Page 458 - Encyclopedia of Nursing Research

QuAlITy OF cARE n 425

relies primarily on informant interviews, medical error mortality and morbidity have
ethnography, and grounded theory and been a continuing epidemic in the united
generally has a more even reliance on partic- States over the past three decades (Brennan Q
ipant observation and interviewing, whereas et al., 1991; HealthGrades, 2010; HHS, 2010).
ethnology relies primarily on observations. Recent studies indicate that patient mortality
Methods for data manipulation include associated with medical errors and subopti-
strategies for taking notes, making memos, mal or substandard medical care in hospitals
and coding and indexing systems. More ranks as the third leading cause of death in
recently, computerized software programs the united States (Heron, 2010; HHS, 2010;
such as ETHNOGRAPH, NuD*IST, and landrigan et al., 2010). Annually, an esti-
MARTIN have been fruitfully employed mated 180,000 Medicare patients die as a
to aid in the management of data. Methods result of harm from the medical care they
used in data analysis are inductive and received during hospitalization, and 27%
include matrix, thematic, and domain anal- (3,216,000) of Medicare patients are harmed
ysis. Finally, the form of the final product by medical care received during hospitaliza-
may vary. In grounded theory, a substantive tion (HHS, 2010). The study findings of HHS
theory with a process model is common; in (2010), HealthGrades (2010), and landrigan
ethnoscience (a form of ethnography), a taxo- et al. (2010) indicate that while there has been
nomic structure is the product. no overall statistically significant improve-
In summary, naturalistic inquiry most ment in medical error morbidity or mortality
commonly occurs in field settings, with rates over the past three decades, there have
investigators collecting data through partic- been significant increases in some categories
ipant observation and unstructured inter- of hospital medical error harm.
views and analyzing data through thematic Attempts to measure the concept of
content analysis. It developed initially in the quality date back to the 1970s and have more
social sciences and began to be incorporated recently taken center stage. Since the release
in nursing research in the 1960s and 1970s. of the landmark Institute of Medicine (IOM,
Today, it is an accepted scientific approach 1999) report that estimated up to 98,000
that complements knowledge derived from patients die annually as a result of hospi-
positivist inquiry. tal medical errors, measuring quality and
reducing health care costs and patient harm
Toni Tripp-Reimer associated with medical care have garnered
Lisa Skemp Kelley renewed emphasis and funding. Efforts
have been made to harmonize common
medical error, patient safety, and quality
lexicon and taxonomy across government
Quality of caRe and nongovernmental enterprises (National
Quality Forum, 2009), although fragmenta-
tion still exists.
Health care quality is commonly assessed care providers today are expected
through measurement of patient safety to provide evidence-based, high-quality,
indicators in hospitals, that is, analyzing accountable, and patient-centered care at
hospital administrative data and conduct- a reasonable cost while attending to the
ing nurse and physician retrospective chart increasing expectations by consumers for
reviews to identify adverse events or medical more information about care choices and
errors (Agency for Healthcare Research and quality outcome data. Gallagher and Rowell
Quality, 2010b; Health and Human Services (2003) suggested that the provision of out-
[HHS], 2010). Research findings show that come-oriented, cost-effective health care is