College of Nursing and Health Sciences Professor Examines a New Measure of Quality

By Anne-Marie Kent

Anyone who has been seriously ill knows that good nursing care can help ease the pain and discomfort of a hospital sta--but can it affect patient outcomes?

UMass Boston nursing professor Laurel Radwin says "yes" and has done a considerable amount of research to help define just what constitutes good care.

"A convincing body of evidence has accumulated that verifies the relation between nurse staffing levels and adverse outcomes for hospitalized patients," says Radwin. "Apparently the quantity of nursing care makes a difference to patient outcomes. The importance of the quality of nursing care deserves similar attention." Defining quality and devising the means to measure it have been a major part of Radwin's work in the field of oncology nursing.

She became interested in cancer nursing when she completed her dissertation on cardiac nurses. "My research indicated that care continuity and time in the nurse-patient relationship were important. At the magnet hospital where I conducted my study, cancer patients often had long-standing relationships with their nurses."

She began by studying individualized nursing care from the cancer patient's perspective. Radwin found that individualization was but one important aspect of excellent nursing care.

"That's how I got launched into a research program about the quality of nursing care, the outcomes of nursing care, and all of the factors that probably affect nursing care quality," says Radwin.

In February, she presented "The Development and Psychometric Testing of the Oncology Patients' Perceptions of Nursing Care Scale (OPPQNCS)" at the Seventh National Conference on Cancer Nursing Research sponsored by the American Cancer Society and the Oncology Nursing Society.

Unlike other approaches, the one developed by Radwin and colleagues Kristine Alster, interim dean of the College of Nursing and Health Sciences at UMass Boston, and Krista Rubin, nurse practitioner at Massachusetts General Hospital, encompasses cancer patients' own perceptions of nursing care.

"Basically, what the OPPQNCS provides is a valid and reliable way for cancer patients to evaluate the quality of their nursing care on dimensions that patients themselves have described as important," says Radwin.

What do patients care about? Radwin says that responsiveness, individuation, coordination, and proficiency are key elements of good nursing care.

Responsiveness, she explains, is about the caring and attention that the nurses demonstrate. Using the instrument Radwin and her colleagues have developed, hospitals can measure responsiveness by asking patients how frequently their nurses provided needed support or comfort, or demonstrated concern.

Individuation, says Radwin, "is about the ways the nurse treats a patient as a person, rather than as a number or a body in the bed." Testing for this entails asking patients whether a nurse included them in care decisions and how frequently the nurses demonstrated that they knew a patient's preferences and individual experiences.

The third element is coordination. This has to do with whether or not patients experience what Radwin calls "care continuity" and not disjointed, uneven care.

The last element-proficiency-is straightforward enough. Good nursing care involves nurses who are knowledgeable and able to advise and inform patients about their conditions.

Recently, Radwin conducted a study that examined whether disparities in cancer nursing care quality exist for patients who differ in age, education, income, or gender. Titled "Are Cancer Patients' Characteristics Related to Patient-Centered Nursing Care?" the study was accepted via refereed review for poster presentation at the Academy Health Annual Meeting and a manuscript is currently under review by a refereed journal. For more information on Radwin's work, visit www.faculty.umb.edu/laurel_radwin/research%20for%20web.html

Image: College of Nursing and Health Sciences's Laurel Radwin has focused a major part of her work in oncology nursing on defining quality and devising the means to measure it. (Photo by Harry Brett)

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