AUDITS OF NURSING-CARE IN BRITAIN - A REVIEW AND A CRITIQUE OF APPROACHES TO VALIDATING THEM

The literature on audits of nursing care shows a strong link between the quality of nursing care and nursing labour force issues. Early attempts to develop a universally applicable formula to set nurse staffing levels on the basis of variations in patient dependency were shown to have been based on unrealistic assumptions about the ability of scientific methods to remove the influence of judgement from such areas of decision-making. The extent to which the validity of audit instruments has been established is reviewed, showing the number of studies to be small, almost exclusively in relation to American instruments, and with inconclusive results. An extension of the concept of validity is discussed, based on House's approach [House, E.R. (1980). Evaluating with Validity. Sage Publications, London, Beverley Hills] towards establishing validity in educational evaluation. This approach explicitly acknowledges the role of judgement in the evaluative enterprise, and widens the debate about how to settle questions of validity for audits of nursing care.