Quality has increasingly become a critical part of life in every aspect. Patients are today continuously looking for good quality services from health professionals. Professional nurses are expected to render quality care to fulfil the patients’ healthcare needs. Poor nursing care has led to several litigations and the loss of patients’ lives. It is essential to explore professional nurses’ viewpoints regarding quality nursing care.
To explore and describe the understanding of professional nurses regarding quality care rendered to patients in the selected hospitals of Limpopo Province.
This study utilised a qualitative, exploratory-descriptive design. Individual semi-structured interviews were conducted for data collection. Participants comprised 35 professional nurses who were purposely selected. Data collected were audio-recorded and transcribed verbatim. Data were analysed using Tech’s eight-step data coding process, which led to the emergence of themes and sub-themes. Trustworthiness was ensured through credibility, confirmability, dependability, and transferability.
Three themes emerged: professional nurses’ descriptions, meanings, and expectations of quality nursing care. The findings highlight that quality nursing care means meeting patients’ needs through advocacy, empathy, fulfilment of patients’ needs, good interpersonal relationships and teamwork. Challenges experienced included the lack of resources and staff shortage.
Hospital management needs to develop effective ways to support professional nurses in delivering quality nursing care. In discussion with the Department of Health (DoH), hospitals should be fully equipped with resources to render quality care to patients. Evaluation of service quality and patient satisfaction should be ongoing for improving the quality of patient care.
The study reveals that professional nurses perceive quality nursing care differently. Moreover, it emphasises the importance of maintaining and promoting quality nursing care as the cornerstone of healthcare.
The World Health Organization (WHO) states that quality healthcare must be rendered to individuals and society (WHO
Quality nursing care is viewed differently by healthcare professionals and patients. Therefore, competent nursing care is considered quality nursing care by healthcare professionals. Good interpersonal relationships and caring are perceived as quality nursing care. According to Hartley et al. (
According to West et al. (
A study conducted by Stalpers et al. (
Chakraborty, Kaynak and Pagán (
The lack of equipment, inadequate training, and limited infrastructure in Limpopo Province make it difficult to provide optimal care to critically ill patients (Netshisaulu, Malelelo-Ndou & Ramathuba
Professional nurses are expected to render quality care to fulfil patients’ healthcare needs in their hospitals. Poor healthcare has led to several litigations and the loss of patients’ lives. This has become a problem in South Africa. Currently, the Department of Health’s claims have increased by 132% in South Africa. The Department had paid a claim amounting R17 million in 1 year to a member, and this is unduly costly for the Department of Health (Bateman
This qualitative descriptive study aimed to explore and describe the professional nurses’ understanding of quality nursing care at selected public hospitals in Limpopo Province.
This study utilised a qualitative, exploratory-descriptive design approach to explore and describe professional nurses’ understanding of quality nursing care in the selected public hospitals. This design was suitable for this study as it provided professional nurses with an opportunity to describe their views or perspectives regarding quality nursing care.
This study was conducted in selected public hospitals in Limpopo province. The selected hospitals are situated in Vhembe, Capricorn and Mopani districts. The settings were selected because they are the major public hospitals in the mentioned districts, provide general patient care, and have a high number and different categories of professional nurses working in the hospital settings.
The target population comprised professional nurses working in selected hospitals in Limpopo Province. A purposive sample of 35 professional nurses with at least five years of experience working in these public hospitals was selected. Data saturation was reached at participant number 30, and an additional five participants were included to ascertain if no new information emerged.
The data were collected using in-depth, face-to-face interviews. It took approximately 30–45 min to conduct the audio-recorded interviews with the participants’ permission. A semi-structured interview (SSI) guide was used as a tool, which consisted of a pre-determined set of open-ended questions (questions that prompted discussion). This provided an opportunity for the interviewer to explore particular responses from participants. The procedure followed during data collection is that the professional nurses were contacted by their District Executive Managers (DEM), Chief Executive Officers (CEO), and Nurse Managers in the hospitals. Permissions were sought after the researcher had applied to the DEM and hospitals’ CEO telephonically and in writing to conduct the study and collect data. Managers arranged the venue and selected professional nurses according to the study requirements. Interviews took place mostly on Wednesdays as the staff were on a double shift, meaning that extra personnel were on duty as it was a changeover of shifts.
