1) Dictionary definitions of quality nursing care

“QNC” does not appear as one term in any dictionary. Thus, the terms are divided into three parts to be clearly defined: “quality,” “nursing,” and “care.”

The definitions of “Quality” in the Oxford Learner's Dictionary are (1) “the standard of something when it is compared to other things like it,” (2) “how good or bad something is,” (3) “a high standard,” and (4) “a thing that is part of a person's character, especially something good” [12]. The definitions for the term in the Cambridge Dictionary of American English are (1) “how good or bad something is,” (2) “a characteristic or feature of someone or something,” and (3) “the degree of excellence of something, often a high degree of it” [13]. The Lexico defines “quality” as (1) “the standard of something as measured against other things of a similar kind,” (2) “the degree of excellence of something,” and (3) “a distinctive attribute or characteristic possessed by someone or something” [14]. Thus, “quality” can be defined as the degree of excellence of something.

The word “nursing” has several definitions. The definition in the Oxford Learner's Dictionary is (1) “the job or skill of caring for people who are sick or injured” [12]. According to the Cambridge Dictionary of American English, nursing is defined as (1) the job of being a nurse and (2) the act of a woman feeding a baby with milk from her breasts [13]. Lexico's definitions include (1) The profession or practice of providing care for the sick and infirm, and (2) “a mother breastfeeding a baby” [14]. Therefore, nursing can be defined as a profession in which a nurse provides care.

“Care” is defined in the Oxford Learner's Dictionary as (1) “the process of caring for somebody/something and providing what they need for their health or protection”; (2) “the fact of providing a home in an institution run by the local authority or with another family for children who cannot live with their parents”; (3) “attention or thought that you give to something that you are doing, so that you will do it well and avoid mistakes or damage”; and (4) “a feeling of worry; something that causes problems or worries” [12]. In the Cambridge dictionary of American English, “care” is defined as (1) “the process of protecting someone or something and providing what that person or thing needs,” (2) “the process of providing for the needs of someone or something,” and (3) “serious attention, especially to the details of a situation or a piece of work” [13]. The Lexico defines “care” as (1) “the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something” and (2) “serious attention or consideration applied to doing something correctly or to avoid damage or risk” [14]. Thus, “care” can be defined as the process of attending to the needs of someone for their health, welfare, maintenance, and protection.

2) Definitions of quality nursing care in the literature

The definition of QNC can be considered from a variety of perspectives, including the patient and family, nurses, nurse managers, and management [15]. This study focused on the micro-level, specifically how nursing staff in a hospital could make a significant and unique contribution. Past studies suggest that a nurse commonly uses two terms/set of terms to explain QNC. The first is “meet” and “need”; these terms are related to meeting the patient's needs. One study defined QNC as the meeting of human needs through caring, empathy, and respectful interactions within which responsibility, intentionality, and advocacy form an essential, integral foundation [16]. Another study defined it as meeting the patient's psychosocial needs [17]. According to Williams [18], providing QNC means meeting the patient's physical, psychosocial, and extra care needs.

Some studies used the term “standard” to explain the meaning of QNC. QNC engenders patient safety and satisfaction and is conducted by nurses and based on nursing standards [19]. One study conducted in Iran defined QNC as nursing care delivery based on nursing standards with safety, which are important factors in patient satisfaction [20].

1) Caring

Caring is an essential part of nursing. Caring is a part of the attitude that humans need while they interact with one another. According to the literature, the majority of the attributes are related to caring. Caring can be divided into two parts: care function and the nurse's personal character. Care function refers to how a nurse's feelings can impact his or her caring experiences. Moreover, a nurse's personal character is obviously a major aspect of the care they provide.

2) Nurse-patient relationship

The QNC process involves nurses and patients. The nurse-patient relationship has evolved. Communication and interpersonal skills are important in constructing the nurse-patient relationship. These skills are used to construct a good relationship between individuals. Specifically, the nurse needs the patient's trust during the treatment (Table 1).

