VARIATIONS IN NURSING PRACTICE MODELS

这是一个重新提交的方法研究，以制定一个数学 专业结构方面和背景因素指数 护理实践在急性护理住院单位中很明显。当前 建议包括方法的改进和增加拉尔夫 统计学家奥布莱恩对研究小组说。变异研究 医生行为和患者严重程度并不能充分解释 住院患者的不同结局。是合理的 护理要素，体现在护理实践模式（NPM） 为患者总体结局提供替代解释。 使用多属性效用理论，将创建一个索引， 描述急性监护病房的护理实践模式。该指数将 提供一个稳定的数值估计的程度， 单位的努力符合选定的做法标准。这样的指数，曾经 开发，可用于检测区域或机构的差异， 护理实践。 该指数对医院和护理工作也有一定的参考价值 寻求改变机构中的NPM的管理者， 以提高效率并改善患者治疗效果。 从倡议报告中收集的初步模式， 在30家医院提供医院护理和改善病人护理， NPM的以下组成部分：患者和护士的规格 特点，护理的既定目标，护理实践的范围， 资源分配战略。七名护士专家，通过一个 雪球抽样策略，将empaneled验证这一点 初步模型为了完成索引过程，小组成员还将 为每个组件分配相对重要性权重。天平将 构建并验证以测量每个模型组件。 一旦构建完成，该指数将在30个住院护理单位进行测试。 每个单位将进行两次评估：一次由一组护士调查员进行， 一次使用索引。这项描述性研究将验证 护理实践模式作为衡量护理团队努力的一个指标。这 经过验证的指数将提供一个有效和可行的措施， 临床护理的背景，然后可以应用于以后的研究 在急性胰腺炎患者中， 在乎

This is a resubmission of a methodological study to develop a mathematical index of the structural aspects and contextual factors of professional nursing practice evident on acute care inpatient units. The current proposal includes methodological improvements and the addition of Ralph O'Brien, a statistician, to the research team. Studies of the variations in physician behavior and patient severity have not sufficiently explained differential outcomes among hospitalized patients. It is plausible that factors of nursing care, embodied in the nursing practice model (NPM) provide alternative explanations in aggregate patient outcomes. Using multiattribute utility theory, an index will be created to characterize nursing practice models on acute care units. This index will provide a stable numerical estimate of the extent to which a nursing unit's effort meets selected practice standards. Such an index, once developed, may be used to detect regional or institutional variations in nursing practice. The index may also be useful to hospital and nursing administrators who seek to change the NPMs in their institutions in order to achieve efficiencies and improve patient outcomes. A preliminary model gleaned from reports of the initiatives,to strengthen hospital nursing and improve patient care in 30 hospitals, included the following components of NPMs: specification of patient and nurse characteristics, stated goals of care, scope of nursing practice, and resource allocations strategies. Seven nurse experts, identified through a snow-ball sampling strategy, will be empaneled to validate this preliminary model. To complete the index process, the panelists will also assign relative importance weights to each component. Scales will be constructed and validated to measure each of the model Components. Once constructed, the index will be tested on 30 inpatient nursing units. Each unit will be assessed twice: once by a team of nurse surveyors, and once using the index. This descriptive study will validate the index of nursing practice models as a measure of the group effort of nursing. This validated index will provide an efficient and feasible measure of the context of clinical care that can then be applied in later investigations of the factors that contribute to successful patient outcomes in acute care.