The researchers and an independent co-coder used Tesch’s eight-step method of data analysis to analyse the data (Creswell
Trustworthiness in this study was ensured through maintaining credibility, confirmability, transferability, and dependability, as summarised by Creswell (
Ethical clearance for this study was attained from the University of Venda Human and Clinical Trial Research Ethics Committee (HCTREC) (SHS/20/PDC/17/1206). The Limpopo provincial Department of Health granted permission to conduct the study. At the same time, the District Executive Managers (DEM), Chief Executive Officers (CEO) and Nurse Managers in the hospitals had also granted further permission. Informed written consent was obtained from participants who knew that anonymity and confidentiality would be maintained throughout the study. The names of the participants would not appear on documentation but their code numbers. Participation in the study was voluntary.
Demographic characteristics of the study comprised 35 professional nurses from the selected public hospitals of Limpopo Province. Majority of participants were females (
Characteristics of participants.
| Item | Biographical data | Count ( |
% |
|---|---|---|---|
| Gender | Male | 4 | 11.4 |
| Female | 31 | 88.6 | |
| Age | 31–34 years | 8 | 22.8 |
| 35–50 years | 16 | 45.7 | |
| Above 51 years | 11 | 31.4 | |
| Qualification | Diploma in Nursing | 23 | 65.7 |
| Bachelor in Nursing or further qualifications | 12 | 34.3 | |
| Years of experience | > 5 | 8 | 22.8 |
| 10–20 | 14 | 40.0 | |
| 21–30 | 8 | 22.8 | |
| > 30 | 5 | 14.2 |
The findings are on the data collected through individual SSI conducted from the 35 participants on the experiences of professional nurses regarding their experiences in the understanding of quality care of patients in the selected hospitals. Understanding the nature of quality care to be rendered to patients is an essential aspect of nursing. The acquired knowledge by professional nurses enables them to share the following experiences: professional nurses’ description of quality care, professional nurses’ meaning of quality care and professional nurses’ expectations related to them receiving quality nursing care. The three themes that emerged are described in narrative form as experienced by professional nurses concerning quality nursing care. The participant identifiers allocated were hospital (
An outline of the identified themes and sub-themes.
| Themes | Sub-themes |
|---|---|
| 1. Professional nurses’ description of quality nursing care | Advocacy for patients |
| Relationship with the patients | |
| Relationship with the family | |
| Total patient care | |
| Good working relationships among nurses | |
| Application of Batho-Pele principles | |
| Proper use of resources | |
| Use of guidelines and policies | |
| 2. Professional nurses’ meaning of quality nursing care | Fulfilment of needs |
| Empathy | |
| Equal treatment of patients | |
| Do to others as I will want them to do to me | |
| 3. Professional nurses’ expectations related to patients receiving quality nursing care | Nurses to have positive attitudes |
| Good nurse–patient relationship | |
| Teamwork | |
| Lack of specialisation |
Theme 1 outlines the professional nurses’ own description of quality nursing care. It is composed of the sub-themes: advocacy for patients, relationship with the patients, relationship with the family, total patient care, good working relationship among nurses, application of Batho-Pele principles, proper use of resources, and use of guidelines and policies. The discussion of sub-themes is as follows:
Participants stated that advocacy for the patient is essential to quality care as professionals. During patient care, professional nurses advocate by speaking on behalf of the patient to meet their needs. This is reflected in the following comments:
‘I have to advocate for the patient; during the assessment, if you pick up abnormalities, you have to liaise with the doctor, and if the doctor prescribes the wrong medication, you have to speak for the patient.’ (H3, P3, F)
‘You tell them the time when a doctor is coming so that they can come and see the doctor. You advocate for the patient with problems, speak to the doctor, allow the patient to verbalize in each and everything she has.’ (H2, P1, F)
Participants commented that maintaining good relationships renders quality care to patients. They further commented that one has to greet the patient, carry out doctors’ orders, and answer their questions. Participants verbalised the following statements:
‘Quality nursing care, according to my understanding, is to nurse the patient with high standard care, giving them a smile, when they ask you a question you answer them.’ (H2, P1, F)
‘The first impression to the patient where the healing of a patient comes, greeting patient first, second, carry out orders for the patient from the doctor and advocate for them.’ (H5, P3, F)
‘Some patients come to the hospital anxious. We must relieve anxiety, reassure the patient, make a relationship with patient …nurse/patient relationship should be good so that the patient can cope with the situation.’ (H2, P3, F)
Participants commented that quality care also involves having a good relationship with the patients’ family, involving them in their care, and informing them about their condition. Participants indicated this in the following manner:
‘When relatives come, if they ask what the problem with the patient is, tell them I’m a sister. I’m not allowed to tell you about the problem of the patient, the doctor will handle it.’ (H2, P3, F)
