Instruments for Assessing Nursing Care Quality: A Scoping Review.

Abstract

Background/Objectives. Quality of nursing care (QNC) is a central concept in healthcare systems worldwide, with growing emphasis on developing reliable and contextually appropriate instruments for its assessment. Over recent decades, there has been a shift from outcome-based evaluation toward more holistic, patient-centered frameworks that consider both clinical indicators and interpersonal dimensions of care. This scoping review aimed to map the range, nature, and characteristics of self-report instruments used to assess the quality of nursing care, including their psychometric properties and contextual applications across different clinical settings. Methods. A systematic search was conducted in CINAHL Complete, MEDLINE (via PubMed), Scopus, Web of Science, and ProQuest Dissertations & Theses, alongside gray literature sources, following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. Studies were included if they reported on the development, validation, adaptation, or application of QNC assessment tools in hospital or community nursing contexts, and were published in English, Portuguese, or Spanish. Results. Fifty-nine studies were included, spanning from 1995 to 2025. The instruments identified were predominantly structured around Donabedian's structure-process-outcome model, and many emphasized relational domains such as empathy, communication, and respect. Tools like the Good Nursing Care Scale (GNCS), the Quality of Oncology Nursing Care Scale (QONCS), and the Karen Scales demonstrated strong internal consistency (Cronbach's α ranging from 0.79 to 0.95). Conclusions. Organizational factors, including leadership and staffing, and predictors such as burnout and work intensity, were found to influence perceived care quality. Important gaps remain regarding longitudinal use and integration of patient-reported outcome measures.