FACTORS INFLUENCING NURSING CARE DELIVERY SYSTEM EFFECTIVENESS IN ACUTE CARE HOSPITALS (HEALTH MANAGEMENT).
Contributors: University of Colorado Health Sciences Center.
Published: 1986
Number of pages: 199
Subjects: Health Sciences, Nursing.
Description: The purpose of this study was to describe the relavant dimensions of nursing care delivery system effectiveness and the influences of selected environmental, contextual and structural characteristics on nursing care delivery system effectiveness in short term general hospitals. The systematic study of these variables can contribute to a knowledge base for decisions about alternative organizational structures, management practices and resource allocation that will have practical significance for nurse administrators who are accountable for the performance of a nursing system in health care institutions. Based on theoretical formulations about effectiveness, empirical studies and national proceedings in nursing, a causal model was constructed which incorporated the following variables: Legal Dependency, Resource Dependency, Size, Integration, Participativeness, Centralization, Budget Management, Departmental Authority, and Nursing Care Delivery System Effectiveness.

A stratified random sample of hospitals of greater than 99 beds and accredited by the Joint Commission on Accreditation of Hospitals was selected. Three hospital strata were included: government, nonfederal; investor owned, for profit; and voluntary, nonprofit. Nursing service administrators in 129 hospitals responded to the mailed Effectiveness Questionnaire which collected data about the hospital, the nursing department and the relationship of the nursing department to the hospital structure. The organization was the unit of analysis. Path analysis was used to test the relationships specified in the causal model and factor analysis was used to describe the dimensions of nursing care delivery system effectiveness.

The results support nursing care delivery system effectiveness as a multivariate concept with aspects of both goal attainment and system resource effectiveness as defining characteristics. The final factor solution was comprised of total cost per patient day, payroll expense per patient day, and ratio of registered nurses to licensed practical nurse staff. This factor composition suggests an emphasis on efficiency goals in nursing systems.

Some of the theoretical formulations about effectiveness proposed in the causal model were not supported by the data. However, path analysis revealed Centralization as the best predictor of Nursing Care Delivery System Effectiveness. The findings support decentralization to the technical level for greater effectiveness in short term general hospitals.

Based on the empirical findings, recommendations were made for research, theory and nursing practice.
Notes: Source: Dissertation Abstracts International, Volume: 47-07, Section: B, page: 2839.

Thesis (PH.D.)--UNIVERSITY OF COLORADO HEALTH SCIENCES CENTER, 1986.

School code: 0831.
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