By Chris Schreiber
June 10, 1999

Most health professionals believe they have a pretty good idea of what makes quality nursing care, but it’s not often that anyone stops to ask patients what they think.

In what may be—incredibly—the first study of its kind, researcher Laurel Radwin, PhD, RN, found that patients, too, have specific ideas about what comprises excellent nursing. Radwin’s study quantified eight qualities of good nursing, traits that nurses have long said were important. Now nurses aren’t the only ones saying it.

“As I present this to nurses, most say the findings don’t come as a surprise,” said Radwin, an assistant nursing professor at the University of Massachusetts, Lowell.

What makes the study unique is that it allows patients to define what makes quality nursing care. “It’s refreshing to have the patients delineating it. It packs so much more of a punch because of who is saying it,” Radwin said. “I think it’s an astoundingly positive portrayal of what excellent care is to patients.”

What patients expect

While other studies have revealed the importance of nurses in health care, Radwin’s study is believed to be the first to create a list of nursing qualities that patients expect.

“Nursing does an outstanding job of monitoring itself,” Radwin said. “But we’ve done a ‘less well’ job of asking the patients what they want.”

The 22 oncology patients she interviewed for the study provided a polished and savvy analysis of nursing care, Radwin said. Their answers can be divided into eight categories.

First, patients expected a level of professional knowledge from their nurse, including technical competence. In addition, they stressed the importance of having a personal relationship with their nurse.

Study participants also described the desire for their nurse to establish rapport with them and to individualize their care so that their feelings were taken into consideration during treatment. This relationship was especially important to patients, Radwin said, because they felt more encouraged when their care felt like a partnership, in which nurses shared decision making with them and honored their experience and skills.

In addition, patients said they’re looking for a nurse who is caring and attentive—someone who will address their needs promptly and with concern. Having the same nurse as often as possible was also important to patients.

Study participants also described the value of coordinated care in their treatment, in which the nurse communicated with other providers and eased transitions.

Perceptions affect outcomes

The effect of quality care was profound, Radwin said. Patients who felt they received excellent nursing care were more optimistic about the future, felt a greater sense of fortitude to fight their illness, and felt better overall. The study also found that good nurses inspired a sense of “authenticity,” helping the patient feel comfortable about being honest and open.

“The thing that surprised me the most was the outcomes that these patients described from good nursing care,” she said. “They’re saying very important things like ‘we have fewer infections if we have good nursing care,’ and these things are really important.”

The study also reflects a change in the type of personal attachment nurses have with their patients, Radwin said. Nurses are no longer trained to maintain a purely clinical relationship with their patients, a change from the days where divulging personal information was considered unprofessional.

“When you don’t get attached, that’s when you burn out,” she said. While nurses should be careful to avoid becoming overinvolved with patients, “the energy in nursing comes from those bonds,” she said.

Experience counts

Ultimately, how nurses used their experience proved to be the most important factor in determining how many attributes of good nursing they displayed, Radwin said.

Patients appreciate it when nurses have experience that can be related to them, Radwin said. “In order to have that kind of knowledge to share with patients, you have to have experience,” she said. “But just because you have experience, it doesn’t mean it will translate to the care you give.”

The study wasn’t intended to answer every question about patient expectations, Radwin said, but she believes her findings could be extrapolated for other situations.

“It’s my hunch that some of those aspects are enduring,” she said. “I imagine that there are similar linkages for families as well, for example, and it really lends itself well to developing instruments [that measure quality care].” Still, she cautions against overextending the intended applications of the study. “I don’t think it should be extended to explain everything.”