Exploring responsibilities for delivering quality nursing care using the Healthcare Quality Framework

  • Lynette Cusack
    Corresponding author: Dr Lynette Cusack, The University of Adelaide, Faculty of Health and Medical Sciences. North Terrace Adelaide. South Australia. 5005
    University of Adelaide. Adelaide Nursing School. Health and Medical Sciences Building. North Terrace. Adelaide. South Australia. 5000

    Northern Adelaide Local Health Network SA Health. Lyell McEwin and Modbury Hospitals. Haydown Road, Elizabeth Vale. South Australia. 5112
    Search for articles by this author
  • Karleen Thornton
    Northern Adelaide Local Health Network SA Health. Lyell McEwin and Modbury Hospitals. Haydown Road, Elizabeth Vale. South Australia. 5112
    Search for articles by this author
  • Janelle Brytan
    Northern Adelaide Local Health Network SA Health. Lyell McEwin and Modbury Hospitals. Haydown Road, Elizabeth Vale. South Australia. 5112
    Search for articles by this author



      Nurses have a professional obligation to provide safe, quality practice responsive to the needs of people they care for. The Healthcare Quality Framework designed to describe nurses’ responsibilities in healthcare quality, was utilised to explore nurses’ perceptions of quality care to improve patients’ experience.


      Qualitative exploratory descriptive design conducted in two stages, in a South Australian metropolitan health service. First stage involved eight focus groups attended by 41 participants, comprising enrolled and registered nurses delivering direct patient care. Discussions recorded digitally, transcribed and thematically analysed. Second stage involved mapping and synthesis of focus group data against 61 elements located across seven domains of the Healthcare Quality Framework.


      First stage: Eleven themes identified that described nurses’ skills and responsibilities to deliver quality nursing care. Most frequently reported were effective communication, delivering basic elements of care, team work, supportive environment and compassionate, respectful, dignified care. Second stage: Out of 61 elements of the Healthcare Quality Framework, twenty-four gaps were identified related to domains: Management of the Environment; Promotion of Safety; Clinical Leadership and Governance.

      Discussion and Conclusion

      Nurses’ narratives focused on delivery of quality care within their unit/ward. Participants did not identify how they may influence the healthcare team and health service to improve care. The Healthcare Quality Framework enabled a broader reflection on nurses’ responsibilities for quality care, identifying improvement initiatives. One initiative could be a specifically designed and evaluated mentorship program, based on the Healthcare Quality Framework that is accessible to all nurses after their transition year.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Australian Commission on Safety and Quality in Health Care
        Australian Safety and Quality Framework for Health care. Putting the Framework into action: Getting started.
        • Aiken LH.
        • Sloane D.
        • Ball J.
        • Bruyneel L.
        • Rafferty AM.
        • Griffiths P.
        Patient satisfaction with hospital care and nurses in England: an observational study.
        Nursing Research. 2017;
      1. East, L., Neville, S., & Galvin, KT. (2008). Chapter 7 - Qualitative research, navigating the maze of research (Fifth Edition), edited by Borbasi & Jackson.

