title: Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators.
abstract: BACKGROUND
  Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care.
  
  
  METHODS
  To calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the publicly reported nurse-sensitive indicators: screening of delirium, screening of malnutrition, and pain assessments, were averaged (2011). Nurse-perceived quality ratings were obtained from staff nurses working in the same hospitals by the Dutch Essentials of Magnetism II survey (2010). Concordance between the quality measures was analyzed using Spearman's rank correlation.
  
  
  RESULTS
  The mean screening performances ranged from 63% to 93% across the six hospitals. Nurse-perceived quality of care differed significantly between the hospitals, also after adjusting for nursing experience, educational level, and regularity of shifts. The hospitals with high-levels of nurse-perceived quality were also high-performing hospitals according to nurse-sensitive indicators. The relationship was true for high-performing as well as lower-performing hospitals, with strong correlations between the two quality measures (rS = 0.943, p = 0.005).
  
  
  CONCLUSIONS
  Our findings showed that there is a significant positive association between objectively measured nurse-sensitive screening indicators and subjectively measured perception of quality. Moreover, the two indicators of quality of nursing care provide corresponding quality rankings. This implies that improving factors that are associated with nurses' perception of what they believe to be quality of care may also lead to better screening processes. Although convergent validity seems to be established, we emphasize that different kinds of quality measures could be used to complement each other, because various stakeholders may assign different values to the quality of nursing care.
authors.affiliation: St. Antonius Academy, St. Antonius Hospital Nieuwegein/Utrecht, PO Box 2500, 3430, EM, Nieuwegein, The Netherlands. d.stalpers@antoniusziekenhuis.nl.
authors.forename: Dewi
authors.initials: D
authors.lastname: Stalpers
authors.affiliation: Dutch Nurses' Association, PO Box 8212, 3503, RE, Utrecht, The Netherlands.
authors.forename: Renate A M M
authors.initials: RAMM
authors.lastname: Kieft
authors.affiliation: Institute of Psychology, Erasmus University, PO Box 1738, 3000, DR, Rotterdam, The Netherlands.
authors.forename: Dimitri
authors.initials: D
authors.lastname: van der Linden
authors.affiliation: Dutch Health Care Authority, PO Box 3017, 3502, GA, Utrecht, The Netherlands.
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Kaljouw
authors.affiliation: Department of Revalidation, Nursing Science & Sports, University Medical Centre Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
mesh_terms: D001291:Attitude of Health Personnel; D003693:Delirium / Q000175:diagnosis* / Q000451:nursing; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000451:nursing; D008403:Mass Screening / Q000592:standards; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data; D009745:Nursing, Supervisory; D010147:Pain Measurement / Q000592:standards*; D018802:Patient-Centered Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results
keywords: Hospitals; Nurse perception; Nursing care; Quality assessment; Quality indicators; Quality of care