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This article describes the historical development of quality assurance in nursing in the United States and its link with quality assurance efforts in other health disciplines. Explored are the creation and application of models, standards, criteria, and tools for measuring quality of care. Highlighted are recent empirical studies addressing structure, process, or outcome dimensions of nursing quality assurance. Emphasized is the use of empirical knowledge as a basis for political, organizational, and clinical decision-making to ensure an agreed-upon level of nursing care provided to the American public. [ABSTRACT FROM AUTHOR]

Background: Research carried out by nurses or by others on patient problems of concern to nurses is contributing to the development of evidence-based nursing practice. In the past few decades, there has been a dramatic increase in clinical research, in health services research, and in the content and process of informatics, all focused on nursing care. The translation of findings of this research into clinical practice and the organization of nursing is less dramatic. The opportunity to implement research-based practice is great, but requires attention, methods, and resources. Also required are a database and an information system which include terms essential to nursing practice. DIMENSIONS OF NURSES' INVOLVEMENT IN EVIDENCE-BASED PRACTICE: The importance of nurses' involvement in evidence-based practice (EBP) can be viewed from three perspectives: (1) nurses' participation in medical problems and medical interventions, (2) nursing problems and nursing interventions, and (3) development and use of a standardized language that describes the problems, interventions, and outcomes important to nursing., Applying Ebp to Combined Medical and Nursing Problems: The best outcomes for a specific patient population are achieved through a combination of the medical and nursing problems and evidence-based interventions. Examples of problems of importance to nursing practice and research include pain, dehydration, incontinence, lifestyle change, confusion, immobility, knowledge deficit, noncompliance, anxiety, skin breakdown, inappropriate use of restraints, and falls. Interventions for prevention and treatment of the individual problem or combination of problems comprise the focus of nursing research and EBP.

This paper reports on the work of the American Nurses Association Steering Committee on Databases to Support Clinical Practice, in existence since 1989. Responding to its broad charges, the Steering Committee has laid down the foundations for its work in declaring the nursing process as the framework for nursing data in database systems, and in endorsing the Nursing Minimum Data Set as the set of minimum elements for any system designed to carry health-related data that reflects nursing care. In addition, the Steering Committee has begun initiatives to: 1) promote the inclusion of nursing-related data in large health-related databases, and 2) develop a Uniform Language for nursing through a phased approach. The Steering Committee also works directly with the International Council of Nurses to promote the inclusion of nursing data in internationally used classification systems and to develop an international language that describes nursing care.

In 1991 the International Council of Nurses (ICN) initiated a long-term project to develop an International Classification for Nursing Practice (ICNP). To identify existing classifications and nomenclatures of nursing, a literature search and survey of national nurses' associations and individuals involved in classification across the world were conducted, in addition to a pilot search for articles describing nursing nomenclatures and classifications in countries other than the US and Canada, the latter having provided most of the examples in the original ICNP proposals. Three sources of literature were examined: international conference proceedings, Med-Line and Exerpta Medica.

In summary, measurement of standards needs to be reframed and rearticulated. If nurses move toward using measurable standards as well as holistic standards, the goal of standards will be refocused appropriately. The standards will articulate the specifics and the whole of nursing to members of society in need of health care. Nurses will also be able to hold each other accountable not only for specific procedures but also for delivering caring, as perceived by the client. The latter is unfortunately lacking in present performance appraisals. There needs to be increasing value given to nursing's unique holistic contribution to the health care of humans, which should be evident in standards. Nurses need not be at the mercy of the quantitative paradigm; neither should they alienate themselves from it. Nurses can use this paradigm to support its value and can become courageous enough to attempt describing our holistic contribution, then to research resulting outcomes. Nurses can and should relate resource consumption, not only to established quality indicators, but also to clients' perceptions of receiving holistic nursing care. As expressed by the ANA in the 1973 standards, the main reason for standards is to hold nurses accountable to what nursing is and to communicate to our clients and other disciplines what they can expect from nurses. If nursing's voice supporting holistic quality of care is to be heard in a consumer-driven health care market, it must not be shy about giving voice to its contribution through articulation of holistic standards. The foundation provided by the ANA and the subsequent work of Paulen, Benner, AHNA, and the upcoming revisions of the ANA standards are applauded.(ABSTRACT TRUNCATED AT 250 WORDS)