Relationship Between Nursing Care Delivery Models and Patient Outcomes in Freestanding Dialysis Units

2.50
Hdl Handle:
http://hdl.handle.net/10755/148296
Type:
Presentation
Title:
Relationship Between Nursing Care Delivery Models and Patient Outcomes in Freestanding Dialysis Units
Abstract:
Relationship Between Nursing Care Delivery Models and Patient Outcomes in Freestanding Dialysis Units
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Hoffart, Nancy
P.I. Institution Name:University of Kansas
Objective. Nursing leaders have asserted that care by registered nurses positively influences patient outcomes. Only recently, however, have we begun to generate empirical data to substantiate that assertion. Nephrology nurses also have asserted that RNs play an important role in achieving desired outcomes for chronic dialysis patients, yet there are few descriptions of what dialysis nurses do to improve outcomes such as quality of life, satisfaction with care, hospitalization rates, and access patency. Thus, the purpose of this study was to describe the organizational context, structure, and processes of care delivered by nephrology nurses in “magnet” freestanding dialysis units and to identify nurse-sensitive dialysis patient outcomes. In this presentation we describe the nursing care delivery models employed in the study units and their relationship to patient outcomes. Design. Qualitative descriptive study using a case study approach. Setting. Four freestanding dialysis units (cases) located within the central Midwest, selected because of their reputation within the nephrology community for providing high quality care and for achieving excellent patient outcomes. Sample. Registered nurses, licensed practical nurses, unlicensed patient care technicians, unit administrators, nephrologists, unit social workers and dietitians, and chronic dialysis patients and their family members. Measures/Instruments. Three research team members collected data through formal interviews with patient care staff, administrators, and nephrologists; focus groups with patients and family members; field observations of routine care delivery, care planning activities, and unit operations; and review of documents (e.g. policies and procedures, mission and philosophy statements, employee and staff newsletters). A data base was developed for each study site to facilitate case analysis. Transcribed data were coded using a combination of a priori (based on Hoffart & Woods’ [1996] model of professional nursing practice) and emergent codes. Data were sorted by code, read, reread, and compared using the constant comparison approach to identify patterns and themes that characterized the structure and processes of care in each unit. Then, cross-case analysis was conducted to identify patterns and themes that occurred in all study units. Findings. Preliminary results show that these units combine elements of three nursing care delivery models: team nursing, functional nursing, and primary nursing. Two factors underlie the use of team nursing: the physical design and staff mix. Three of four units have architecturally separate “pods” that are staffed with separate teams of direct care providers. All four units employ a mix of staff; three employ RNs, LPNs, and patient care technicians; the fourth unit employs RNs and LPNs, but not patient care technicians. Functional nursing is revealed most strongly in three units, but all have some evidence of this model. All four have traditional staff educator and quality assurance/improvement roles. Each unit offers both in-center dialysis and home dialysis programs and have designated staff nurses who provide home dialysis training. Three units have created additional specialized roles to develop, implement and evaluate programs designed to impact patient outcomes. These include exercise nurse, diabetes educator, transplant coordinator, transonics technician, medication nurse, and patient educator. Finally, three of the four units also overlay primary nursing onto the other models. Each primary nurse is assigned a group of patients and is responsible for monitoring indicators of dialysis adequacy, patient adherence, and dialysis-related co-morbidities. Preliminary scanning of data related to patient outcomes suggests that there are few outcomes that can be attributed solely to RNs. Further analysis, however, is being conducted to identify immediate (i.e. during the dialysis treatment) and long-term patient outcomes and to understand the relationship between the nursing care delivery model and the outcomes identified. Conclusions and Implications: Careful study of these “magnet” dialysis units has revealed the mixing of nursing care delivery models. Further analysis will help in identifying outcomes of care that can be linked with the functions and responsibilities of the direct care staff. By understanding this link interventions to strengthen the impact of nursing on patient outcomes can be designed and tested.