Joanne R. Duffy

Using the Quality-Caring Model to organize patient care delivery.

The organization of patient care in many acute care institutions lacks a foundation in nursing theory, yet preliminary evidence of the value of professional nursing care is increasing. The process and preliminary benefits of organizing patient care according to a professional practice model are presented using a collaborative partnership between an acute care organization and a school of nursing. A pilot implementation plan with formative and summative evaluation provided preliminary evidence used in project expansion.

Nonpharmacological strategies for improving heart failure outcomes in the community: a systematic review.

The purpose of this systematic review was to synthesize current evidence regarding nonpharmacological approaches to heart failure (HF) management. Following a literature search, identified studies were coded using the Heart Failure Study Assessment Scale (HFSAS) developed by the authors. Results included high-quality ratings, a predominance of multidisciplinary disease management studies, decreased readmission rates, and some improvement in quality of life. Implications for practice, leadership, education, and research are described.

Revision and Psychometric Properties of the Caring Assessment Tool

Evaluation of the Caring Assessment Tool (CAT) is essential for its use in the monitoring and ongoing improvement of patient–nurse relationships. This descriptive, prospective study evaluated the dimensionality and internal reliability of the instrument in a sample of hospitalized adults. In addition, reduction of items was achieved, lessening clinical and administrative burden. Data were collected from 1,111 patients in 12 U.S. hospitals in 4 geographically distinct regions. A single factor explained 73% of the variance in the construct and the number of items was reduced to 27. Internal consistency remained high (a = .97). Patient–nurse relationship data were collected safely and efficiently from hospitalized patients using a paper-and-pencil approach. The CAT holds promise for providing acute care registered nurses with the information they need to deliver reliable patient-centered care.

Feasibility of a multi-institution collaborative to improve patient-nurse relationship quality.

Objective: The objective of the study was to assess the feasibility of a multi-institution quality improvement collaborative to improve patient-nurse relationship quality. Background: Patient-nurse relationships provide the foundation for nursing services and are linked to patient outcomes. Measuring the quality of these relationships is important for ongoing practice changes. Methods: A prospective evaluation approach was used. Patients from 12 hospitals in 4 distinct areas of the United States comprised the sample. Results: All 12 hospitals submitted patient data on a quarterly basis, yielding a reliable database for performance improvement. The Caring Assessment Tool (CAT) performed well, and individual hospitals used the results to improve their performance. Inconsistencies in labeling, differing sample sizes, and administrative burden limited the results. Conclusions: Adult patients were willing to provide feedback about their care during hospitalization and multiple institutions successfully participated in the project. An electronic version of the CAT with real-time analysis would decrease burden and provide more timely and accurate results for actionable practice changes.

Research challenges and lessons learned from a heart failure telehomecare study.

Examining the benefits of nursing interventions through research significantly contributes to both professional nursing and quality healthcare, yet few benefits of home healthcare have been rigorously studied. Research challenges and lessons learned during a clinical trial of heart failure patients receiving home health nursing services are presented with recommendations

Older adults' perceptions of feeling safe in urban and rural acute care.

OBJECTIVE: The purposes of this study were to identify factors that influenced hospitalized older adults’ perceptions of feeling safe and to identify differences in perceptions between rural and urban contexts. BACKGROUND: Efforts are underway to ensure patient physical safety and improve care quality in acute-care environments. Perception of care is a unique and independent dimension of quality that includes patients’ views of care and how these perceptions might affect responses to illness. METHOD: Grounded theory method was used to identify the basic social process of feeling safe in acute care. RESULTS: Older adults felt safe when nurses provided oversight, were predictable, provided personalized care, and were willing to advocate for them. CONCLUSIONS: Findings are consistent with professional models that center on the human relational components of care. Nurse leaders can facilitate practice environments where relational aspects of nurse work, including patients’ perceptions of feeling safe, are the norm, thereby creating exceptional patient care delivery systems.

Evaluating patient-centered care: Feasibility of electronic data collection in hospitalized older adults

Evaluating patient-centered care (PCC) is crucial to its improvement. This pilot study tested the feasibility of an electronic format to assess PCC during hospitalization. Using a validated indicator of PCC embedded on a mobile device, 86 older adults evaluated its delivery by registered nurses. Patients older than 85 years rated PCC poorer than those who were younger (r = −0.22; P = .04). The electronic format was appraised as feasible; it performed well and took on average 30 minutes to complete.

Psychometric testing of the caring assessment tool: Administration (CAT-Adm©)

Objectives: The overall purpose of this study was to evaluate the validity and reliability of the Caring Assessment Tool-Administration survey. Three specific aims were to (1) evaluate construct validity of the Caring Assessment Tool-Administration survey by testing the hypothesized eight-factor structure of staff nurses’ perceptions of nurse manager caring behaviors, (2) estimate the internal consistency, and (3) conduct item reduction analysis. Methods: A 94-item Caring Assessment Tool-Administration designed to assess nurse manager caring behaviors appeared in the literature but lacked robust psychometric testing. Using a foundational theory and a cross-sectional descriptive design, the Caring Assessment Tool-Administration was evaluated for reliability and construct validity. Using convenience sampling, 1143 registered nurses were recruited from acute care hospitals in three states located in the Midwestern, Mid-Atlantic, and Southern Regions of the United States. Results: Psychometric testing of the Caring Assessment Tool-Administration was conducted using confirmatory analysis to determine the dimensionality of the construct, nurse manager caring behavior. The null hypothesis was an eight-factor solution fitting the theoretical model being tested. The null hypothesis was rejected because none of the measures examined for goodness of fit indicated the model fit the data. Confirmatory factor analysis did not support the hypothesized structure; however, exploratory factor analysis supported a one-factor solution that was conceptually labeled caring behaviors. To decrease subject burden, the 94-item survey was reduced to 25 items using item reduction analysis including assessing minimum factor loadings of ≥0.60 and evaluating survey item-total correlation and alpha. The Cronbach’s alpha of the new 25-item survey was 0.98. Conclusion: The new 25-item Caring Assessment Tool-Administration survey provides hospital administrators, nurse managers, and researchers with a sound, less burdensome instrument to collect valuable information about nurse manager caring behaviors.