‘It means when I’m done with the patient care, every aspect has been touched, like in ICU. I’m ICU trained specialist. We work as a multidisciplinary team, which means everybody concerned must do his work and consider family, update family concerning the patient’s condition.’ (H3, P4, F)
Participants view total patient care as giving the patient care in totality, giving care to their physical aspect and treating them holistically until healing occurs. Participants highlighted this as follows:
‘This is nursing the patient in totality, like … meeting the needs of the patients ehh … mentally, physically, emotionally until the patient is healed with the medication.’ (H1, P4, F)
‘Nursing a patient physically, spiritually and emotionally, spending time with patient listening to the patient, be an advocate for the patient.’ (H5, P3, F)
Professional nurses’ good working relationship was viewed as an essential aspect of quality care as the involvement of all inpatient care, including the patient themself, results in quality care. The following comments were given:
‘In rendering quality care … as nurses, we work hand in hand [
‘Participation is to give quality care to patient needs. It means all of us need to be involved, and teamwork is important, and the patient needs to be involved in his care.’ (H5, P4, F)
Participants viewed the application of the Batho-Pele principles as part of rendering quality care to patients as patients rely on professional nurses for care, and the care that nurses render should be transparent and open. The following statements support the view of the participants:
‘Since I am a nurse, it means a lot to me because I would always like to provide is quality care to patients as patients rely on us [
‘Quality patient care is the care that is offered to the patient, providing patient with treatment, application of Batho-Pele Principles, taking care of patients.’ (H5, P5, F)
‘Patient has value for money-they pay for care rendered. Openness and transparency where patients should be given the information on their illness and their options to decide their healthcare interventions.’ (H5, P1, F)
Participants view proper use and optimal resources as aspects of giving quality care. The lack of such resources is viewed as preventing patients from receiving quality care. The following statements support the view of the participants:
‘Quality nursing patient care is providing service to patient using optimal resources at hand.’ (H4, P2, F)
‘Lack of resources and shortage of staff will prevent patients from receiving quality care.’ (H2, P2, F)
Participants commented that as they give quality care to patients, they are guided by scientific guidelines and policies that work within a legal framework. They following comments by the participants present their views:
‘As a quality orientated person, you also need to look at adverse effects that can occur [sic] during nursing care. Again … you make sure that you stick to the set standards for the patient’s care, you follow the policy and regulations and the Act governing us, which is Act. no. 33 of 2005 …’ (H3, P2, F)
‘We are guided by steps, standards and protocols, e.g. In MDR patients. CPD is done in this way. People need to remind one another in this way.’ (H2, P5, F)
Theme 2 outlines the professional nurses’ own description of the meaning of quality nursing care. It is composed of the following sub-themes: fulfilment of patient needs, advocacy for patients, empathy, equal treatment of patients, and doing to others as I want them to do to me. The discussion of sub-themes follow.
Participants commented that quality care is the fulfilment of needs. Patients need their health needs to be fulfilled in time and referred to other multidisciplinary team members if required. They commented in the following statements:
‘It means all my needs should be fulfilled. If I am hungry, I should be fed; if I have a problem, let it be addressed and solved in time.’ (H1, P5, F)
‘I would expect the caregivers to treat me the right way. They should give me full care, if I need psychological care, they should refer me to get help …’ (H2, P5, F)
Participants commented that empathy should be shown when nurses offer care to patients. The following comments were stated:
‘You nurse the patient in totality. You show empathy and advocate for the patient.’ (H2, P1, F)
Participants verbalised that all patients should receive equal treatment from professional healthcare providers, not considering who they are. Participants commented the following:
‘It means the manner in which you treat patients, and you should treat them equally. Apply the Batho-Pele principles. Patients should be treated the same in nursing.’ (H2, P5, F)
‘It means you must treat them in total, any culture, colour, sex, treat them the same, rich or poor.’ (H1, P7, F)
Participants, in the view of quality care rendered, reiterated that the quality of care they render to the patient is the same care they would like to receive. They stated the following:
‘It is the provision of service that I would like to give if I were in the patient’s same position or situation.’ (H4, P3, F)
‘It means what I want others to do to me is what I have to do to another person.’ (H1, P1, F)
Theme 3 outlines the professional nurses’ expectations related to patients receiving quality nursing care. It comprises the following sub-themes: nurses to have positive attitudes, good nurse–patient relationships, teamwork and the lack of specialisation. The discussion of sub-themes follow.
