This paper discusses a development of Flanagan's critical incident technique (CIT) to elicit indicators of high and low quality nursing from patients and their nurses on medical, surgical and elderly care wards. Stages in undertaking the CIT are identified and presuppositions held by most researchers about the nature of the technique are identified. The paper describes how the authors moved to a different set of presuppositions during the course of the study. Preliminary analysis of interview transcripts revealed that critical incidents need not always be demarcated scenes with a clear beginning and end, but may arise from respondents summarizing their overall experience within their description of one incident. Characteristically respondents were unable to give a detailed account of such incidents but validity may be established by the fact that respondents appear to recount what actually happened as they saw it, and what they said was clearly important to them. The researchers found that the most appropriate basic unit of analysis was not the incident itself but 'happenings' revealed by incidents that are 'critical' by virtue of being important to respondents with respect to the quality of nursing care. The importance of CIT researchers achieving an understanding of the 'meaning' of critical happenings to respondents is emphasized. Analysis of the interview transcripts is facilitated by the use of INGRES, a relational database computer program which should enable a 'personal theory' of quality nursing for each respondent, both patients and nurses, to be described. The study suggests that the CIT is a flexible technique which may be adapted to meet the demands of nursing research. If carefully applied, the CIT seems capable of capitalizing on respondents' own stories and avoids the loss of information which occurs when complex narratives are reduced to simple descriptive categories. Patients and nurses have unique perspectives on nursing and their views are of primary importance in understanding what quality means with respect to the interpersonal processes that are integral to nursing care. This paper discusses the identification of indicators of quality nursing from interviews with patients and nurses using the authors' development of Flanagan's critical incident technique.

The aim of the study was to refine and improve the inter-observer reliability of an observation schedule, developed by Le May & Redfern, designed to record the amount and type of nurse-patient interpersonal communication. The new technique involved observation of non-verbal interactions using a portable computer programmed as an event recorder and a tape recorder to record conversation. The observation schedule was employed in an acute/rehabilitation care of the elderly ward and inter-observer reliability was tested on two occasions. The second observer used a handwritten version of the schedule. Reliability coefficients were acceptable (greater than or equal to 0.60 or greater than or equal to 70% agreement) for all the schedule components although the recording of non-verbal response was inadequate. Use of the portable computer produced no additional benefits over the handwritten schedule. The observation confirmed previous research which found that relatively little expressive touch takes place between nurses and elderly patients. A simplified version of the handwritten schedule together with tape-recording of verbal communication is likely to increase reliability.

Interpersonal communication between nurses and elderly patients: refinement of an observation sdieduieThe aim of the study was to refine and improve the inter-observer rehabihty of an observation schedule, developed by Le May & Redfem, designed to record the amount and type of nurse-patient mterpersonal communication The new techmque involved observation of non-veital mterachons using a portable computer programed as an event recorder and a tape recorder to record conversation The observation schedule was employed m an acute/rehabihtation care of the elderly ward and mter-observer reliabihty was tested on two occasions The second observer used a handwntten version of the schedule Rehabibty coeffiaents were acceptable (> 0-60 or ^ 70% agreement) for all the schedule components although the recording of non-verbal response was madequate. Use of the portable computer produced no additional benefits over the handwntten schedule The observation confirmed previous research which found that relatively httle expressive touch takes place between nurses and elderly patients A simphfted version of the handwntten schedule together with tape-recordmg of verbal commumcation is likely to increase rehabihty.

This paper describes inter-rater reliability of three quality assessment instruments: Monitor, Senior Monitor and Qualpacs. The work forms part of a Department of Health funded study examining the reliability and validity of these three instruments. Inter-rater reliability is not a fixed entity and therefore should be tested every time raters or the setting change. In this instance, testing was carried out in three wards (one elderly and two surgical). Two methods of analysis were used: percent agreement and intra-class correlation coefficient. Results and some of the techniques that were found to be useful in enhancing reliability are described. Acceptable levels of inter-rater reliability with all three instruments were reached.