The validity of the quality assessment instrument Qualpacs is discussed. The literature reviewed addresses the sensitivity, scoring and scope of the instrument, operational decisions and cost and policy implications. Specific attention is given to the reliability and validity of Qualpacs and methodological challenges of convergent validity testing. The study, which was funded by the Department of Health, England, employed a multiple triangulation research design to assess the validity of the instrument. Qualpacs was compared to two other instruments (Monitor and Senior Monitor) and to other quality of nursing care data derived from: observation of patients' activities and nurse-patient interaction, and interviews with patients and nurses on their perceptions of quality of care. The results support Qualpacs as a relatively valid instrument in that it displayed greater convergent validity than Monitor or Senior Monitor. Convergent validity was stronger when compared to Senior Monitor and the Monitor DG3 schedule than the other Monitor schedules. Comparison with the observation of nurse and patient activities and interactions supported Qualpacs for medical and surgical wards but not for elderly care wards. Congruence between Qualpacs' items and the views of patients and nurses provides evidence in support of construct validity of the instrument.
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