Advertisement

Zeitschrift für Gerontologie und Geriatrie

, Volume 52, Issue 5, pp 468–476 | Cite as

Kritische Diskussion zur bisherigen Qualitätsdebatte in der Langzeitpflege – ein Plädoyer für eine systemische und auf empirischen Erkenntnissen beruhende Betrachtung der Entwicklung und Messung von Qualität in der Langzeitpflege

  • Martina HasselerEmail author
Übersichten
  • 176 Downloads

Zusammenfassung

Vor dem Hintergrund der Qualitätsdebatten in der Langzeitpflege und immer wiederkehrender Reformmaßnahmen in der Politik zu dieser Thematik erfolgt eine kritische Diskussion zum derzeitigen Stand der Qualitätsentwicklung, -prüfung und -berichterstattung in Deutschland. In Deutschland wird überwiegend noch das lineare Modell der Struktur‑, Prozess- und Ergebnisqualität von Donabedian für Qualitätsfragen in der pflegerischen Versorgung zugrunde gelegt. Internationale Forschungsergebnisse lassen jedoch die Erkenntnis zu, dass vielfältige und wechselseitig interagierende Faktoren die Qualität in der Pflege beeinflussen und eine systemische Perspektive für die weitere Entwicklung von Merkmalen, Kriterien und Indikatoren von Qualität in der Pflege angemessener erscheint. Dieser Beitrag intendiert, die Sichtweise von Entstehung, Messung und Darstellung von Qualität in der Pflege zu öffnen und einen kritischen Beitrag für eine systemische Theorieentwicklung als eine relevante Grundlage zukünftiger Entwicklungen von Qualitätsprüfsystemen und -berichterstattungen zu leisten.

Schlüsselwörter

Qualität in Langzeitpflege Qualitätsdebatte Theorieentwicklung in Pflege Qualitätsberichterstattung in Langzeitpflege Qualitätsmessung in Langzeitpflege 

Critical discussion on the current quality debate on long-term care—a plea for a systemic and empirical insight into the development and measurement of quality in long-term care

Abstract

Against the background of the quality debates on long-term care and recurrent reform measures in politics on this topic, a critical discussion on the current state of quality development, testing and reporting in Germany is presented. In Germany, the linear model of Donabedian’s structural, process and outcome quality is still used as a basis for quality issues in nursing care; however, international research suggests that multiple and mutually interacting factors influence nursing quality and that a more systematic and systemic perspective for the further development of nursing quality (especially of features, criteria and indicators of nursing quality) appears more appropriate. This article intends to open the perspective of the development, measurement and reporting of quality in nursing and to make a critical contribution for a systemic theory development as a relevant basis for future developments of quality evaluation programs and quality reporting systems in long-term care.

