Factors Impacting Staff Nurse Care Coordination Open Access

Abstract

Abstract
Factors Impacting Staff Nurse Care Coordination
By Ingrid Hopkins Duva
Purpose:
This study examines relationships among the nurse practice environment, patient and
hospital characteristics, and staff nurse care coordination activities in the hospital. Care
coordination is a key nursing process.
Background/ Significance:
Previous research links hospitals with professional nurse practice environments to better
patient outcomes, such as lower mortality and higher satisfaction. Little is known about
how these work environments impact central nursing processes. Understanding the
context for achieving better outcomes through nursing processes such as staff nurse care
coordination is critical, particularly as the number of chronically ill patients in the
hospital, who are known to benefit from care coordination, continues to rise.
Methods:
This descriptive correlation study utilized a cross-sectional survey design. The sample
consisted of 337 Registered Nurses on 32 medical surgical units in four metro area
hospitals. Lake's 2002 Practice Environment Scale of the Nursing Work Index (PES-
NWI) measured professional practice in the work environment. Lamb et al.'s 2008
Nursing Care Coordination Inventory (NCCI) measured staff nurse care coordination,
and Gittell's 2000 Relational Coordination Inventory (RCI), served as an alternate
coordination measure. Analyses included aggregation of data to the unit level,
correlations, regression and multilevel modeling to partition variance components.
Findings:
Significant correlations were found between the PES-NWI and the time spent on general
care coordination activities (r = -.41, p< .05), as well as to the frequency of completing
work assigned to other nursing staff (r = -.51, p< .01). Time spent on staff nurse care
coordination activities was positively related to the RCI (r = +.48, p< .05). Also, a
relationship between time spent on staff nurse care coordination activities and the percent
of patients with ambulatory sensitive chronic conditions was noted (r = - .89, p< .01).
Discussion:
Study results begin to establish support for the mediating role of nursing process between
the practice environment and outcomes. Findings suggest that improvements to the
practice environment facilitating the work of nurses can lead to better patient outcomes.
This study also supports further study of nursing process, improved process measures and
the use of multi-level methods to better understand the work of hospital nurses.

Factors Impacting Staff Nurse Care Coordination
By
Ingrid Hopkins Duva
MSN, Emory University 1994
Advisor: Gerri Lamb, PhD
A dissertation submitted to the Faculty of the James T. Laney School of Graduate Studies
of Emory University
in partial fulfillment of the requirements for the degree of Doctor of Philosophy in
Nursing
2010

Table of Contents

TABLE OF CONTENTS




Chapter 1:
Introduction & Specific Aims
1
Significance
1
Specific Aims
3
Purpose
4
Conceptual Framework
5

Chapter 2: Background and Significance

19
Impact of Chronic Illness
19
The Critical Role of Care Coordination in the Hospital
21
The Role of the Staff Nurse in Care Coordination

25

Link to the Practice Environment

27

Chapter 3: Design and Methods

30
Sample
30
Instruments

35
Data Collection

41
Data Analysis
42
Summary

45
Chapter 4:
Findings

47
Descriptive
47
Missing Data Management
57
Psychometric Testing
57
Research Question 1A
73
Research Question 1B
74
Research Question 1C
75

Chapter 5:
Conclusions
80
The PES-NWI and Staff Nurse Care Coordination
80
Antecedents
86
Implications for Future Research
89
Significance of Findings

99
Summary

101

Appendix A


103
Appendix B

105
Appendix C

118
Appendix D

119
Appendix E

120
References

121

About this Dissertation

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Nursing
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Nursing
Keyword	Staff Nurse Chronic Illness Hospital Patient Care Practice Environment Care Coordination Nursing
Committee Chair / Thesis Advisor	Lamb, Gerri, Emory University
Committee Members	Weston, Marla Jean, Emory University Dunbar, Sandra, Emory University Hepburn, Kenneth, Emory University

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