EFFECTS OF A COLLABORATIVE PRACTICE DESIGN IN AN ACUTE CARE SETTING ON PROFESSIONAL AUTONOMY AND PATIENT CARE OUTCOMES.
Contributors: Columbia University. Teachers College.
Published: 1993
Number of pages: 194
Subjects: Health Sciences, Nursing.; Health Sciences, Health Care Management.
Description: The purpose of this study was to examine to what extent a Collaborative Practice design on a medical-surgical unit in an acute care hospital setting impacts on physician and nurse perceptions of collaborative practice, on professional nurse perceptions of autonomy, as well as on inpatient care outcomes of length of stay, resource use and satisfaction with hospital care for selected Diagnostic Related Groups.

A non-equivalent Pretest-Posttest Quasi-Experimental research design was used, for one experimental and one contrast unit in a 520 bed voluntary hospital. There were 44 nurse and 12 physician volunteer subjects. The total sample of 110 inlier inpatients had the specified study DRG numbers of 758, 324, 130, 148, 209, and 198.

Nurse and physician perceptions of collaborative practice were measured by the Weiss and Davis Collaborative Practice Scales (Weiss & Davis, 1985). Nursing professional autonomy was measured by the Nurse-Autonomy-Patient's Rights Questionnaire (Pankratz & Pankratz, 1974). Nursing and physician subjects demographics were ascertained through designed forms. Pre-test of nurse subject equivalency was by self-rating on the Slater's Nurse Competencies Rating Scale (Wandelt & Stewart, 1975). Hospital patient data was used for resource use, demographics and length of stay. Patient satisfaction with hospital care was self-measured with the Hospital Report Card (Nelson et al., 1991).

Analyses indicated: (1) Participation in a nurse-physician collaborative model significantly increased the physicians' agreement with the importance of collaborating with nurses on patient care. (t (11) = 4.65, $p<.001).$ (2) The nurses in both groups did not differ with respect to demographics. These variables were not related to nurses' pretest rating of the importance of collaborating with doctors on patient care. With the exception of country where the basic R.N. education was obtained and work status, they were not related to the nurses' perception of pretest professional autonomy. (3) Participation in the model was not related to nurses' perception of autonomy. (4) There was no overall relationship between the model and patients' length of hospital stay or inpatient resource use; however, taking DRG into account, treated in a collaborative practice unit may lead to a shorter stay or to less resource use for some DRGs. (5) Patients treated in the model unit indicated somewhat more satisfaction with hospital care.
Notes: Source: Dissertation Abstracts International, Volume: 54-04, Section: B, page: 1895.

Thesis (ED.D.)--COLUMBIA UNIVERSITY TEACHERS COLLEGE, 1993.

School code: 0055.