Nurse staffing and patient outcomes: evolution of an international study.

Industry-wide health sector reforms in the United States, Canada, and Europe have provided a unique opportunity to examine the effects of hospital restructuring on inpatient nursing care and patient outcomes across an array of settings. Seven interdisciplinary research teams--1 each in Alberta, British Columbia, England, Germany, Ontario, Scotland, and the United States--have formed an international consortium whose aim is to study the effects of such restructuring. Each site has enrolled large numbers of hospitals and nurses to explicate the role that organization of nursing care, a target of hospital restructuring, plays in differential patient outcomes. The study seeks to understand more fully the influence of both nurse staffing and the nursing practice environment on patient outcomes. Discussion of the theoretical foundation, study design, and process of developing the study instruments and measures illustrates the process to date, as well as the feasibility of and opportunities inherent in such an international endeavour.

Patterns of research utilization on patient care units.

BACKGROUND: Organizational context plays a central role in shaping the use of research by healthcare professionals. The largest group of professionals employed in healthcare organizations is nurses, putting them in a position to influence patient and system outcomes significantly. However, investigators have often limited their study on the determinants of research use to individual factors over organizational or contextual factors. METHODS: The purpose of this study was to examine the determinants of research use among nurses working in acute care hospitals, with an emphasis on identifying contextual determinants of research use. A comparative ethnographic case study design was used to examine seven patient care units (two adult and five pediatric units) in four hospitals in two Canadian provinces (Ontario and Alberta). Data were collected over a six-month period by means of quantitative and qualitative approaches using an array of instruments and extensive fieldwork. The patient care unit was the unit of analysis. Drawing on the quantitative data and using correspondence analysis, relationships between various factors were mapped using the coefficient of variation. RESULTS: Units with the highest mean research utilization scores clustered together on factors such as nurse critical thinking dispositions, unit culture (as measured by work creativity, work efficiency, questioning behavior, co-worker support, and the importance nurses place on access to continuing education), environmental complexity (as measured by changing patient acuity and re-sequencing of work), and nurses' attitudes towards research. Units with moderate research utilization clustered on organizational support, belief suspension, and intent to use research. Higher nursing workloads and lack of people support clustered more closely to units with the lowest research utilization scores. CONCLUSION: Modifiable characteristics of organizational context at the patient care unit level influences research utilization by nurses. These findings have implications for patient care unit structures and offer beginning direction for the development of interventions to enhance research use by nurses.

The Internet and access to evidence: how are nurses positioned?

BACKGROUND: Published literature that describes the use of the Internet by nurses is scant, but it does reveal that there has been a delay in the acceptance of the Internet as a workplace tool by the medical community and, in particular by nurses. AIMS: The purpose of this article is to report on a study of how often and from what location nurses accessed the Internet, as well as the types of information they were seeking. In addition, our goal was to compare nurses' Internet use with that of physicians and the public at large, and to highlight structural and institutional challenges to nurses' use. METHODS: Surveys (1996 and 1998) of Alberta Registered Nurses were used to examine their use of technology at work and at home. Additional data sources were used to compare nurses to physicians and to the general public. RESULTS: While nurses' Internet and e-mail use at home increased over the 2-year period and was comparable with other groups, Internet use at work was low compared with other groups despite adequate workplace access. CONCLUSIONS: Nurses are more likely to value interpersonal contact, and prefer to use personal experience and communication with colleagues and patients rather than on-line and traditional sources of practice knowledge. In order for an information source to be seen as valuable in the clinical setting, contextually relevant information needs to be accessed quickly and efficiently. Energies should be focused on constructing information systems that address the particular needs of nurses.

Measuring the hospital practice environment: a Canadian context.

The primary purpose of this study is to document the psychometric properties of the revised Nursing Work Index (NWI-R) in the context of a large Canadian sample of registered nurses. A self-administered survey containing the NWI-R was completed by 17,965 registered nurses working in 415 hospitals in three Canadian provinces. Using exploratory principal components analysis, with a forced one-factor solution, the practice environment index was obtained. In addition, key assumptions were tested from previous work about the rationale for the aggregation of NWI-R responses. In the Canadian context the one-factor solution provides a parsimonious index of the practice environment of registered nurses working in acute care hospitals. Further work is needed to determine the predictive capability of this index and its relevance to cross-national organizational contexts.