l have my computer, I'm computer literate
ARE REACHED TO IDENTIFY PROBLEMS
Not all the way but I'rn getting there
OR OPPORTUNITIES FOR IMPROVEMENT
and so l have great respect for the technology
8 TAKE ACTION TO CORRECT IDENTIFIED
and it's a lot of fun But we need to provide
PROBLEMS OR IMPROVE CARE
this linkage and v/ith the opportunities through
9 ASSESS THE EFFECTIVENESS OF THE AC―
TIONS AND DOCUMENT THE IMPROVE‐
computers and NATA analysis, we can link
one data base with the other and this is really
MENT IN CARE
10 COMMUNICATE THE RESULTS OF THE
an ёxciting period to move in that direction
A qualitative research, insuring that the
MONITORING AND EVALUAT10N PROCESS
TO RELEVANT INDIVIDUALS, DEPART―
MENTS,OR SERVICE AND TO THE ORGANI‐
patient outcomes must meet accepted standards
will help to assure an improved level of care
for patients I'd like to finish 、
vith a quote
ZAT10NWIDE QA PROGRAM
from who else but F10rence Nightingale:
Once said, “ No system can endure that
SO uRCE:
」01NT COMMISS10N FOR ACCREDITAT10N OF HEALTHCARE
ORGAN ZAT10NS OVERVIEW OF ouALITY ASSURANCE
AND MONITORING AND EVALUAT10N FOR OBSTETRICS
AND GYNECOLOGY CHICAGO:」
01NT COMMISS10N′ 1988′
does not march" (“ March"meaning mov―
ing forward as a step at a time) She
asked, “
Are we walking into the future,
or are we going to remain in the past?''
We are still at the threshold of nursing
P ,2
because v′
e as the caring profession can iden―
But again, the importance of this is that
tify these Outcome Measures And most impoⅢ
this」
oint cOmmission which is listedtant,
downit's
there as a reference, is the ioint accrediting
body for all hospitals in Our country So if
what's important to the patient and
Quality of Care
Let us march together to accomplish this
there's acceptance there, you kno、 / that the
goal of providing Quality Of Care for everyone
emphasis on Outcome lVIeasures will be very
Sayonara
important
日本看護研究学会雑誌 Vol.15 No.3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States"
16 Abdellah,FG,et al(1960)Pα
REFERENCES
l COyne,W (1990)Nurses Are the Key to Quality
Puta, D F
(1989) Nurse―
んθ
s ι
Oハ7zrsjれ
prοαι
g New york:ヽ Iacrnillan CO
17 HOver,」 and Zimmer,M (1978)Nursing Quality
Health Care RA″ , February, 69-74
2
Physician Collaboration
Assurance:The WiscOnsin system ハ
raηcο
, 3(2)111‐18
18 Mc Cormick, KA (1988) Urinary lncontinence in
3 Mnls,w (1990)Is Quanty Assurance Dead?■
■]ヽ1
2g Cιれjcs o/Nο ´
the Elderly (Ed)ini rん θⅣ2rs」
ι
ん
46(9): 11-12
スれorjOαPhiladelphia:W B Saunders Co 23(1)
4 Donabedian,A (1985)Twenty Years of Research
19 Lenberg, C B and ヽ
litchel, CA (1991) Assessment
ι
われ
on the Quality of Medical Care 1965 1984 Eυ αttα
of Outcome:The Design and use of Real and Simu‐
αれdιん。■rο
れS, 8 :243-265
αι
ι
んPro/essjο
lation Nursing Performance ExaminatiOns A/“
Mariano, C
(1990) Qualitative Research 」
Vしrsれg
& f f οαι
ι
んC α″ 1 1 ( 7 ) : 3 5 4 3 5 9
21 SOvie,MD (1989)clinical Nursing Practices and
7 Fowlem M E (1990)Trends Quality Assurance:
Patient Outcome:Evaluation, Evolution, and Revo―
DefinitiOn and lmportance Pι αsι
jοSμrgjο
αιⅣαおι
πg,
lution Ⅳ″ぉれg Ecοれο“Jcs, 7(2):7985
22 Abdelah, FG (1961) CriteriOn Measures h Nursing
Summer,10(2)
8 Donabedian, A (1980)E″
Ⅳ″βj″
26
ακた, 10: 21‐
g Rοsο
οれι
」
οれs れ o ″αι
jι
ρι
y
Assassれ`″ιαれd』イοれじ
ι
ο′
jれ
g,VOl l: rん
οDe/1″jι
jο
れ
23 Holzemer,WL (1990)Ⅳ
Arbor,Ml:Health Administrative Press
″rsj′
αι
ι
た Cα″,11
τ &∬ θ
415
(8): 412‐
as ι
0/Q″ α“ι
οαcん
οjι
s 4ss′ssれ0″ιAnn
y α2ごスρρ′
24 Brooten, D,et al(1986)A RandOmizes Clinical
1う」
d, p 13
Trial of Early Hospital DLscharge and Home Fo1low‐
10 Griffith,NH (1989)Historical Perspectives and
Up of Very Low Birth Weight lnfants AIθ ω Eュgわれ
ご
」0レ乃唸
jル
θ, 315:934_939
αιo/]イ`ごjο
ANA Policies ln ANA(Ed):Classification System
for Describing Nursing Practlce:ヽ「
orking Papers
25 Mc COrmick, KA (1991) Future Data Needs for
Kansas City,MO:ANA,pp 4_5
1l Hasselmeyer,EG (1961)Bο
′
sj″
g
ι
ι
んCαに,12(2):68‐
74
&∬ oα
20 」bjご, p 71
6 fbjご , p 357
9
/“
rsjル
ι
οοた
