الفهرس 
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Abstract
Nurses are uniquely positioned to serve as change agents within health systems. By partnering with other health care providers who share their vision for improving care and by linking with institutional quality professionals, the impact of nursing improvement efforts is heightened. Health care systems increasingly recognize the value of quality, nurses find that their contributions to care improvement lead not only to a sense of personal reward, but may lead to professional advancement.
Recently, the nursing professional identity has been pressured to demonstrate its contributions to patient outcomes and to provide evidence of nursing sensitive indicators that directly or indirectly measure the quality of nursing care. Quality of nursing care may be influenced by nurses’ professional identity and has been shifted from structures (having the right things) to processes (doing the right things) to outcomes (having the right things happen). Moreover, the nursing model helps to explain the correlation among variables and that has become one of the most widely used frameworks for quality measurement.
The aim of this study was to develop and validate a model for nurses’ professional identity and quality of nursing care through determining the level of nurses’ professional identity, evaluating the quality of nursing care given to the patients, investigating the relationship between nurses’ professional identity level and the quality of nursing care.
This study was carried out in eight hospitals representing four sectors Ministry of Health, Health Insurance Organization, University Hospitals, and Private Hospitals. The study sample consisted of 80 nurse managers, 280 staff nurses for assessment of fulfillment of structure criteria of nursing department and nurses’ professional identity. It also included 280 patients for assessing the fulfillment of process and outcome of nursing care standard. A jury group of 20 members validated the developed model.
Five tools were used for data collection, namely the nurses’ professional identity tool (NPIT) to determine the level of nurses’ professional identity, a questionnaire of structure criteria to assess the fulfillment of structure criteria of nursing department in the studied hospitals, a questionnaire of patients’ satisfaction to assess the fulfillment of outcome standard based on the relationship between patient satisfaction and quality of nursing care, and patient’s nursing care checklist based on outcome criteria to assess the fulfillment of quality of nursing care standard based on patient care provided. Lastly, an opinionnaire checklist form was used for validation of the model.
The main study findings were as follows:
o The total nursing professional identity of nurse managers and staff nurses was similar, except for assertiveness, which was lower among nurse leaders (42.5%) compared to staff nurses (60.7%), p=0.004.
o Nurse managers and staff nurses’ total agreements upon presence of structure elements was high, 81.3% and 81.8%, respectively, being highest for human resources and lowest for the relation with physicians.
o Overall, 52.5% of the patients had total satisfaction with nursing services, being highest for the outcome of nursing care (70.7%), and for continuity of nursing care (44.6%).
o Only 26.1% of the staff nurses showed adequacy of process, with the highest adequacy for rest and sleep (80.8%), and the lowest for nutrition, fluid and electrolyte balance (28.4%).
o Total professional identity was statistically significantly related to working hospital (p<0.001), being highest in the Ministry of Health for nurse manages, and in private hospitals for staff nurses.
o Statistically significant relations were revealed between professional identity agreement upon structure elements among nurse managers and staff nurses.
o The percentages of adequate process were higher among nurses working in private hospitals, with ten or more experience years, having specialty diplomas, and having attended three or more training courses.
o Professional identity was higher among nurses with agreement upon structure elements, process, and with patient satisfaction.
o The components of nurses’ professional identity had statistically significant positive correlations with each other.
o Statistically significant positive correlations were found between the scores of total professional identity, structure and process elements, and patient satisfaction.
o Based on these findings, a model for nurses’ professional identity and quality of nursing care was developed and validated through experts’ opinions.
In conclusion, a model for nurses’ professional identity and quality of nursing care was developed and validated. It can be used as a framework for quality measurement, suggests ideas for research, and provides order and logic to an investigation and type of variables to be considered for a reasonable view.
It is recommended that the developed model be used for promotion of the importance of positive professional identity in influencing and improving the quality of nursing care. It must be emphasized in nursing schools and faculties curricula, and in in-service nursing education activities. There is a need to improve structure, as well as staff nurses’ performance. The model can inspire many research ideas related to its elements and factors, and can help designing and evaluating related interventions