3) Patient needs

Patient needs are slightly complex and comprehensive. They include physical care, psychosocial support, emotional care, and spiritual needs. Meeting patient needs in the context of QNC involves providing basic nursing care treatment and having enough time to provide treatment and complete the assignment as well. Patient needs are attended to, in order to meet nursing care needs and to achieve QNC.

1) Model case

In the intensive care unit of a tertiary hospital, the ratio of nurses to patients is 1:2 for the morning shift and 1:3 for the afternoon and night shifts. Nurses meet the patients during the handover. They greet the patient and call his or her name even when the patient is in a comatose state. Then the nurse talks to the patient as if he or she were in compos mentis to report on handover. During a patient's treatment, nurses always ask the patient's permission to perform an intervention. The nurses try to adhere to standard operational procedures, and provide patients with adequate care. They always maintain good communication with the patient and family, educate the patient about his or her problem, and provide positive encouragement. Nurses carry out actions and interventions based on their patient's condition. They will call other healthcare workers if collaboration is required. For this case, the nurses provided QNC. They expressed adequate care for all patients in any condition and followed standard procedures during treatment. They consistently maintained a good relationship with the patient and family and encouraged them to deal with the patient's health problem. Nursing actions to satisfy the patient needs that had an essential role included observing the patient's condition, patient mobilization, providing information to the patient and family, and advocating for collaboration in the treatment of the patient.

1) Contrary case

A contrary case is an example of a contradiction or opposite of the concept. One case is described below:

One hospital had severe problems during the pandemic. There was a nursing shortage and a bed occupancy rate of 100%, which caused fatigue and increased nursing care burden. Nurses did not have enough time to talk in person with the patient and felt distant from the patient. In addition, the patient complained because of the nurse's attitude. They did not feel safe and felt that they were being ignored by the nurse. Patients were also unsatisfied because they did not feel that they had a good relationship with the nurse during nurse implementation. Thus, nurses could not meet patient needs.

In the case described above, the high workload prevented the nurses from providing QNC. The nurse could not express care for the patient. They could not meet the patient's needs due to the work situation. The nurse-patient relationship suffered because of the treatment situation. Thus, in this contrary case, all of the attributes were absent.

2) Borderline case

A similar case, a borderline case (or boundary case), is a case that cannot be regarded as an illustration of the concept because it only includes some of the important attributes of the concept. An example is presented below:

Nurses in the emergency unit need to save the life of a patient. Nurse C gives enough treatment to patient A. Then the family and patient A must wait for the doctor's diagnosis. However, the family cannot accept the situation because they are required to wait for a long time. Nurse C tries to explain the situation many times, but the family ignores Nurse C's explanations. Nurse C is unable to build a trusting nurse-patient relationship because of the family situation. Thus, in this borderline case, one of the attributes is absent.

3) Related case

A related model case that could aid researchers in understanding the vital attributes of the concept was also identified. The concept is quite similar to nursing care. An example is given below:

Nurse A usually provides good care to patients. However, she needs to finish the patient's documentation, and it takes considerable time. Patient and family can tolerate the condition because the nurse-patient relationship is well-constructed. However, nurse have not enough time for the patient, that would miss or delay of the nursing intervention. Thus, the nurse provided good nursing care.

1) Caring

This attribute can be assessed by statements consisting of loving, respect, empathy, and responsibility such as “encouraging the patient to call if there are problems; or allowing the patient to express feelings about his or her disease and treatment; or being empathetic or identifying with the patient, or showing concern for the patient” [49].

2) Nurse-patient relationship

Statements which can measure this attribute consist of presence, trust, and interaction such as “returning to the patient voluntarily; or spending time with the patient” [49].

3) Patient needs

Statements, which can be used to evaluate this attribute, consist of physical, psychosocial, and extra needs like “including the patient in planning his or her care; or giving the patient's treatments and medications on time; or helping to reduce the patient's pain” [49].

However, in several cultures, circumstances, and environments, QNC may have other empirical references. For this purpose, researchers may establish additional empirical sources based on the characteristics of this study by interviewing the experts in their contexts.