EXAMINING THE NATURE AND EXTENT OF PROFESSIONAL STAFF NURSE PARTICIPATION IN PATIENT CARE DECISION-MAKING (AUTONOMY, INTERDEPENDENCE).
Contributors: University of Maryland at Baltimore.
Published: 1985
Number of pages: 171
Subjects: Health Sciences, Nursing.
Description: Professional autonomy of hospital staff nurses was examined using patient care-specific measures of independent and interdependent decision-making to describe staff nurse involvement in decisions for which nurses have professional authority and accountability, yet which have not been adequately examined in current literature.

A self-report instrument was administered to a stratified random sample of 260 full-time military and civilian staff nurses working on 52 inpatient units in four medical centers. Professional autonomy was operationalized using eight patient need items repeated for each of three decision steps (Identify problems, Evaluate alternatives, Select action) for both independent and interdependent decision-making. Other variables included providers with whom nurses make decisions, interrelationships with physicians and head nurse, and type of knowledge used as basis for decision-making. Nurses used 5-step Likert scales to score items. Alpha coefficients of internal consistency reliability exceeded .80 for major variables. Construct validity was also demonstrated. A 72% (n = 187) response yielded 176 usable questionnaires. Analysis procedures included descriptive statistics, analysis of variance with repeated measures, and regression analysis.

Nurses demonstrated greater involvement in independent than interdependent decision-making (p < .0001), with greatest involvement for Identify and Evaluate decision steps. Extent of decision-making varied with differences in patient need addressed (p < .0001). Nurses' interdependent decision-making was most frequently with physicians (p < .01) and least frequently with the head nurse (p < .01). Nurses using hospital system knowledge more frequently than patient-specific knowledge as basis for decisions perceived extent of involvement to be greater than did nurses using patient-specific knowledge more frequently (p < .02). Regression analyses accounted for 18.7% and 28.3% of variance in professional and job autonomy scores, respectively.

Despite limitations, results demonstrated that refinements in current definition and measurement of professional autonomy may provide a more practice-relevant understanding of nurses' patient care decision-making. Variability between independent and interdependent decision-making scores supported examination of professional autonomy in a manner consistent with current multidisciplinary health care settings. Variability across decision step scores supported multivariate studies as more indicative of all aspects of decision-making involvement. Examination of professional and job autonomy as distinct variables may provide a more comprehensive understanding of professional functioning in organizations.
Notes: Source: Dissertation Abstracts International, Volume: 47-04, Section: B, page: 1490.

Thesis (PH.D.)--UNIVERSITY OF MARYLAND AT BALTIMORE, 1985.

School code: 0373.