Evaluation of Kitson's therapeutic nursing function matrix in the assessment of quality of nursing care in hospital

Abstract

This paper describes our test of Kitson's structured observation and scoring technique (the Therapeutic Nursing Function Matrix—TNFM) and our development of her technique (referred to as the Quality Assessment Project scheme—QAP scheme) as methods of assessing the quality of patient care in hospital wards. Both techniques were tested for inter-observer reliability and for validity against continuous observation. Kitson's technique and the QAP scheme reached acceptable levels of inter-observer agreement for identification of patients' activities, but not for scoring of those activities. Overall, the QAP scheme was found to be more reliable than the Kitson technique. Validity testing against continuous observation again revealed acceptable levels of inter-observer agreement for identification of activities, but not for scoring of those activities. For the Kitson technique there was virtually no agreement in scoring between observers. The QAP scheme achieved higher agreement but needs further work to iron out problems of detail. The conclusion reached is that the QAP scheme is a promising method for assessing the quality of nursing care in hospital wards.