QUANTIFICATION AND EVALUATION OF NURSING IN AN AMBULATORY CARE SETTING USING A COMBINED PRODUCTIVITY AND QUALITY ASSURANCE MODEL.
Contributors: Indiana University School of Nursing.
Published: 1988
Number of pages: 291
Subjects: Health Sciences, Nursing.
Description: The study purpose was to develop and test a model to evaluate professional nursing from a cost and quality perspective. A combined quality assurance and productivity model was used to frame the study. Data were collected and analyzed on inputs (structure/process) and output (outcome) in a convenience sample of 3 sessions each in 37 pediatric ambulatory clinics for a total of 111 observations.

Information about facility-related structure was obtained for each observation. Needs assessment questionnaires were completed by 1082 patients to provide information about patient-related structure. Process data were obtained on 1775 patients using a revised Verran patient classification instrument that included both time and complexity weights for nursing activities. The outcome patient satisfaction was determined from 1144 revised Risser patient satisfaction questionnaires completed by patients.

Aggregate data from clinic observations were analyzed using correlation coefficients and standard multiple regression. Facility-related structure variable were significantly correlated with nurse time. Patient classification time and complexity variables were highly correlated and appeared to be measuring the same thing. Structure variables of patient need; nurse, doctor, clinic, and room time; and process variables of patient classification time and complexity were all positively and significantly correlated with patient satisfaction.

Structure variables predicted patient classification time (R Square =.47, p = $<$.000) and complexity (R Square =.47, p = $<$.000) with nurse time highly predictive of both. Structure and process variables significantly predicted patient satisfaction (R Square =.19, p $<$.01). The complexity of nursing tasks was the most predictive, with clinic time and doctor time also contributing to patient satisfaction. A curvilinear relationship was found between patient need and patient satisfaction which indicated that patients with high needs were less satisfied with nursing care.

Results, which partially supported the model, indicated that patient and structural elements of the health care environment were related to nursing care received by patients; in addition, both structural elements and nursing processes were related to patient satisfaction. Research is needed to further explore the process of nursing care, the structural context in which it is delivered, and the effects of both on patient outcomes.
Notes: Source: Dissertation Abstracts International, Volume: 50-07, Section: B, page: 2848.

Thesis (D.N.S.)--INDIANA UNIVERSITY SCHOOL OF NURSING, 1988.

School code: 0815.