Total quality management

Nursing care is considered a primary predictor of patient assessment of the overall
hospital experience. Yet, quality nursing care remains difficult to define. Limited
research about nurse or patient perspectives on what constitutes quality nursing care in
hospital settings prevents the identification of a shared description or insight into their
possible interrelationship. Research about nurse and patient descriptions is needed to
establish behaviors, attributes, and activities associated with quality nursing care to
improve the health and well-being of hospitalized patients.

The purpose of this descriptive study was to explore public health nurse managers' perception of Total Quality Management (TQM) Initiatives in the practice setting. Data sources included interviews with six public health nurse managers. A conceptual model was developed and subsequently analyzed in relationship to Watson's (1988) Human Theory of Caring and Total Quality Management Theory. It was discovered that public health nurse managers described favorable experiences working with TQM implementation and the team process. Although the study's findings did not support a direct relationship between Watson's Theory and congruence with public health nursing practice and TQM initiatives there is an implied relationship to the universal nursing theories of caring with a strong emphasis on advocacy in guiding public health nursing practice. Recommendations for nursing administration, practice, education and research are presented.

This paper examines the association between the employment of industry specialist auditors, and the degree of information asymmetry and the cost of debt of a client company. Unlike auditors without industry expertise, auditors with industry expertise can better improve the credibility of financial statements (Krishnan 2003; Balsam et al. 2003) and verify management forecasts, thereby minimizing management's discretion in applying accounting principles and standards (Kwon 1996). This suggests that industry specialist auditors can enhance audit quality. Consequently, clients of industry specialist auditors are expected to achieve more significant economic benefits than clients of nonspecialist auditors. Based on product differentiation theory and signaling theory, it is hypothesized in this study that clients of industry specialist auditors are more likely to enjoy a lower level of information asymmetry and a lower cost of debt than clients of nonindustry specialist auditors. In addition, this study hypothesizes that the marginal economic value added by auditor industry specialization varies between financially troubled clients and financially healthy clients that seek external financing. The results indicate that clients of specialists experience a lower information asymmetry level than clients of nonspecialists. This economic value provided by specialists is important and more pronounced for unregulated firms than for regulated firms. This inference, however, does not hold when information asymmetry is measured using analyst forecast dispersion. In addition, clients hiring specialists enjoy better credit ratings and lower cost of debt than clients of nonspecialists, and this economic value is more significant for financially troubled firms than for financially healthy firms. However, these findings do not hold for each proxy of auditor industry specialization.

I investigate the association between large shareholder heterogeneity and firms' accounting quality and information asymmetry. Specifically, I construct three measures of ownership heterogeneity based on the type, size, and monitoring aggressiveness of large shareholders present in a firm. Applying these three measures of heterogeneity, I examine whether large shareholder heterogeneity is associated with the variation in firms' accounting quality and information asymmetry. I also examine new block formations to provide evidence on the consequences of large shareholder investment on firms' accounting quality and information asymmetry. I find that the monitoring aggressiveness of large shareholders is positively associated with firms' accounting quality and information asymmetry. These findings suggest that large aggressive shareholders constrain earnings management, but contribute to firms' overall information asymmetry. Further, using new blockholder data, I find that investments by large aggressive shareholders are positively associated with firms' accounting quality and firms' information asymmetry in the post investment period. This finding provides additional support to my hypotheses that large shareholders play an important role in firms' accounting quality and information asymmetry.