The instrument that measured structure had low reliability scores on both the original reliability studies and in this study, which calls validity into question. Several possible sources of bias were evident in the sampling techniques and not addressed in this article. It is difficult to know what bias may have been present in the original selection of units since this is not addressed, but selection of patients was through permission of head nurses could introduce some bias into the findings. Some units had only one staff nurse as a respondent. The researchers suggest that nurse administrators develop nursing units around these technical and structural parameters without having much support from their research, and the recommendations are in general too strong for the findings of this study.
Nursing is a complex activity requiring many decisions and actions on the part of the nurse.
As rules and procedures cannot encompass all of the possible situations, it seems more sensible to place an emphasis on problem-solving techniques. Implementation of findings should be done only after research with reliable and valid instruments has shown that manipulation of these parameters genuinely results in better quality of care for patients. Key Words Hospital Unit Structure, Technology, Structure, Nursing Activities, Quality of Care, Research.