The Meaning of High-Quality Nursing Care as Derived from King's Interacting Systems

The purpose of this study is to conceptualize quality with in a framework unique to nursing, King's Interacting Systems. Clarification of the concept with in the metaparadigm and a nursing conceptual framework provides the understanding of the domain and scope of nursing necessary for professional autonomy. This differentiation fosters the continued development of the discipline as well as facilitating collaboration with medicine and other health care disciplines for the ultimate benefit of the patient.

Gadamer's philosophical hermeneutics involves a dialogical interaction between the whole and parts of the text and between the horizons of the text and the interpreter. In this research study, using dialogical interaction, King's (1981) A for was approached with the question: What are the characteristics of high-quality nursing care? Using the framework of Fawcett's (1997) Structural Hierarchy of Contemporary Nursing Knowledge, the meaning and experience of high ­ quality nursing care is found in the metaparadigm relational proposition that nursing is concerned with the nursing actions or processes by which positive changes in the person's health status are effected.

Findings: Performed in an interpersonal field, nursing actions are influenced by the developmental level of the personal system of each participant as well as the conceptual characteristics of the larger social system. Quality is an experiential judgment emerging from the nurse-patient interaction and reflects both the unique and shared values of the participants. As such it mirrors King's interaction-transaction model. Goal attainment provides measurable evidence of the quality of the nursing care provided.

Conclusion: Empathic understanding, requiring the nurse's selfawareness and perceptual accuracy, guides communication during the nurse­-patient interaction aimed at mutual decision-making regarding actions leading to goal attainment. Role and power influence mutuality, an interdependence of nurse and patient, in decision-making. Goals and subsequent actions are reflections of the patient's values manifested through nursing interventions.

Application: The fusion of the horizons of the text and the interpreter's situation in today's health care environment results in a theory of high-quality nursing care from which specific empirical indicators may be developed. The theory supports the baccalaureate degree as entry level for professional nursing with recommendations regarding curriculum content; supports differentiated practice care delivery models; and identifies future research questions and problems.