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleRelationship Between Nursing Care Delivery Models and Patient Outcomes in Freestanding Dialysis Unitsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/148296-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Relationship Between Nursing Care Delivery Models and Patient Outcomes in Freestanding Dialysis Units</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Hoffart, Nancy</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Kansas</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">nhoffart@kumc.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective. Nursing leaders have asserted that care by registered nurses positively influences patient outcomes. Only recently, however, have we begun to generate empirical data to substantiate that assertion. Nephrology nurses also have asserted that RNs play an important role in achieving desired outcomes for chronic dialysis patients, yet there are few descriptions of what dialysis nurses do to improve outcomes such as quality of life, satisfaction with care, hospitalization rates, and access patency. Thus, the purpose of this study was to describe the organizational context, structure, and processes of care delivered by nephrology nurses in &ldquo;magnet&rdquo; freestanding dialysis units and to identify nurse-sensitive dialysis patient outcomes. In this presentation we describe the nursing care delivery models employed in the study units and their relationship to patient outcomes. Design. Qualitative descriptive study using a case study approach. Setting. Four freestanding dialysis units (cases) located within the central Midwest, selected because of their reputation within the nephrology community for providing high quality care and for achieving excellent patient outcomes. Sample. Registered nurses, licensed practical nurses, unlicensed patient care technicians, unit administrators, nephrologists, unit social workers and dietitians, and chronic dialysis patients and their family members. Measures/Instruments. Three research team members collected data through formal interviews with patient care staff, administrators, and nephrologists; focus groups with patients and family members; field observations of routine care delivery, care planning activities, and unit operations; and review of documents (e.g. policies and procedures, mission and philosophy statements, employee and staff newsletters). A data base was developed for each study site to facilitate case analysis. Transcribed data were coded using a combination of a priori (based on Hoffart &amp; Woods&rsquo; [1996] model of professional nursing practice) and emergent codes. Data were sorted by code, read, reread, and compared using the constant comparison approach to identify patterns and themes that characterized the structure and processes of care in each unit. Then, cross-case analysis was conducted to identify patterns and themes that occurred in all study units. Findings. Preliminary results show that these units combine elements of three nursing care delivery models: team nursing, functional nursing, and primary nursing. Two factors underlie the use of team nursing: the physical design and staff mix. Three of four units have architecturally separate &ldquo;pods&rdquo; that are staffed with separate teams of direct care providers. All four units employ a mix of staff; three employ RNs, LPNs, and patient care technicians; the fourth unit employs RNs and LPNs, but not patient care technicians. Functional nursing is revealed most strongly in three units, but all have some evidence of this model. All four have traditional staff educator and quality assurance/improvement roles. Each unit offers both in-center dialysis and home dialysis programs and have designated staff nurses who provide home dialysis training. Three units have created additional specialized roles to develop, implement and evaluate programs designed to impact patient outcomes. These include exercise nurse, diabetes educator, transplant coordinator, transonics technician, medication nurse, and patient educator. Finally, three of the four units also overlay primary nursing onto the other models. Each primary nurse is assigned a group of patients and is responsible for monitoring indicators of dialysis adequacy, patient adherence, and dialysis-related co-morbidities. Preliminary scanning of data related to patient outcomes suggests that there are few outcomes that can be attributed solely to RNs. Further analysis, however, is being conducted to identify immediate (i.e. during the dialysis treatment) and long-term patient outcomes and to understand the relationship between the nursing care delivery model and the outcomes identified. Conclusions and Implications: Careful study of these &ldquo;magnet&rdquo; dialysis units has revealed the mixing of nursing care delivery models. Further analysis will help in identifying outcomes of care that can be linked with the functions and responsibilities of the direct care staff. By understanding this link interventions to strengthen the impact of nursing on patient outcomes can be designed and tested.</td></tr></table>en_GB
dc.date.available2011-10-26T09:43:06Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:43:06Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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