Clinical nursing practices and patient outcomes: evaluation, evolution, and revolution (legitimizing radical change to maximize nurses' time for quality care)

Today's environment demands revolutionary as well as evolutionary changes in practice patterns. All clinical practices must be critically examined in terms of their contributions to quality patient outcomes, and their effects on nurses' time and morale.     

Leadership-organizational culture relationship in nursing units of acute care hospitals

The phenomena of leadership and organizational culture (OC) has been defined as the driving forces in the success or failure of an organization. Today, nurse managers must demonstrate leadership behaviors or styles that are appropriate for the constantly changing, complex, and turbulent health care delivery system. In this study, researchers explored the relationship between nurse managers' leadership styles and OC of nursing units within an acute care hospital that had achieved excellent organizational performance as demonstrated by a consistent increase in patient satisfaction ratings. The data from this study support that transformational and transactional contingent reward leaderships as nurse manager leadership styles that are associated with nursing unit OC that have the ability to balance the dynamics of flexibility and stability within their nursing units and are essential for maintaining organizational effectiveness. It is essential for first-line nursing leaders to acquire knowledge and skills on organizational cultural competence.     

Restructured patient care delivery: evaluation of the ProAct model

This budget-neutral model uses fewer RNs with increased clinical and nonclinical support and demonstrates potential to improve quality of care, reduce length of stay, and increase revenue.     

Evaluation of a client care delivery model, Part 2: Variability in client outcomes in community home nursing

Using similar variables, Part II explores variation in client outcomes such as OMAHA knowledge, behavior, and SF-36 scores. Medical and nursing diagnoses explained large variations in client outcomes. Clients cared for by degree-prepared nurses improved knowledge and behavior scores. Unanticipated case complexity was negatively associated with client outcome even with nursing intervention. The study revealed that "for every unit increase in assignment of baccalaureate-prepared nurses, clients will on average demonstrate an 80% greater likelihood of improvement in knowledge scores and a 120% greater likelihood of improvement in behavior scores in relation to their health condition at discharge." This two-part study has offered insight into the controllable variables influencing the cost and quality of home care services.     

A transparency and accountability framework for high-value inpatient nursing care

Transparency and accountability are terms that typically refer to activities aimed at measuring and holding providers responsible for their performance through such vehicles as public disclosure of comparative results. Today, transparency and accountability policies are widely accepted strategies to drive quality improvement and stimulate consumer choice. Yet nursing, the single largest health care profession, has not yet been engaged in these policy directions nor considered in their design or implementation. The framework reported here offers nurses and their professional organizations a model for which to advocate for policy change. Hospital and health system executives who have the freedom to establish institutional policies might implement this framework to achieve higher value. This framework provides both the context and components of a system that, if implemented, would measure, report, and reward hospital nursing's contributions to high value.     

Expanded role of nursing in ambulatory managed care. Part II: Impact on outcomes of costs, quality, provider and patient satisfaction

This evaluation project used a triangulation of methods and data sources to link the expanded role nurse clinician (NC) to outcomes of costs, quality, and satisfaction in managed care. Results of patient surveys, case studies, cost-benefit analyses, interviews, focus groups, and HMO documents suggest that the impact of the role has benefit far beyond its costs. This article builds on an earlier article (Nursing Economic$, Vol. 17, No. 1). Part I reviewed literature on expanded role nursing in population management, and described the development of the NC role. In Part II, the NC expanded role is linked to organizational outcomes of costs, quality, and satisfaction. Results here could be used by managers and planners to provide rationale for implementing expanded nursing roles in managed care in order to improve ambulatory care processes, recruit and retain nurses, reduce costs, and increase patient and provider satisfaction.     

Nursing unit characteristics and patient outcomes

In this exploratory cross-sectional study, nursing unit organizational characteristics and how they influenced patient outcomes in the form of nurse-sensitive adverse events and failure to rescue were examined. Results showed significant associations between characteristics and adverse events at the unit level. Autonomy/collaboration was associated with pressure ulcer and failure to rescue, practice control with urinary tract infection, and continuity/specialization with death. Unit-level study provided a better understanding of the effect of unit work environment upon nursing practice and outcomes.     

A nurse-run business to improve health care for nursing home residents

The costs of health care for the rapidly growing segment of our population over age 75 are staggering. EverCare is a nurse-run business that seeks to improve cost-effectiveness and quality of health care for nursing home residents enrolled in a health maintenance organization.     

A seasonal fractional multivariate model. A testing procedure and impulse responses for the analysis of GDP and unemployment dynamics

This paper deals with the analysis of seasonally, fractionally integrated, multivariate models. We present a procedure that permits us to test the seasonal fractional differencing parameters from the reduced-form system, which allows us to recover the parameters of the structural model through simple restrictions as in the standard VAR case with the additional incorporation of seasonality and fractional integration. An empirical application based on a bivariate system using GDP and unemployment in the UK, USA and Japan is also carried out at the end of the paper.     

Health care reform: current updates and future initiatives for ambulatory care nursing

While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations' quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surrounding competencies, education modules, and leadership must be addressed immediately.     

