A recent comment posted on the Health Foundation website in response to Peter Griffith’s piece on measuring the quality of nursing asked: ‘Do we really want to measuring quality in nursing or the overall quality of care provided to the patient? I believe that patient centred care is much more important than focusing solely on the provision of care by nurses.’
This made me start to think about the relationship between nursing and patient, or person, centred care. It seems to me that that there is a false distinction here as there is no single endpoint for healthcare. Person-centred care that produces poor outcomes is of no benefit to the patient, just as a full tank of fuel but no brake pads is not safe for a car driver, so it's important to measure both.
Healthcare is made up of complex interactions – in order to improve person-centred care we need to understand the quality of the component parts. For example, as a car driver I want to be sure that the car starts, travels smoothly and gets me to my destination. If I don’t understand the importance of and monitor the fuel level, the oil and the brake pads, I can’t ensure that they are all in good condition and I can’t be sure I won’t break down. And if I do break down, I won’t know why I’ve broken down or what to do to get going again. If I only measure the fuel, I’ll be stuck if the oil runs out. When looking at the components, fuel is no more important than oil or brake pads; they are equal but different.
Whilst nursing is only one element of healthcare, patients in hospital spend more time with nurses than any other professional group. The reports into care at at Mid Staffordshire Foundation NHS Trust have repeatedly demonstrated that patients and their families see nurses as an essential component of delivering person-centred care.
The nursing profession agrees. Virginia Henderson defined the purpose of nursing in 1960 as ‘to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.’
The problem is that many people don’t know what nurses contribute to either clinical outcomes or to person-centred care. Florence Nightingale wrote in 1859 that the elements of nursing are all but unknown – I would suggest that, nearly 150 years later, they are still unknown to large numbers of people.
Improvement science tells us we cannot improve a thing unless we can measure it to see if a change is an improvement. So yes, I would say it is important for person-centred care (and all other aspects of good, safe healthcare) that we can measure the quality of nursing in addition to other quality measures, just as it is important for car drivers to monitor oil along with fuel levels and brake pads.
Elaine is an Assistant Director at the Health Foundation