        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        QualRes Psycho. 2006; 3: 77-101
        • Burhans LM.
        • Alligood MR.
        Quality nursing care in the words of nurses.
        Journal of Advanced Nursing. 2010; 66: 1689-1697
        • Cusack L.
        • Drioli-Phillips P.
        • Brown JA.
        • Hunter SA.
        Contemporary discussion of professionalism for nurses using a regulatory professional practice framework.
        Journal of Nursing Regulation. 2019; 10: 21-27
        • Cusack L.
        • Smith M.
        • Hegney D.
        • Rees CS.
        • Breen LJ
        • Witt RR.
        • Cheung K
        Exploring Environmental Factors in Nursing Workplaces that promote Psychological Resilience: Constructing a Unified Theoretical Model.
        Frontier in Psychology. 2016; 7 (1:8): 600
        • Feo R.
        • Donnelly F.
        • Athlin A.
        • Jangland E.
        ‘Providing high-quality fundamental care for patients with acute abdominal pain: A qualitative study of patients’ experiences in acute care.
        Journal of Health Organization and Management. 2019; 33: 110-123
        • Garcia-Moyano L.
        • Altisent R.
        • Pellicer-Garcia B.
        • et al.
        A concept analysis of professional commitment in nursing.
        Nursing Ethics. 2019; 26: 778-797
        • Hakim C.
        Research designs: successful designs for social and economic research.
        2nd edn. Routledge, Abington2012
        • Jangland E.
        • Mirza N.
        • Conroy T.
        • Merriman C.
        • Suzui E.
        • Nishimura S.
        • Ewens A.
        ‘Nursing students’ understanding of the Fundamentals of Care: A cross-sectional study in five countries.
        Journal of Clinical Nursing. 2018; 27: 2460-2472
        • Kol E.
        • Arıkan F.
        • İlaslan E.
        • Akıncı MA.
        • Koçak MC.
        A quality indicator for the evaluation of nursing care: determination of patient satisfaction and related factors at a university hospital in the Mediterranean Region in Turkey.
        Collegian. 2018; 25: 51-56
        • Kowalski M.
        • Basile C.
        • Bersick E.
        • Cole D.
        • McClure D.
        • Weaver S.
        What do nurses need to practice effectively in the hospital environment? An integrative review with implications for nurse leaders.
        Worldviews on Evidence-Based Nursing. 2020; 17: 60-70
        • Matinolli H.
        • Mieronkoski R.
        • Salantera S.
        Health and medical device development for fundamental care: Scoping review.
        Journal of Clinical Nursing. 2020; 29: 1822-1831
        • Meehan T.
        • Timmins F.
        • Burke J.
        Fundamental care guided by the Careful Nursing Philosophy and Professional Practice Model.
        Journal of Clinical Nursing. 2018; 27: 2260-2273
        • Nursing and Midwifery Board of Australia
        Code of Conduct for nurses.
        • Nursing and Midwifery Board of Australia
        Registered Nurse Standards for Practice.
      2. Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. (2015) SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process.

        • Oldland E.
        • Botti M.
        • Hutchinson AM.
        • Redley B.
        A framework of nurses’ responsibilities for quality healthcare- Exploration of content validity.
        Collegian. 2020; 27: 150-163
        • Oldland E.
        • Hutchinson A.
        • Redley B.
        • Mohebbi M.
        • Botti M.
        Evaluation of the validity and reliability of the Nurses’ Responsibility in Healthcare Quality Questionnaire: An instrument design.
        Nursing and Health Sciences. 2021; 23: 525-537
        • Parr J.
        • Bell J.
        • Koziol-McLain J.
        Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.
        Journal of Clinical Nursing. 2018; 27: 2360-2372
        • Pentecost C.
        • Frost J.
        • Sugg H.
        • Hilli A.
        • Goodwin V.
        • Richards D.
        Patients’ and nurses’ experiences of fundamental nursing care: A systematic review and qualitative synthesis.
        Journal of Clinical Nursing. 2020; 29: 1858-1882
        • Peršolja M.
        The quality of nursing care as perceived by nursing personnel: Critical incident technique.
        Journal of Nursing Management. 2021; 29: 432-441
        • Richards D.
        • Borglin G.
        ‘’Shitty nursing’ – The new normal?.
        International Journal of Nursing Studies. 2019; 91: 148-152
        • Schneider Z.
        • Whitehead D.
        • LoBiondo-Wood G.
        • Haber J.
        Nursing and midwifery research methods and appraisal for evidence-based practice.
        4th edn. Elsevier, Chatswood2013
        • van Belle E.
        • Giesen J.
        • Conroy T.
        • van Mierlo M.
        • Vermeulen H.
        • Huisman-de Waal G.
        • Heinen M.
        Exploring person-centred fundamental nursing care in hospital wards: A multi-site ethnography.
        Journal of Clinical Nursing. 2020; 29: 1933-1944