The relationship of the hospital-acquired injurious fall rates with the quality profile of a hospital's care delivery and nursing staff patterns

Fall occurrence during hospital stays is a well-recognized nursing-sensitive outcome indicator. This study was intended to determine the unique contributions of three inpatient satisfaction measures on the hospital-acquired injurious fall rates. Study results demonstrated the higher the inpatient satisfaction levels with the quietness of hospital environment, the lower the injurious fall rates. The physical environment (quietness) of the acute inpatient care settings was a significant and meaningful determinant of the prevalence of injurious falls. Additionally, more total nursing personnel FTEs per 1,000 discharges and a higher percentage of RN FTEs by total nursing personnel FTEs would not result in better patient outcomes.     

Nursing home costs and quality of care outcomes

The relationship between cost and quality of care in nursing homes was examined using quality indicator measures of resident outcomes. While each individual quality measure makes only small contributions to costs, when considered across the facility, quality could have a substantial financial impact on the operations of the home.     

Environmental standards as strategic outcomes: A simple model

This paper analyses the strategic nature of choice of environmental standards considering both local and global pollution under alternative regimes of international trade. It also compares and contrasts the strategic equilibrium environmental standards and levels of pollution, local and global, with the world optimum levels. It shows that, in case of open economies, environmental standards can be either strategic substitutes or strategic complements. On the contrary, in case of closed economies, environmental standards are always strategic substitutes. It also shows that the strategic equilibrium environmental standards in case of open economies are higher than the world optimum in certain situations. Whereas, in absence of international trade, countries set, in equilibrium, lower environmental standards than the world optimum.     

Managed care, quality of care, and patient rights

The growth of managed care has been accompanied by calls for increased government regulation because HMOs and other forms of managed care are seen by the public as more concerned about controlling costs than with protecting the rights of patients to quality care. This paper applies a theory of health care rights and clinical evidence of managed care quality in an analysis of public opinion about managed care. The paper concludes that there is no persuasive evidence that managed care has resulted in a general deterioration in the quality of care and that, with one exception, restrictions imposed by managed care plans are consistent with a theory of health care rights. The paper concludes with the recommendation that public policy should dispense with attempts to fine tune managed care and address an unquestionable violation of health care rights, the failure to guarantee a minimum standard of care to some 43 million Americans.     

The Iowa model: a proposed model for nursing administration

The purpose of the Iowa Model is to serve both as a heuristic device and as a framework for articulating knowledge for nursing administration research, practice, and education. The model delineates two domains of knowledge (systems and outcomes), each with three levels (patient aggregates, the organization, and the health care system). Concepts useful for knowledge development are identified for each level. Practice, research, and curricular applications of the model are made.     

A testing of the purchasing power parity hypothesis using a vector autoregressive model

The paper examines the hypothesis of purchasing power parity relations and the hypothesis of interest rates parity relations between the Japanese yen and the US dollar in a four-dimensional VAR (4-VAR) model, using the statistical technique developed by Johansen and Juselius (1992). The paper demonstrates that the so-called symmetry restriction on the PPP relationship holds not in a 3-VAR model but in the 4-VAR model, which indicates that a correct specification of the sampling distribution of data is important. The interest rates parity relation also holds in the 4-VAR model. The one-step prediction based on the ECM representation with such long-run relations outperforms the random walk model. These results are similar to those under the exchange rate control period (January 1974 to December 1980), which support the inclusion of this period in a whole sample period (January 1974 to December 2001).The author is very grateful to the referees and the editor of the journal for their variable and helpful comments. The first draft of the paper was presented at the autumn meeting of Japan Society of Monetary Economics in Oct 1999. The author is thankful to Eiji Ogawa for his helpful comments. The research was supported by Grant-in-Aid 13630104 of the Ministry of Education, Science and Culture of Japan and the Nomura Foundation for Social Science in 2000.First version received: March 2001/Final version received: April 2003     

Localization of a demand for nursing model at the grassroots level

A major obstacle to the development of a usable demand model for nursing is the standardization of the definition for "demand." The lack of standardization of economic terms which are utilized in the state demand models is contributing to the failure of the long-range forecasting process for nursing nationwide. Any state that chooses to utilize U.S. Department of Health and Human Services' Health Resources and Services Administration data has selected a model which is invalid due to failure to include all members of the nursing population since this definition excludes LPNs completely. Likewise, state nursing demand models in California, Pennsylvania, North Dakota, New Jersey, and the District of Columbia have similar disadvantages. Only at a localized county-by-county grassroots level can a nursing demand model be translated into an equation which would actually calculate demand for nursing.     

Bank privatization in Argentina: A model of political constraints and differential outcomes

Although case studies suggest that political constraints affect bank privatization transactions, these constraints have been neither theoretically modeled nor econometrically tested. This paper presents a simple model of the tradeoffs governments and buyers face during these transactions. In addition to price, the buyer is concerned about solvency and profitability following privatization. Similarly, politicians are concerned about layoffs and service coverage. We apply the framework to provincial bank privatizations in Argentina, finding that provinces with fiscal problems were willing to accept more layoffs and guarantee more of the privatized bank's portfolio in return for a higher price.