Participants commented that nurses need to have good attitudes toward patients; this is an attribute they were taught during their training/development. This includes communicating well with patients. Another participant verbalised that patients should be treated well; patients lost their lives on account of being ill-treated by nurses rather than dying from the disease. They commented as follows:
‘We were developed we were told about our attitudes towards patients, how to communicate well with patients, and how we were brought up differently as nurses. If one of the nurses is having depression, we need to support them.’ (H2, P3, F)
‘I would expect to be treated well. I will expect a good attitude from the nurses … People die outside because of nurses’ attitudes. As a nurse, you need to treat patients with respect. If my nurses are rude to the patient, I reprimand them because I don’t want them to suffer. I’m living a good life because of what I give my patient.’ (H2, P1, F)
Participants commented that a good relationship between the nurse and the patient should exist. One participant reported that greeting a patient is the first impression where healing starts. Another participant verbalised that when nurses respond to patients’ calls for help, it is a way of rendering quality care. Participants highlighted that:
‘The first impression to the patient where the healing of a patient comes, greeting patient first, second, carry out orders for the patient from the doctor and advocate for them.’ (H5, P3, F)
‘When patients call you and are in need, you go and answer that bell. We can say you are providing quality nursing care to the patient. You don’t neglect them.’ (H1, P1, F)
Participants verbalised that teamwork is an essential aspect of quality care. They stated that patients should be involved in their care. They verbalised that although they work as a team, everyone has to do their work, and the family should also be involved. They commented as follows:
‘Participation is to give quality care patient needs. It means all of us to need to be involved, teamwork is important and patient needs to be involved in his care.’ (H5, P4, F)
‘It means when I’m done with the patient care, every aspect has been touched, like in ICU, I’m ICU trained specialist, we work as a team, means everybody concerned must do his work also considering family, update family concerning the condition of the patient.’ (H3, P4, F)
Participants indicated that they wish more professional nurses should be trained as nurse specialists as these skills are needed in the hospital. Only a few professional nurses have these skills. They stated that these skills are essential as they will have the knowledge to teach others, including doctors. They commented as follows:
‘For professional nurses, I wish if they can train them for speciality, Trauma, ICU, Paeds etc. I myself [
‘We need those specialists in the hospital. It’s important that we have them to be able to teach the doctors and nurses. We need them to teach us. We want to learn. We want them to be here in the hospital to teach us weekly, at least.’ (H1, P4, F)
Based on the findings of this study, it is conclusive that participants had their description of quality nursing care and the meaning thereof, including their expectations of them receiving quality care. A nurse as an advocate speaks on behalf of patients whose voices are not heard and is empathetic to the patient. The professional nurse acts on behalf of the patients before doctors and other members of the multidisciplinary team to ensure that the patients’ needs are met. In quality nursing care, values such as empathy and advocacy are essential aspects of quality care as professionals. Oliveira and Tariman (
Professional nurses’ teamwork and good attitudes towards patients are attributes that need to be inherent in them as they perform their duties. These are important aspects of quality care; this includes communicating well with patients. In supporting this view, Gholamzadeh et al. (
Professional nurses must distinguish between their values and professional ethics as they nurse patients daily. Professional nurses have an essential function of becoming advocates to speak on behalf of the patient to meet their needs holistically. They need to treat patients equally without considering who they are. A good relationship between healthcare providers and patients is essential in achieving the goals of the care plan. Teamwork is a critical aspect of quality care. Everyone has to do their work so that medical errors are reduced. The Department of Health should ensure that hospitals are fully equipped with resources to render quality care to patients.
This study shares valuable information on the quality nursing care of patients by professional nurses in healthcare settings. However, this study is limited to professional nurses in public hospitals. Hoping future research will consider the opinions of professional nurses from private hospitals and primary healthcare centres.
Advocacy should be one of the inherent roles of professional nurses. Nurses should act with kindness when delivering care to patients. Training institutions should continuously reinforce values such as advocacy and empathy in ethics and legal knowledge in nursing care. Batho-Pele principles should be an inherent value of professional nurses and should be practised continuously to ensure that patients are treated with respect and consideration. Professional nurses should treat patients equally, irrespective of who they are. Nurses must have positive attitudes towards patient care if quality care is to be provided. Managers need to offer support by encouraging nurses to work as a team. Managers and the Department of Health should ensure that hospitals are fully equipped with resources to render quality care and ensure that scientific guidelines and policies are adhered to by staff.
The authors would like to thank all the professional nurses who participated in the study.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
M.N., L.M. and T.L. contributed and approved the final manuscript.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
The data that support the findings of this study are available from the corresponding authors, M.N. Data analysed in this study were a re-analysis of existing data, which are openly available at locations cited in the reference section.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors, and the publisher.