g Oン ι
26 : 242-248
Toward Quality Jο “′
παιo/ハ ″
jι
″′
sJ″
γ A SS2_
g o“ αι
5
ι
ルれιCοれι
′
″ごスp―
Quality of Care mOnitoring, DRG Considerations,
んαυjο
′Pαι
′
れso/P″ ―
ι
′
Reimbursement and outcome Measurement F′
th Service Publication No 840 Government Printing
ηαgο:
」ο″れα′o/Ⅳ “κjれ
αrsん
g Scんοι
ゎ,23(1):2932
れαι
″″ [Ssれ ι
S Washington, DC" U S Pubhc Heaト
26 LOwer,MS,and Burton,S(1989)Measuring the
Office
lmpact of Nursing lnterventions on Patlent Outtomes
F Nαrstag Q“αι
the Challenge of the 1990s 」oこ′
ら
αιο
●
り
12 Schwartz,D Henley,B Zeitz,L (1964)『んo Eι
滋′
ι
y
｀
「
スれb″ι
πι:」
2g αれd Psyttο―
sο
ο
ttι
ハJθ
ο
法
αι
ο′
μrs力
γ Pα `Jο
αれι
O, 4(1):27‐
34
Jι
ノAss“′
New YOrk:Macmillan Publishing Co
13 Aydelotte,M (1962)The Use Of Paient Werare as
14
a CriteriOn ヽleasure ハ″
“´
sjれ
g ROSOα rcん 11 : 10‐
14 Abdellah, F G and Levine, E (1957 ; revised 1964)
0UEST10NS ANSWERS
l
ln 1981, the I)RG influenced the approach
of nursing Here in」
apan, we seem to be
Pα`jθ
ιだ
αた Pubhc Health Service
れι
s α2ご P′rsοれれθ
わο
examining the DRG intrOduction Or simi―
PublicatiOn No 527 V′ ashington, D C U S Govern_
lar system So 、
ment Printlng Offlce
the DRG on the nursing?
/hat kind of influence of
(Hattori)
15 Abdellah, FG, and Levine, E (1957) Developing a
Measure of Patient and Personnel Satisfaction with
Good question
Nursing Care Ⅳ “rsれg Resοα´
αcん 5(3)
l rnention the Diagnositc Related Cate―
日本看護研究学会雑誌 V。1.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States"
But that is an Outcome measure But as
gorles
The big prOblern there in terms of nurs_
l rnentiOned in my earlier¨
・
to the patient, the
ing is that the nursing components were not
patient looks at patient and quality of care
identified
some、 vhat differently than M′
e do as health
professiOnals The patient v′
ants to know,
And M″ ith the big push now for getting
outcome measures, v′
e hope that each of the
wants to be comfortable, to be free of pain,
467 Diagnostc cOnditions can have a nursing
to be able to go home, to be able to return to
component M/ithOut that defined then what
the comm■ unity
happens to nursing is that nursing gets put
looking at a much broader goal in terms of
under housekeeping, under dietary, and other
what brOught that patient here, 、
related duties
health promotion, disease preventionr environ_
And for years, v/e have been suffering
under that umbrella So what the effort is now
Ours includes those but we're
′
hat is the
mental factors
What's the theory and basis and part of
is to really define outcorne measures for each
that sO that there are several aspects in rela―
of these 467 conditions So there is a specific
tion tO that But you need to develop a com―
nursing component and there is a cost factOr
mon definition of patient satisfactiOn from the
related to that Yes there have been sorne stu―
patientノ /Client point of view, v/hich is pa―
dies and a fev/ 1've mentioned in my paper
tient and quality of life
But we need a lot more to really move ahead
lf we had had in 1981 the outcOme mea―
sures for Diagnostic Related GrOups, we
v/ould be a lot further ahead But, v′
And then from the health care providers
point Of viev′ , what are some of the broader
parameters that the patient may not neces―
e didn't
have them And at that point in '81 our em_
sarily be involved Or interested in, prevention,
disease prevention, and that kind of thing (I
phasis was on Quantitative Research and not
don't know whether I've answered that or not
Qualitative Research So it's an opportunity
M/e can chat a little bit later if not)
and you nurse researchers really need to move
I misunderstood
l thought you were
in that・…take advantage of that
talking about the patient
2
satisfactiOn and particularly one Outstanding
There have been many studies about nurse
1vleasurements of trying to evaluate and
assess the nursing the satisfaction on the
part of care provider HOM′
do you think
any specific 、/ay of trying to accomlnodate
One at Beth_Israel Hospital in Boston, which
has been published v′
