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The article discusses the results of a study that examines the effects of patient, organizational and nursing unit characteristics on patient safety and quality outcomes. It cites the major concepts of Systems Research Organizing Model including client characteristics, context, action focus and outcomes. It concluded that better outcomes can be achieved through effective communication and collaboration among health care professionals.

The article discusses the results of a study on the decision-making process of nurse managers. The strategies employed to conduct a comprehensive literature search include using such headings as nursing and supervisory to search the database PubMed. An alert generated by direct observation or a verbal or written report marked the beginning of majority of decision procedures. The emergence of education as the most frequently reported action selected is said to connote a bias toward remedial training. Also cited are the limitations of the study such as the small size of the sample and reliance of the interviews on self-report.

Patient classification according to nursing care requirements is routine in inpatient settings. When a monograph from the Division of Nursing was published, little information was included about patient classification in community health settings, such as ambulatory care. Since 1978, some work on classification for outpatient areas has been done, but not to the extent of the work in inpatient settings that established standards for classification instruments. Although the terms patient classification instrument and patient classification system appear similar, they are not meant to be used interchangeably. A patient classification instrument is a tool to identify nursing care requirements of patients in a specific setting. A patient classification system is the full program for identifying the number and type of staff needed to meet the care requirements of clients.

Provides information on cross-lagged panel correlation (CLPC) analysis, a technique used in longitudinal, nonexperimental designs to draw inferences about the relationship between two variables. Characteristics of CLPC; Assumptions that underlie the technique.

Discusses the application of exploratory data analysis in nursing research. Comparison of groups and variables; Oncology knowledge test of baccalaureate nursing students; Measurement of attitudes toward caring for the oncology patient.

Describes exploratory data analysis procedures that are used to examine single variable distributions. Stem-and-leaf display technique; Usefulness of the quantile or Q-plot on the initial examination of the data; Median hinge number summary; Box plots technique.

Presents a brief review of the assumptions underlying the causal modeling technique in nursing research. Benefits of causal modeling to nurse researchers; Use of graphical residual analysis to assess for violations of the assumptions underlying the modeling process; Example of residual examination.

Explores the technique of residual analysis which may be used by nurse researchers to examine linear equation for violations of statistical assumption. Robustness of regression analysis; Basis for the acceptance of assumption violations; List of regression assumptions surrounding a regression analysis.

This article describes psychometric testing and refinement of the Verran Professional Governance Scale (VPGS), which measures behaviors associated with professional governance. Phase 1 reduced the items on the scale based on floor and ceiling effects and redundancy of items. Phase 2 examined structural construct validity using exploratory (EFA) and confirmatory factor analysis (CFA). The final 22-item instrument demonstrates satisfactory internal consistencies and fit indices and significant positive correlation between the VPGS, job satisfaction, and control over nursing practice. [ABSTRACT FROM AUTHOR]

Describes the philosophy and value of exploratory data analysis (EDA) for nursing research. Requirement for a successful use of the EDA; Purpose of EDA; Use of visual displays and graphical approaches.

Presents responses of authors to several commentaries on the use of data in testing multivariate theoretical models. Usefulness of graphic residual analysis for reassessing the underlying model assumptions; Ways to avoid the increasing experiment-wise error rate; Benefits of causal modeling.

Aim To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects. Background Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research. Methods A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety. A panel of 25 international experts in leadership and safety engaged a three-round modified Delphi study with Likert-scored surveys. Results Eighty per cent of participating experts from six countries were retained to the final survey round. Consensus (>66% agreement) was achieved on 40 factors believed to influence safety climate in the acute care setting. Conclusions Consensus regarding specific factors that play important roles in an organisation's climate of safety can be reached. Generally, the demonstration of leadership commitment to safety is key to cultivating a culture of patient safety. Implications for Nursing Management Transformational nurse leaders should consider and employ all three categories of factors in daily leadership activities and decision-making to drive a strong climate of patient safety. [ABSTRACT FROM AUTHOR]

Discusses the use of residual analysis to examine for violation of assumptions specific to causal modeling. Analysis of the empirical results of Young's Professional Commitment Model for three groups of subjects; Assessment of the causal model assumptions of correct model specification; Valuable methodology in the secondary analysis of Young's Professional Commitment model.

