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Quality of Care

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Nurses' contributions to patient-centered care and care equity are important components of health care quality

In 2001, the Institute of Medicine defined patient-centered care as care that is "respectful of and responsive to individual patients' preferences, needs, and values and ensures that patient values guide all clinical decisions." Patients' reports are the usual approach for measuring patient-centered care, an important component of health care quality.

According to a recent study, hospitalization for cancer was negatively related to patients' perceptions of patient-centered nursing care. Hospitalized patients may experience a wider range of care quality than clinic patients, possibly accounting for the inverse relationship between hospitalization and patient centered care.

The study was conducted by Laurel E. Radwin, R.N., Ph.D., C.S., of the College of Nursing and Health Sciences at the University of Massachusetts Boston, and supported by the Agency for Healthcare Research and Quality (K08 HS11625). The purpose of the study was to examine whether patient-centered nursing care for cancer patients differed according to patients' demographic characteristics, including race, sex, age, education, income, and hospitalization for cancer.

For the study, Dr. Radwin analyzed data on 423 cancer patients aged 18 or older who were in active treatment for their disease at a New England tertiary care medical center. About two-thirds of the patients were women, most of the patients were white (more than 80 percent), and 70 percent had been hospitalized for cancer. All reported that they had received cancer nursing care in the clinic or hospital.

Dr. Radwin used the Oncology Patients' Perceptions of the Quality of Nursing Care Scale to measure the quality of four dimensions of patient-centered interpersonal nursing interventions. The four dimensions are defined as: responsiveness, the nurse meets the patient's needs in a caring, attentive manner; individualization, the nurse personalizes care according to the patient's feelings, preferences, and desired level of involvement; coordination, the nurse promotes communication among other nurses and the patient; and proficiency, the nurse provides knowledgeable, skillful care.

Hospitalization for cancer was an important factor for each dimension of patient-centered care and resulted in a negative relationship between hospitalization for cancer and patients' reports of patient-centered nursing care. However, this finding probably does not indicate a relationship between illness severity and care quality, according to Dr. Radwin. Rather, it may be explained in part by the fact that participants who were hospitalized had been exposed to nursing care 24 hours per day and likely experienced a larger quantity of nursing care and a wider range of care quality, compared with clinic patients.

There was no correlation between age or patient sex with any of the four types of patient-centered care. Education had different effects in different income groups in this study, as well as differences between men and women. Inferences about race could not be made because of the limited racial diversity of the study sample. Participants were mainly white, well-educated, and had higher incomes; also, all data were collected at one site.

Details are in "Cancer patients' demographic characteristics and ratings of patient-centered nursing care," by Dr. Radwin, in the Journal of Nursing Scholarship 35(4), pp. 365-370, 2003.

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