INFLUENCES ON VOLUME OF NURSING CARE: AN EXPLORATORY STUDY (PATIENT CLASSIFICATION, HEALTH POLICY).
Contributors: Boston University.
Published: 1991
Number of pages: 347
Subjects: Health Sciences, Health Care Management.; Health Sciences, Nursing.
Description: Nursing Services is usually the largest budget item in a hospital but relatively little is known about the forces that influence volume of nursing care. This research draws on literature from nursing, management and sociology, among others, and argues that patient assessment as an activity of problem definition will be subject to influences similar to those described for problem definition in other areas.

An exploratory study was conducted in five Massachusetts hospitals. A multivariate regression analysis investigates 1,656 admissions in six high volume DRGs. The dependent variable is hours of nursing care per case from a factor-type patient classification system. Independent variables include length of stay, factors that describe the patient and the severity of illness, as well as contextual factors that describe the work situation.

Results show that most of the variance in nursing volume care per case is explained by length of stay. Statistically significant contributions were made also by emergency admission status and use of special care units, as well as skill mix and standing orders. The effect of contextual variables was not consistent across DRGs, leading to the inference that some DRGs provide more opportunity for discretion to the providers. Due to limitations of the research, most findings are suggestive rather than definitive.

Concerning the implications for management, the research identifies key factors that influence volume of nursing care, most prominently the physician. The interpretation of findings included inferences about contextual factors as an influence on nurses' perceptions of patient need. This has implications for nursing theory. There are several opportunities for future research. Factors with strong conceptual support but weak or inconsistent empirical support in this dissertation should be studied further. As well, a larger number of DRGs, and more varied ones, should be investigated to explore whether patient need for nursing care is more flexible in some DRGs and, therefore, more susceptible to influences from the work context or providers' perceptions.
Notes: Source: Dissertation Abstracts International, Volume: 52-04, Section: B, page: 1938.

Thesis (D.B.A.)--BOSTON UNIVERSITY, 1991.

School code: 0017.