Discusses the use of residual analysis to test the statistical assumptions of a causal model. Review of the graphical and numerical analysis involved in the examination of the empirical results of Young's Professional Commitment model; Background of subjects involved in the study; Variables assessed through the use of graphic residual analysis and supplementary statistical tests.

Comments on Susan E. Pollock's article on adaptive responses to diabetes mellitus. Enhancement of stress resulting from illness; Importance of diabetic identification; Explanatory theory for adaptive responses to chronic disease.

OBJECTIVE: The aim of this study is to describe the maturation of the concept of shared governance to professional governance as a framework for structural empowerment. BACKGROUND: An analysis of the literature and concept clarification of structural empowerment and shared governance demonstrate that the concept and attributes of shared governance have evolved toward professional governance. METHODS: A comprehensive, deductive literature review and concept clarification of structural empowerment, shared governance, and related constructs was completed. RESULTS: The concept and practice of shared governance has matured to a concept of professional governance with the attributes of accountability, professional obligation, collateral relationships, and effective decision-making. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager''s work domain. Methods: Data for the WDA were obtained from semi-structured interviews with nurse managers, division directors, CNOs, and other managers (n =20) on 10 patient care units in three Arizona hospitals. The WDA described the nurse manager''s environment in terms of the constraints it imposes on the nurse manager''s ability to achieve targeted outcomes through organizational goals and priorities, functions, processes, as well as work objects and resources (e.g., people, equipment, technology, and data). Constraints were identified and summarized through qualitative thematic analysis. Results: The results highlight the competing priorities, and external and internal constraints that today''s nurse managers must satisfy as they try to improve quality and safety outcomes on their units. Nurse managers receive a great deal of data, much in electronic format. Although dashboards were perceived as helpful because they integrated some data elements, no decision support tools were available to help nurse managers with planning or answering “what if” questions. The results suggest both the need for additional decision support to manage the growing complexity of the environment, and the constraints the environment places on the design of that technology if it is to be effective. Limitations of the study include the small homogeneous sample and the reliance on interview data targeting safety and quality. [Copyright &y& Elsevier]

Abstract: Purpose: We used ORA, a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units. Methods: Using a survey methodology, we collected communication network data from nursing staff on seven patient care units on two different days. Patient outcome data were collected via a separate survey. Results of the staff survey were used to represent the communication networks for each unit in ORA. We then used ORA''s analysis capability to generate communication metrics for each unit. ORA''s visualization capability was used to better understand the metrics. Results: We identified communication patterns that correlated with two safety (falls and medication errors) and three quality (e.g., symptom management, complex self care, and patient satisfaction) outcome measures. Communication patterns differed substantially by shift. Conclusion: The results demonstrate the utility of ORA for healthcare research and the relationship of nursing unit communication patterns to patient safety and quality outcomes. [Copyright &y& Elsevier]

Summary: As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we used a computational modeling program, OrgAhead, to model patient care units’ achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 32 units in 12 hospitals in Arizona. Validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units. In this paper, we report how we used OrgAhead to develop testable hypotheses about the kinds of innovations that nurse managers might realistically implement on their patient care units to improve quality and safety outcomes. Our focus was on unit-level innovations that are likely to be easier for managers to implement. For all but the highest performing unit (for which we encountered a ceiling effect), we were able to generate practical strategies that improved performance of the virtual units that could be implemented by actual units to improve safety and quality outcomes. Nurse managers have responded enthusiastically to the additional decision support for quality improvement. [Copyright &y& Elsevier]

Abstract In implementing a generalist model of public health nursing (the Comprehensive Multi-level Nursing Practice Model) in a rural county health department, a research team encountered critical challenges. The framework for the model was a philosophy of public health nursing practice and action research to support the public health nurse generalist role. Challenges in implementing the model stemmed from conflicts between the research team and the health department that were rooted in philosophical differences about how to implement care and the nature of nursing and the public health nursing role. Key factors were the subtle forces operating in the public health environment that constrain the public health nurse generalist role. Based on conflicts that arose in implementing the model, implications for public health nursing practice are in opportunities to influence policy at health department and other levels and responsibility for assuring professional practice. [ABSTRACT FROM AUTHOR]