enveloping quality indicators of home care nursing practice for older adults : Defining items and their standardization based upon the best practice

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The purpose of this study was to define the best practice of home care nursing for older adults and to develop and standardize quality indicators based upon the best practice.First we selected the 16 areas of home care nursing in which we developed the quality indicators. The 16 areas were commonly practiced or considered to become important in near future. Each researcher was responsible in developing the quality indicators. The basic resources to rely on in developing the indicators were past literature on the target area and practical knowledge owned by the expert practitioners. As a result, 483 quality indicators were developed.Second, we conducted a national survey on the quality of care provided by the home care nurses in Japan, using the developed quality indicators. The questionnaires were sent out to the 10,644 nurses working at 5,322 home nursing stations nation-wide, and 3,068 (29.7%) nurses responded. The response showed that on average over 70% of quality indicators from all 16 areas were practiced in the nurses' daily works. In all areas, the nurses were affirmative of the QIs. The results suggested that the QIs were generally applicable to today's home care nursing in Japan. We have finalized the quality indicators based upon the survey results.Then we have examined the validity of quality indicators in the areas of family support and pressure ulcer care. We have reviewed 60 nursing charts and examined how much contents of quality indicators were actually reported in nursing charts. In the area of family support, there were some quality indicators with low validity. Most quality indicators in the area of pressure ulcer care showed relatively high validity. The results suggested that the nurses' response to the quality indicators alone cannot be relied upon in estimating the actual quality of care.