Components of the Theory

Reading left to right on the Quality-Caring Model©, the first major component is "Structure".  Originally, structure was defined by Donabedian (Donabedian, 1988) and relates to components of a system such as the resources, equipment, and providers.  Dr. Duffy's definition of structure blends the causal past of the participants and takes into account characteristics of the provider and the system.  Within each of the participants (provider, patient/family, and system), there are unique attributues and knowledge that characterizes their previous life's experiences, demographics, physiological, psycho-socio-cultural, biomedical, and spiritual factors.  Structural characteristics influence the processes and outcomes of health care. 

Within the structure component, Person is defined as a multidimensional interdependent particpant who is connected to the larger diverse world.  Participants include the provider, the patient and family, and the system.  Each participant has a phenomenal field that has a unique frame of meaning.  Unique experiences, demograpics, attitudes, and behaviors comprise the participant's phenomenal field.

The second major component of the Quality-Caring Model© is "Process" which is located in the center column.  Processes, according to Duffy, are the real focus of the model since the caring practices of nursing professionals assist patients and other health care providers to meet health outcomes.  Relationship-centered professional encounters, a concept unique to this model are comprised of independent and collaborative caring relationships.  The independent relationships between the patient, family, and nurse are interactions that the nurse implements autonomously and is held accountable for in the nursing practice domain (Duffy & Hoskins, 2003).  Necessary human connection is created by Clinical Caring Processes (Watson, 1979; 1985). Collaborative relationships include activites and responsibilities that the nurse shares with other members on the health care team who may include physicians, pharmacists, technicians, care managers, secretaries, home care providers, insurance carriers, therapists, and nutritionists.  The role of the nurse is the link between the patient and the health care team; "initiating, cultivating and sustaining caring relationships" (Duffy & Hoskins, 2003, p 79-80). 

Donabedian defined "Outcomes" as the consequences or the end point of a process (Donabedian, 1988).  These are high priority indicators for quality.  Dr. Duffy's outcomes are viewed in the model on the bottom of the second column and in the third column.  Intermediate outcomes are the end results of the individual and collaborative relationships that produced feelings of being "cared-for," necessary to the attainment of terminal outcomes.  Terminal outcomes are depictd not only for the patient, but for providers and the health care system.  Examples of terminal outcomes include quality of life, costs, disease-specific outcomes, and satisfaction with care.  The Quality-Caring Model© provides a continuous, dynamic framework to practice professional nursing and assess health care outcomes. 

References

Donabedian, A. (1988). The quality of care. How can it be assessed? JAMA, 260, 1743-1748.

Duffy, J. R. & Hoskins, L. M. (2003). The Quality-Caring Model©: Blending dual paradigms.  Advances in Nursing Science, 26(1), 77-88.

Watson, J. (1979). Nursing: the Philosophy and Science of Caring. Boston: Little & Brown Company.

Watson, J. (1985). Nursing: Human science and human care. CT: Appleton-Century-Crofts. 2^nd printing 1988; 3^rd printing 1999. NY: NLN (Jones and Bartlett).

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