Content area
Full Text
Background and Purpose: To test a Donabedian model in a pilot study of nurses' perceptions of the quality of nursing care. Methods: Four methods for detecting the tridimensionality of perception are compared: Cronbach's alpha, Steenbergen's similarity coefficients, the box and whiskers plot (B&W), and the Friedman test. Results: Low alphas suggested multidimensionality; the similarity coefficients indicated confounding between two factors but B&W and the Friedman test (p < .001) suggest nurses perceive more quality in outcome than in process. Conclusions: The similarity coefficients are preferable to Cronbach's alpha for estimating internal consistency and for detecting multidimensionality. B&W suggests the factors confounded using Steenbergen's method occupy different levels of perception, suggesting tridimensionality. The homogeneous social group is largely responsible for the apparently contradictory results obtained from statistical analysis.
Keywords: nursing; quality; Donabedian; small sample methods
(ProQuest: ... denotes formula omitted.)
The purpose of this research was to test a Donabedian model in a pilot study of nurses' perceptions of the quality of nursing care provided in an emergency department of a Portuguese obstetrics and gynaecology/birthing unit and, in particular, to focus on the conceptual and methodological problems that emerge during the data gathering process. A pilot study of a particular social group was chosen because it is especially appropriate in helping us to understand those problems.
BACKGROUND AND CONCEPTUAL FRAMEWORK
A Donabedian model assumes the existence of three essential factors in assessing quality-structure, process, and outcome-and possibly a causal relationship between them. For Donabedian (2005), structure is defined as the places where medical care takes place and the instrumentalities of each product, and may include the features of the system, the service provider, or the patient. Process refers to the set of activities that take place, on the one hand, between professionals and, on the other, between professionals and patients. It includes technical and interpersonal aspects. Outcomes are the consequences for the health and well-being of individuals and society (Donabedian, 1980) and include clinical outcomes, quality of life, and satisfaction with the care provided.
Assuming they exist, it is important to know if the three factors are correlated in the same direction, in opposing directions, or if they do not correlate at all. To exemplify this, the perception that nurses have of structural aspects may...