Nursing care quality: a concept analysis


  • Virya Koy Chulalongkorn University, Faculty of Nursing, Bangkok
  • Jintana Yunibhand Chulalongkorn University, Faculty of Nursing, Bangkok
  • Yupin Angsuroch Chulalongkorn University, Faculty of Nursing, Bangkok



Nursing care quality, Concept analysis, Nursing outcomes, Patient care


The purpose of this paper is to provide a clear definition of nursing care quality that contributes to the formulation, application, and measurement of quality nursing outcomes for patients, organisations, and nursing staff. It also indicates the manner in which, by using the definition, empirically based operational definitions can be developed for different operational environments and settings. The study employed a concept analysis methodology to extract terms, attributes, antecedents, and consequences (outcomes) from relevant literature databases. The analysis identified nine attributes: nurse competency performance, met nursing care needs, good experiences for patients, good leadership, staff characteristics, preconditions of care, physical environment, progress of nursing process, and cooperation with relatives. Antecedences include nurse-staffing levels, positive practice environment, and nursing turnover. Consequences include patient safety, patient satisfaction, nursing outcomes, nurse satisfaction, and budget management. Because of the breadth and depth of modern nursing practice, further research and development of the concept is required.


Charalambous A, Papadopoulos R, Beadsmoore A. Listening to the voices of patients with cancer their advocates and their nurses: A hermeneutic-phenomenological study of quality nursing care. European Journal of Oncology Nursing. 2008;12:436-42.

Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington DC: National Academy Press; 2004.

Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press; 2011.

Burhans LM, Alligood MR. Quality nursing care in the words of nurses. Journal of Advanced Nursing. 2010;66(8):1689–97.

Clarke SP, Aiken LH. More nursing, fewer deaths. Quality and Safety in Health Care. 2006;15:2–3.

American Nurses Association. Nursing: Scope and Standards of Practice. Maryland: Nurse 2004.

Sochalski J. Is more better? The relationship between nurse staffing and the quality of nursing care in hospitals. Medical Care. 2004;42(2):1167–73.

Donabedian A. Evaluating quality of medical care. Milbank Memorial Fund Quarterly-Health and Society. 1966;44(3):166–206.

Donabedian A. The quality of care: how can it be assessed? Journal of the American Medical Association. 1988;260(12):1743–8.

Donabedian A. An Introduction to Quality Assurance in Health Care. New York: Oxford University Press, 2003.

Donabedian A. Evaluating the quality of medical care. Memorial Fund Quarterly. 2005;44(3):106–206.

Doran D, Harrison MB, Laschinger H, Hirdes J, Rukholm E, Sidani S, et al. Relationship between nursing interventions and outcome achievement in acute care settings. Research in Nursing and Health. 2006;29(1):61–70.

Jeffs L, Beswick S, Martin K, Campbell H, Rose DN, Ferris E. Quality nursing care and opportunities for improvement insights from patients and family members. Journal Nursing Care Quality. 2013;28(1):76–84.

Leino-Kilpi H, Vuorenheimo J. The patient’s perspective on nursing quality: Developing a framework for evaluation. Quality Assurance in Health Care. 1994;6:1–11.

Lynn MR, McMillen BJ, Sidani S. Including the provider in the assessment of quality care: development and testing of the nurses’ assessment of quality scale –acute care version. Journal of Nursing Care Quality. 2007;22(4):328–36.

Lucero RL, Lake ET, Aiken LH. Nursing care quality and adverse events in US hospitals. Journal of Clinical Nursing. 2010;19:2185–95.

Walker LO, Avant KC. Strategies for Theory Construction in Nursing. NJ: Pearson Prentice Hall, 2010.,ssl&ei=SzdlVePZMsyD8gXS9YPoAQ#q= Merriam-Webste.

Coulon L, Mok M, Krause K, Anderson M. The pursuit of excellence in nursing care: what does it mean? Journal of Advanced Nursing. 1996;24:817–26.

Spilsbury K, Hewitt C, Stirk L, Bowmanc C. The relationship between nurse staffing and quality of care in nursing homes: A systematic review. International Journal of Nursing Studies. 2011;48:732–50.

Attree M. Patients and relatives experiences and perspectives of ‘Good’ and ‘Not so Good’ quality care. Journal Advanced Nursing. 1999;33:456–66.

Maben J, Griffiths P. Nurses in Society: Starting the Debate. London: National Nursing Research Unit, King’s College, London University, 2008.

Glen S. Emotional and motivational tendencies: the key to quality nursing care? Nursing Ethics. 1998;5(1):36–42.

Aiken LH, Clarke SP, Sloane DM. Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration. 2008;38:223–9.

Kunaviktikul W, Anders RL, Srisuphan W, Chontawan R, Nuntasupawat R, Pumarporn O. Development of quality nursing care in Thailand. Journal of Advanced Nursing. 2001;36(6):776–84.

Leinonen T, Leino-Kilpi H, Ståhlberg MH, Lertola K. Comparing patient and nurse perceptions of perioperative care quality. Applied Nursing Research. 2003;16(1):29–37.

Burhans L. What is quality? Do we agree, and does it matter? Journal for Healthcare Quality. 2007;29(1):39–44.

Royal Nursing Association of Ontario. Registered Nurses Association of Ontario, Healthy work environments best practice guidelines overall project background. Toronto, Canada: RNAO, 2006.

Brewer CS, Kvner CT, Greene W, Tukov-Shuser M, Djukic M. Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals. Journal of Advanced Nursing. 2012;68(3):521–38.

Aiken L, Sermeus W, Van den Heede K, Sloane D, Busse R, McKee M, et al. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012;344:e1717.

Lynn MR, McMillen BJ. Do nurses know what patients think is important in nursing care? Journal of Nursing Care Quality. 1999;13:65–74.

Leino-Kilpi H. Patient as an Evaluator of Nursing Services. Proceedings: Congress in Nursing Administration; Hellenic Graduate Nursing Association; Kavala, Greece, 1996; 11–24.

Kirwan M, Anne Matthews A, Scott A. The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach. International Journal of Nursing Studies. 2013;50(2):253–63.

Lindgren M, Andersson IS. The Karen instruments for measuring quality of nursing care: construct validity and internal consistency. International Journal for Quality in Health Care. 2011;23(3):292–301.

Leino-Kilpi H. Good nursing care: On what basis? Doctoral dissertation, 1990. Available from database.




How to Cite

Koy, V., Yunibhand, J., & Angsuroch, Y. (2017). Nursing care quality: a concept analysis. International Journal of Research in Medical Sciences, 3(8), 1832–1838.



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