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Understanding and Measuring Patients' Assessment of the Quality of Nursing Care

Lynn, Mary R.; McMillen, Bradley J.; Sidani, Souraya

doi: 10.1097/01.NNR.0000270025.52242.70

Background: Traditionally, patients have been considered incapable of evaluating the quality of care they receive, leading to their minimal involvement.

Objective: To develop the Patient's Assessment of Quality Scale-Acute Care Version (PAQS-ACV) to provide a mechanism through which patients can evaluate meaningfully the nursing care they receive.

Methods: Developed from qualitative interviews with patients, the original 90-item PAQS-ACV was tested with 1,470 medical surgical patients in 43 units across seven hospitals. The typical patient was a married, 50-year-old, high school-educated patient hospitalized for the fourth time. Every 10th patient was asked to complete the PAQS-ACV 2 weeks later.

Results: After exploratory factor analysis, 45 items remained in five factors, accounting for 54% of the variance. Internal consistency estimates were above.83 for four of the five factors, with the fifth factor being.68. Test-retest reliability ranged from .58 to .71. Content validity was established and construct validity has been explored preliminarily by examining the relationship between the PAQS-ACV scores and patients' compliance.

Discussion: Although the PAQS-ACV is a relatively new measure of quality nursing care, it has met many criteria for an adequate measure of quality care. The instrument fills a void in the assessment of quality by including patients in the direct evaluation of the care received.

Mary R. Lynn, PhD, is Associate Professor, School of Nursing, University of North Carolina at Chapel Hill.

Bradley J. McMillen, PhD, is Senior Director for School Accountability, Wake County Public Schools, Raleigh, North Carolina.

Souraya Sidani, PhD, is Professor, Faculty of Nursing, University of Toronto, Ontario.

Accepted for publication January 3, 2007.

Funded by the National Institute for Nursing Research, R01 NR03606. With early work funded by University of Arizona College of Nursing, BRSG, 2 S07 RR05913.

Corresponding author: Mary R. Lynn, PhD, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460 (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.