Skip to main content

Currently Skimming:

Quality of Care, Organizational Variables, and Nurse Staffing
Pages 308-332

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 308...
... INTRODUCTION: THE STATE OF THE SCIENCE Nurses in acute health care settings are convinced that there is a link between organization variables, including the numbers and types of nursing staff available to provide care, and the quality of nursing care that patients receive. It is plausible to assume that nursing organizational variables interact with clinical treatments to influence patient care outcomes.
From page 309...
... The ANA also attests to the lack of conclusive research supporting the inclusion of these outcomes that are reflective of quality nursing care. The purpose of this manuscript is to summarize the state of the science on the relationship among nursing organizational variables and patient outcomes.
From page 310...
... For the purpose of the research component of the project, eight practice model units and eight comparison units were included in the analysis, which examined three sets of outcomes. Nursing outcomes included work satisfaction and retention; cost outcomes included personnel expenditures, recruitment costs, and orientation costs; patient outcomes included satisfaction, health status, and perceived functional status at discharge and two weeks after discharge.
From page 311...
... Descriptive Research The three descriptive studies vary considerably from each other in their initial impetus and their approach. The first of these examines the environment in which nurses practice in the critical care setting and is like the previous intervention studies, in that it was an attempt to examine factors that would influence
From page 312...
... For nursing, technology includes elements of a professional practice model as described in some of the previous intervention research projects. The model for critical care indicates that the more the actual practice environment approaches the ideal, then the greater will be the organizational and patient care outcomes.
From page 313...
... Outcome variables may be organized under three classifications: staff outcomes, organizational outcomes, and client outcomes. None of the studies described included a direct measurement of staffing mix and staff numbers as one of the independent or outcome variables.
From page 314...
... In the microlevel research project with patients with AIDS, the staff outcome was nursing care activities. These activities were thought to be influenced by the independent variable, patient problems, and to influence client outcomes.
From page 315...
... Other common client outcome measures included some form of client satisfaction for two of the demonstration and one of the descriptive studies. Two of the intervention studies used negative indicators of client outcomes in the form of untoward hospital incidents and nosocomial infection.
From page 316...
... The microlevel San Francisco study did not report the examination of nursing care on client outcomes. Discussion of Findings The findings of the current macrolevel research projects are consistent with the literature in terms of staff outcomes and organizational outcomes, and support the contention that a professional practice environment will improve these variables.
From page 317...
... The following sections report on the results of published research that is related to more generalized client outcomes. The primary outcomes that have been examined in the literature are mortality, nosocomial complications, adverse incidents, service utilization, and patient satisfaction.
From page 318...
... failed to support the original result. The Seattle critical care study described at the invitational conference also failed to find a relationship between units that were closer to the ideal level of practice and adjusted mortality rates.
From page 319...
... Only the design variables are amenable to change. These variables include the nursing care delivery model, staff skill mix, and staffing levels.
From page 320...
... Even though a support system index was included in this research, the interaction effect with nursing variables was not examined. Of significance, however, is the fact that patient age had the greatest impact on falls and that age, along with acuity, were the two significant variables in the regression of patient injury on contextual and organizational variables.
From page 321...
... The nursing delivery system at this facility involves a network of home care, hospice, community wellness centers, and hospital nursing with a nurse case manager bridging community and in-hospital care. Case managers, prepared at least at the bachelor's level, are the hub of the health care delivery system.
From page 322...
... report the results of the implementation of a system of professional nursing practice through collaboration with physicians. The system contained the five interrelated parts as specified by the National Joint Practice Commission in 1977: a joint practice committee of physicians and nurses; primary nursing; nursing clinical decision making within the scope of nursing practice as defined by the joint practice committee; integrated patient records; and joint practice review.
From page 323...
... Relationship of Staff Satisfaction to Client Outcomes Much of the research investigating factors to increase staff nurse satisfaction makes the assumption that increased levels of satisfied staff will directly lead to increased quality of care. Two projects have examined this relationship as their primary hypothesis and will be described here, even though one of the studies occurred prior to the 1985 review date.
From page 324...
... (6) A professional practice environment has a positive influence on severity-adjusted Medicare mortality rates, over and above the influence of staffing mix.
From page 325...
... Published studies indicate that satisfaction is stable or increased with professional practice environments even when staffing levels are reduced; current unpublished research as presented at the invitational conference does not support this conclusion.
From page 326...
... sample sizes have no significant results. The same may be true for other measures of client outcomes such as untoward hospital incidents and nosocomial infections.
From page 327...
... Currently, an expert panel of the American Academy of Nursing is beginning work on the identification of a set of these outcomes. What may be needed is to expand this work into a nationally supported nursing Patient Outcomes Research Team similar to those established for specific patient conditions through the Agency for Health Care Policy and Research.
From page 328...
... Second, a review of literature from 1985 to 1995 on the effect of nursing care on general client outcomes was presented. From these two approaches, the linkages and gaps in our current knowledge about the effects of nursing care on client outcomes on a macrolevel were identified.
From page 329...
... "The Enhanced Professional Practice Model." Cooperative agreement award jointly funded by the National Institute of Nursing Research, National Institutes of Health and the Division of Nursing, Public Health Service (U01 NR02156)
From page 330...
... Mitchell, P., Hegevary, S., and Secrest, K "Critical Care Nursing Systems, Retention and Patient Outcomes." Funded by the National Institute of Nursing Research, National Institutes of Health (R01 NR02343)
From page 331...
... Improving Intensive Care: Observations Based on Organizational Case Studies in Nine Intensive Care Units: A Prospective, Multicenter Study. Critical Care Medicine 21:1443-1451, 1993.
From page 332...
... 332 NURSING STAFF IN HOSPITALS AND NURSING HOMES APPENDIX Attendees at the Invitational Workshop "Quality of Care: Examining the Influences of Nursing Resources" October 23-24, 1994 Phoenix, Arizona The workshop was sponsored and organized by the American Academy of Nurs~ng. Chairperson: Margaret Sovie Researchers: Dorothy Gordon Gail Ingersoll Joyce Verran Rose Gerber Doris Milton Ann Minich Pam Mitchell William Holzemer Sue Henry Methodologists: Sandra Ferketich Lee Secrest Ada Sue Hinshaw Organizations: Jan Heinrich, American Academy of Nursing Pat Moritz, National Institute of Nursing Research Gooloo Wunderlich, Institute of Medicine Angela McBride, American Academy of Nursing Barbara Donohoe, American Academy of Nursing and the Robert Wood Johnson and Pew Foundations Marjorie Beyers, American Organization of Nurse Executives Deborah Nansom, Joint Commission on Accreditation of Healthcare Organizations Marilyn Chow, American Nurses Association


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.