2.50
Hdl Handle:
http://hdl.handle.net/10755/149168
Type:
Presentation
Title:
A Model for Evaluating the Context of Nurse-Sensitive Outcomes
Abstract:
A Model for Evaluating the Context of Nurse-Sensitive Outcomes
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Houser, Janet
P.I. Institution Name:Regis University
Objective: Nurse staffing is traditionally assessed using acuity systems designed to represent patient care needs. These systems, generally based on counting observable tasks, are unreliable and underestimate the complexity of the practice of nursing. The purpose of this study was to determine what contextual factors have an impact on nursing care delivery. Design: A mixed method was used to develop and test a model of the context of nursing care delivery and its relationship to nurse-sensitive outcomes. Qualitative data were generated through individual interviews, focus groups, and analysis of print material. Axial coding was used to hypothesize a model that represented both the direction and strength of relationships between contextual factors in the nursing care environment and nurse-sensitive outcomes. Measures were identified and data collected for each factor. Both the measurement and structural models were tested quantitatively using EQS analytic software. Sample and Setting: Data were gathered from a convenience sample of 46 patient care units from seven facilities of an integrated delivery system in the Midwest. The units represented care classified as critical care, medical-surgical care, mother-baby care, emergency care, and long-term care. Thirty-six nurses participated in focus groups and more than 400 nurses responded to the Work Environment Scale. Variables and Measures: Six factors were hypothesized that affect nurse-sensitive outcomes: leadership; staff stability; resources; workload; work environment; and staff expertise. Measures were identified for each factor, including scores on the Leadership Practices Inventory (86% return rate), measures of turnover, measures of volume and severity, measures of teamwork via the Work Environment Scale (40% return rate), and expertise levels of staff. Patient outcomes were measured relative to adverse events and complication rates. The specific measures were consistent with those identified as valid nurse-sensitive indicators by the American Nurses’ Association. Findings: Leadership had a significant direct effect on staff stability and staff expertise, and a significant indirect effect on outcomes. Teamwork, as an element of the work environment, had a significant direct effect on outcomes. Staff expertise had a direct effect on the avoidance of adverse outcomes and complications. Interestingly, workload measures and resources did not register as meaningful predictors of adverse outcomes. This was consistent with the findings of the qualitative analysis, when nurses stated that when workload is high and resources scarce, good nurses “make do.” Conclusions: The initial structural model was complex and data management was a significant challenge. Nevertheless, significant linkages between leadership, perceived teamwork, and staff expertise were identified. Future research will focus on testing individual elements of the model, increasing the size of the database, and creating a structural equation that can be used as a diagnostic tool to evaluate a specific organizational context. Implications: This study took a novel approach to evaluating the context of nursing care delivery. It represents a meaningful first step toward determining a comprehensive approach to the evaluation of nursing staffing. The final model can be used to determine the elements of the nursing care delivery context that can be modified to support nursing efforts in achieving optimal outcomes.
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.titleA Model for Evaluating the Context of Nurse-Sensitive Outcomesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/149168-
dc.description.abstract<table><tr><td colspan="2" class="item-title">A Model for Evaluating the Context of Nurse-Sensitive Outcomes</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">Houser, Janet</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Regis University</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jhouser@regis.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective: Nurse staffing is traditionally assessed using acuity systems designed to represent patient care needs. These systems, generally based on counting observable tasks, are unreliable and underestimate the complexity of the practice of nursing. The purpose of this study was to determine what contextual factors have an impact on nursing care delivery. Design: A mixed method was used to develop and test a model of the context of nursing care delivery and its relationship to nurse-sensitive outcomes. Qualitative data were generated through individual interviews, focus groups, and analysis of print material. Axial coding was used to hypothesize a model that represented both the direction and strength of relationships between contextual factors in the nursing care environment and nurse-sensitive outcomes. Measures were identified and data collected for each factor. Both the measurement and structural models were tested quantitatively using EQS analytic software. Sample and Setting: Data were gathered from a convenience sample of 46 patient care units from seven facilities of an integrated delivery system in the Midwest. The units represented care classified as critical care, medical-surgical care, mother-baby care, emergency care, and long-term care. Thirty-six nurses participated in focus groups and more than 400 nurses responded to the Work Environment Scale. Variables and Measures: Six factors were hypothesized that affect nurse-sensitive outcomes: leadership; staff stability; resources; workload; work environment; and staff expertise. Measures were identified for each factor, including scores on the Leadership Practices Inventory (86% return rate), measures of turnover, measures of volume and severity, measures of teamwork via the Work Environment Scale (40% return rate), and expertise levels of staff. Patient outcomes were measured relative to adverse events and complication rates. The specific measures were consistent with those identified as valid nurse-sensitive indicators by the American Nurses&rsquo; Association. Findings: Leadership had a significant direct effect on staff stability and staff expertise, and a significant indirect effect on outcomes. Teamwork, as an element of the work environment, had a significant direct effect on outcomes. Staff expertise had a direct effect on the avoidance of adverse outcomes and complications. Interestingly, workload measures and resources did not register as meaningful predictors of adverse outcomes. This was consistent with the findings of the qualitative analysis, when nurses stated that when workload is high and resources scarce, good nurses &ldquo;make do.&rdquo; Conclusions: The initial structural model was complex and data management was a significant challenge. Nevertheless, significant linkages between leadership, perceived teamwork, and staff expertise were identified. Future research will focus on testing individual elements of the model, increasing the size of the database, and creating a structural equation that can be used as a diagnostic tool to evaluate a specific organizational context. Implications: This study took a novel approach to evaluating the context of nursing care delivery. It represents a meaningful first step toward determining a comprehensive approach to the evaluation of nursing staffing. The final model can be used to determine the elements of the nursing care delivery context that can be modified to support nursing efforts in achieving optimal outcomes.</td></tr></table>en_GB
dc.date.available2011-10-26T09:57:21Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:57:21Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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