idely
And the thing that comes out very much
the satisfaction of care provider so that
in terms of nurse satisfaction is the access
we will be able to improve the qtality Of
to decision― making , the access to managed
the care 、′
e can provide? Is there any re―
care, the access to budget determination, a
search going on in the United States?
voice in the whole management structure And
(Hattori)
v′
e speak about empo、
′
erment and governance
These are v″ ords that are kicked around but
The patient satisfaction is an Outcome measure
Of all IIny publications l guess l get more re―
essentially that's what nurses are seeking
N/1uch more emphasis occurs on that in
quests for the work we did in developing a
terms of salary The salary's important, but
patient satisfactiOn tool
in terms of individual satisfactiOn and pride
日本看護研究学会雑誌 Vol.15 No 3 1992
“
Trends and lssues of Qualitative(Evaluative)Research of Nursing in the United States''
and what they do,the emphasis is on involve―
into the comrnunity care field therefore I
ment, decision―making, a voice in the whole
had to suspend my research career But I
collaborative plan of care And yes there are
believe nO、
′the significance of your early
several studies that have documented this and
research has been taken up as the current
as a result there are some encouraging changes
issue right now The level of satisfaction
But the Beth_Israel one in BOston is a classic
that you defined 30 years ago in the 1960's
one, which they have been able, a marvelous
and also your cOncept might have still
model, they've been able to accomplish
the useability in spite of the fact that the
(I
hope that answers number two)
medical involvement has changed greatly
The point is made that if the nurse is
(Dr Kinoshita)
satisfied then hOpefully the patient's care v′
ill
be improved Obviously, yes, we hOpe so But
Point has been made that our early work on
the more we understand outcome measures,
patient satisfaction the questionnaire, has been
the impact of what we do so we don't iuSt
translated intO 」apanese and this research
follow a procedure manual but we really
that the lady spoke about So glad to have a
understand the impact of what v′
e do so we
really understand the ilnpact of v′
fan in the audience and another lesson there
is that 30 years¨・
30 years You out― live your
don't just follow a procedure manual but we
hat we do
we can measure this and certainly this 、
/ould
enemies and yOu learn to never give up, never
give up to bring abOut change. So sometimes
provide a great mOre satisfactiOn for both the
it does take 30 years and now we are talking
nurse and the patient So again it's working
about outcomes measures and 30 years ago
together, that's why l emphasize so much, to
we tried to talk about that too
include the¨ ・
don't forget to include the patient,
Thank you for sharing that with us and
the consumer in the process that you arrive
l hope that if someone is interested in using
of that They have a voice and can add a
that questionnaire now that you might make
great deal
it available to them
That's a good question Thank you
4
3
30 years ago in 1960 you made a great
Do you still feel that the usefulness of this
type of work still is viable today?
researach on the level of satisfaction and
(Dr Kinoshita)
Professor Umaki of the University of
Tokyo School of Nursing and ourselves
The patient satisfaction is an outcome measure.
made the study on that And we have trans―
Absolutely yes
lated your checklist into 」
get it published!
apanese
And
we investigated whether if the nursing
staff increased then whether the satisfac―
tion level increased or not That's、
′
hat v′
e
did a long years ago and you mentioned
at the historical part You actually pointed
out that you made that research and l dO
believe v′hat you have done is a great ac―
complishment After that research l went
日本看護研究学会雑誌 VOl.15 No 3 1992
So pull out your research and

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