Keywords

Quality in long-term care Quality debate Theory development in nursing Quality reports in long-term care Quality measurement in long-term care 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Hasseler gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Antwi YA, Bowblis JR (2016) The impact von nurse turnover on quality of care and mortality in nursing homes: evidence from the great depression. Upjohn Institute working paper, Bd. 16-249. W.E. Upjohn Institute For Employment Research, KalamazooCrossRefGoogle Scholar
  2. 2.
    Backhaus R et al (2014) Nurse staffing impact on quality of care in nursing homes: a systematic review of longitudinal studies. J Am Med Dir Assoc 15:383–393CrossRefGoogle Scholar
  3. 3.
    Barba BE et al (2011) Quality geriatric care perceived by nurses in long-term and acute care settings. J Clin Nurs 21:833–840CrossRefGoogle Scholar
  4. 4.
    Burhans LM, Allligood MR (2010) Quality nursing care in the words of nurses. J Adv Nurs 66(8):1689–1697CrossRefGoogle Scholar
  5. 5.
    Castle NG, Ferguson JC (2010) What is nursing home quality and how is it measured? Gerontologist 50(4):426–442CrossRefGoogle Scholar
  6. 6.
    Castle NG (2012) Reviewing the evidence base for nurse staffing and quality of care in nursing homes. Evid Based Nurs 15:23–24CrossRefGoogle Scholar
  7. 7.
    Castle NG, Decker FH (2011) Top management leadership style and quality of care in nursing homes. Gerontologist 51(5):630–642CrossRefGoogle Scholar
  8. 8.
    Castle NG, Engberg J (2007) The influence of staffing characteristics on quality of care in nursing homes. Health Serv Res 42:5CrossRefGoogle Scholar
  9. 9.
    Chu CH et al (2016) An integrative review of the structures and processes related to nurse supervisory performance in long-term-care. Evid Rev 13(6):411–419Google Scholar
  10. 10.
    Dellefield ME et al (2015) The relationship between registered nurses and nursing home quality. Nurs Econ 33(2):95–108Google Scholar
  11. 11.
    DiGiorgio L et al (2016) Is higher nursing home quality more costly? Eur J Health Econ 17:1011–1026CrossRefGoogle Scholar
  12. 12.
    Findlay SD (2016) Consumers’ interest in provider ratings grows, and improved report cards and other steps could accelerate their use. Health Aff 35(4):688–696.  https://doi.org/10.1377/hlthaff.2015.1654 CrossRefGoogle Scholar
  13. 13.
    Flynn L et al (2010) Effects of nursing practice environments on quality outcomes in nursing homes. J Am Geriatr Soc 58(12):2401–2406CrossRefGoogle Scholar
  14. 14.
    Forder J, Allan S (2014) The impact of competition on quality and prices in the English care homes market. J Health Econ 34:73–83CrossRefGoogle Scholar
  15. 15.
    Geraedts M et al (2011) Beurteilungskriterien für die Auswahl einer Einrichtung. In: Böcken J et al (Hrsg) Gesundheitsmonitor 2011. Bertelsmann, Gütersloh, S 155–172Google Scholar
  16. 16.
    Griffiths P et al (2014) Nurses’ shift length and overtime work in 12 European countries. The association with perceived quality of care and patient safety. Med Care 52(11):975–981CrossRefGoogle Scholar
  17. 17.
    Hasseler M (2014) Herausforderungen und Anforderungen an eine systematische Qualitätsmessung und Qualitätsberichterstattung in der Langzeitpflege. Vierteljahresh Wirtschaftsforsch 83(4):67–85CrossRefGoogle Scholar
  18. 18.
    Hasseler M, Stemmer R (2018) Entwicklung eines wissenschaftlich basierten Qualitätsverständnisses für die Pflegequalität. In: Jacobs K, al (Hrsg) Pflegereport 2018. Springer, WiesbadenGoogle Scholar
  19. 19.
    Hasson H, Arnetz JE (2011) Care recipients’ and family members’ perceptions of quality of life of older people care: a comparison of home-based care and nursing homes. J Clin Nurs 20:1423–1435CrossRefGoogle Scholar
  20. 20.
    Havig AK et al (2011) Leadership, staffing and quality of care in nursing homes. BMC Health Serv Res 11:327CrossRefGoogle Scholar
  21. 21.
    Isola A (2008) Quality of institutional care of older people as evaluated by nursing staff. J Clin Nurs 17:2480–2489CrossRefGoogle Scholar
  22. 22.
    Kajonius PJ, Kazemi A (2016) Structure and process quality as predictors of satisfaction with elderly care. Health Soc Care Community 24(6):699–707CrossRefGoogle Scholar
  23. 23.
    Kjos BO, Havig AK (2016) An examination of quality of care in Norwegian nursing homes – a change to more activities? Scand J Caring Sci 30(2):330–339CrossRefGoogle Scholar
  24. 24.
    Kurtzmann ET (2010) A transparency and accountability framework for high-value inpatient nursing care. Nurs Econ 28(5):295–306Google Scholar
  25. 25.
    Kvist T et al (2014) The relationship between patients’ perceptions of care quality and three factors: nursing staff job satisfaction, organizational characteristics and patient age. BMC Health Serv Res 14:466CrossRefGoogle Scholar
  26. 26.
    Li Y et al (2014) Associations between family rating on experience with care and clinical quality-of-care measures for nursing home residents. Med Care Res Rev 73(1):63–84Google Scholar
  27. 27.
    McGilton KM et al (2016) Outcomes related to effective nurse supervision in long-term care homes: an integrative review. J Nurs Manag 24:1007–1026CrossRefGoogle Scholar
  28. 28.
    Murphy K et al (2007) Nurses’ perceptions of quality and the factors that affect quality care of older people living in long-term care settings in Ireland. J Clin Nurs 16:873–884CrossRefGoogle Scholar
  29. 29.
    Purdy N et al (2010) Effects of work environments on nurse and patient outcomes. J Nurs Manag 18:901–913CrossRefGoogle Scholar
  30. 30.
    Reichert AR, Stroka MA (2014) Nursing home prices and quality of care – evidence form administrative data. RUHR Economic Papers, Bd. 470. Ruhr-Universität Bochum, BochumGoogle Scholar
  31. 31.
    Rudert B (2016) Das Dilemma von Struktur‑, Prozess- und Ergebnisqualität. Ansätze für ein erneuertes Qualitätsmodell in der stationären Altenpflege. Schriftenreihe Gesundheitswissenschaften, Bd. 14. Dr. Kovač, Hamburg. ISBN 978-3830091899Google Scholar
  32. 32.
    Stadnyk RL et al (2011) Improving quality of care in nursing homes: What works? CMAJ 183(11):1238–1239CrossRefGoogle Scholar
  33. 33.
    Stalpers D et al (2015) Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of literature. Int J Nurs Stud 52:817–835CrossRefGoogle Scholar
  34. 34.
    Tenkin-Greener H (2012) Nursing home environment and the risk of pressure ulcers and incontinence. Health Serv Res 47(3:Part I):1179–1200.  https://doi.org/10.1111/j.1475-6773.2011.01353.x CrossRefGoogle Scholar
  35. 35.
    Tolson E et al (2014) Editorial. Quality of life and care in the nursing home. J Am Med Dir Assoc 15(3):154–157CrossRefGoogle Scholar
  36. 36.
    Vinsnens AG et al (2011) Quality of care in Norwegian nursing homes – typology of family perceptions. J Clin Nurs 21:243–254CrossRefGoogle Scholar
  37. 37.
    Wan TTH et al (2010) Improving the quality of care in nursing homes. An evidence-based approach. John Hopkins University Press, BaltimoreGoogle Scholar
  38. 38.
    Werner RM et al (2013) Do consumers respond to publicly reported quality information? Evidence from nursing homes. J Health Econ 31(1):50–61CrossRefGoogle Scholar
  39. 39.
    Wingenfeld K, Engels D (2011) Entwicklung und Erprobung von Instrumenten zur Beurteilung der Ergebnisqualität in der stationären Altenhilfe. Abschlussbericht. BMFSJ, BerlinGoogle Scholar
  40. 40.
    Zhaou X (2016) Competition, information, and quality: Evidence from nursing homes. J Econ 49:136–152Google Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Medizinische Fakultät, Abteilung Allgemeinmedizin & VersorgungsforschungUniversität HeidelbergHeidelbergDeutschland

Personalised recommendations