title: What does quality care mean to nurses in rural hospitals?
abstract: OBJECTIVE
  This paper is a report of a study conducted to answer the question: 'How do rural nurses and their chief nursing officers define quality care?'
  
  
  BACKGROUND
  Established indicators of quality care were developed primarily in urban hospitals. Rural hospitals and their environments differ from urban settings, suggesting that there might be differences in how quality care is defined. This has measurement implications.
  
  
  METHODS
  Focus groups with staff nurses and interviews with chief nursing officers were conducted in 2006 at four rural hospitals in the South-Eastern United States of America. Data were analysed using conventional content analysis.
  
  
  RESULTS
  The staff nurse and chief nursing officer data were analysed separately and then compared, exposing two major themes: 'Patients are what matter most' and 'Community connectedness is both a help and a hindrance'. Along with conveying that patients were the utmost priority and all care was patient-focused, the first theme included established indicators of quality such as falls, pressure ulcers, infection rates, readmission rates, and lengths of stay. A new discovery in this theme was a need for an indicator relevant for rural settings: transfer time to larger hospitals. The second theme, Community Connectedness, is unique to rural settings, exemplifying the rural culture. The community and hospital converge into a family of sorts, creating expectations for quality care by both patients and staff that are not typically found in urban settings and larger hospitals.
  
  
  CONCLUSIONS
  Established quality indicators are appropriate for rural hospitals, but additional indicators need to be developed. These must include transfer times to larger facilities and the culture of the community.
authors.affiliation: School of Nursing, University of Virginia, Charlottesville, VA, USA. mb2vy@virginia.edu
authors.forename: Marianne
authors.initials: M
authors.lastname: Baernholdt
authors.forename: Bonnie Mowinski
authors.initials: BM
authors.lastname: Jennings
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Merwin
authors.forename: Deirdre
authors.initials: D
authors.lastname: Thornlow
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D036301:Qualitative Research; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States