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The Gerontologist 41:539-545 (2001)
© 2001 The Gerontological Society of America

Care-as-Service, Care-as-Relating, Care-as-Comfort

Understanding Nursing Home Residents' Definitions of Quality

Barbara J. Bowers, PhD, MSN, FAANa, Barbara Fibich, BS, BSNb and Nora Jacobson, PhDa

a School of Nursing, University of Wisconsin–Madison
b Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin

Correspondence: Barbara J. Bowers, PhD, MSN, FAAN, School of Nursing, University of Wisconsin–Madison, K6/328 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792. E-mail: bjbowers{at}facstaff.wisc.edu.

Decision Editor: Eleanor S. McConnell, RN, PhD

Purpose: This study explored how nursing home residents define quality of care. Design and Methods: Data were collected through in-depth interviews and were analyzed using grounded dimensional analysis. Results: Residents defined quality in three ways: (a) Care-as-service residents focused on instrumental aspects of care. They assessed quality using the parameters of efficiency, competence, and value. (b) Care-as-relating residents emphasized the affective aspects of care, defining quality as care that demonstrated friendship and allowed them to show reciprocity with their caregivers. (c) Care-as-comfort residents defined quality as care that allowed them to maintain their physical comfort, a state that required minute and often repetitive adjustments in response to their bodily cues. Implications: Residents' perceptions of care quality have implications for long-term care practice. The integration of these perceptions into quality assurance instruments could improve the usefulness of tools designed to obtain resident input.

Key Words: Nursing homes • Long-term care facilities • Quality of care • Consumer quality assessment




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