Donna Diers

Nursing staffing, nursing workload, the work environment and patient outcomes

Nurse staffing (fewer RNs), increased workload, and unstable nursing unit environments were linked to negative patient outcomes including falls and medication errors on medical/surgical units in a mixed method study combining longitudinal data (5 years) and primary data collection.

Nurse Practitioner Research: Selected Literature Review And Research Agenda

Selected literature is reviewed to illustrate current conceptual and methodological issues in nurse practitioner research. Concepts of style of practice, acceptance, satisfaction, and outcome are discussed. Methodological issues are linking process to outcome, complexity measures, use of existing data, and the effect of nurse practitioner education and experience on interpretation of findings. A research agenda with two objectives is proposed: (1) studies designed to improve rather than evaluate practice and (2) studies designed with a policy framework in mind.

The effect of nursing interaction on patients in pain.

A replication in three parts of a clinical experiment testing the effect of nursing interaction on pain is reported. Three treatment groups were designed according to categories of an interaction analysis scheme, the Nurse Orientation System. Patients who complained of pain were randomly assigned to one of the three approaches, and measurements of pulse, respiration, verbal and nonverbal behavior were taken at the beginning of the interaction, at the end, and about one hour later. Findings tended to be differentiated according to nursing approach with some variation across studies. Secondary analysis of the sample characteristics and of the conduct of the three studies provided information on the differences among studies. The use of interaction analysis categories seems to contribute methodological rigor to definitions of the independent variable, nursing approach. Suggestions for future studies are made, as well as suggestions for consideration of some issues in replication.

Understanding the Unmanageable Nursing Unit with Casemix Data: A Case Study

The unmanageable nursing unit is one that has the reputation of being wastefully over budget, not using nursing resources well, not cost effective, and certainly not well managed. Serendipity led us to discover ways to understand the unmanageable unit in one institution. The nurse manager knew the unit was not working well, but had no way to describe this in clinical management terms that would be understood by others. When data from before and after major structural and system redesign initiatives became available, they showed a situation in which decisions were made without data that worked. How much better might it have been had the data that was now accessible been used? We suggest a design for using standard hospital data to define alleged problems of inefficient nursing units, the design is also the structure for monitoring the effects of management changes.

Effects of Health Policy Reforms on Nursing Resources and Patient Outcomes in New Zealand

Health policy reforms in New Zealand during the 1990s impacted on hospital operations, on the nursing workforce, and on patients. This study analyses changes in rates of 20 adverse patient outcomes that are potentially sensitive to nursing (OPSNs) before (1989-1993), during (1993-2000), and after (2000-2006) the policy reforms, using all New Zealand public hospital inpatient discharge data for this period. Comparisons of changes in mean annual rates across periods revealed the expected trajectory of acceleration during the reform period relative to the prereform period, and a subsequent deceleration in the postreform period. This S-shaped pattern was clearly evident in 16 of the 20 OPSNs, and partially evident in the remaining 4. These results are interpreted as evidence that the 1990s policy reforms inspired by managerialism had deleterious effects on patient outcomes, and that these effects coincided with changes in nursing resources and the work environment.

Interaction analysis in nursing research.

SummaryWe have presented a review of some studies of interaction in nursing. The problem of analyzing interaction can be seen as a problem in the application of a taxonomy, requiring explicit understanding of the guiding theory. The review of interaction research suggests that categories constructed with a nursing situation in mind will be more likely to tap relevant dimensions of the interaction, and that application of category systems from other areas may not produce answers to nursing questions.We have indicated how, as nursing has moved from consideration of the technical, physical aspects of patient care to inclusion of the totality of patient experience, nursing research has had to include methodological models developed in the social sciences. The use of techniques of interaction analysis is an illustration of one situation in which nursing research has borrowed a method, and in some cases actual category systems for use in analyzing the nursing-patient interaction. We have commented on some of the difficulties of uncritical application of a social science method to nursing practice research, and have raised general issues in this regard.

Developing data for practice and management: an Australian educational initiative.

As in other countries, the Australian healthcare industry is replete with massive data collections, often not used effectively to generate meaningful information to inform decision making, particularly at the operational or clinical level. While senior administrators and planners may use the data for forecasting or benchmarking, it is imperative that clinicians, including nurses and nurse managers, appreciate the value of the data and develop the knowledge and skills to access, analyze, and use it to inform their decision making. Only in the last decade or so have increasing numbers of nurses moved toward higher levels of information technology competence, particularly as information technology applications entered the healthcare sector. Facility in understanding standard administrative data is an important new skill for nurses who have an interest in information management. It is a skill that can readily be taught and its value becomes clearly evident to the students. This article describes an Australian Universitys Faculty of Nursings approach to teaching this material at the masters level.

A Modest Proposal: Nurse Practitioners to Improve Clinical Quality and Financial Viability in Critical Access Hospitals

Rural health care has achieved a new focus of attention with the passage of the Affordable Care Act (ACA). This article argues that nurse practitioners may be an important resource to help rural hospitals, especially critical access hospitals (CAH), achieve their mission of community service while protecting their always-delicate financial sustainability. Nurse practitioners’ scope of practice is well suited to the needs of rural patients, and their ability to participate in expanding preventive services is especially essential in remote areas. Barriers to nurse practitioner practice include restrictive state laws and federal and state policies.

A statement by nurse editors in response to ANA's decision to discontinue its affiliation with the American Journal of Nursing [3]

Policy, Politics, & Nursing Practice Vol. 7 No. 2, May 2006, 121-124 DOI: 10.1177/1527154406291572