2008
Marie Boltz, PhD, RN, GNP-BC
Assistant Professor and Practice Director,
The Hartford Institute for Geriatric Nursing
New York University College of Nursing
New York, NY
Title: Nurse Certification and Patient Outcomes in NICHE Medical-Surgical Units
Abstract. Hospitalized older adults experience more complications than younger patients, including increased falls and injury falls, pressure ulcers, and adverse outcomes associated with restraint use. These clinical areas are dominantly under the control of nursing practice and thus are regarded as nursing quality indicators. Certified nurses have demonstrated competency in evidence-based gerontological nursing care practice. However, the influence of nursing certification upon nursing quality indicators is not known. The proposed pilot study will utilize linear mixed modeling to examine the relationship between the percentage of nurses certified (non-gerontologic and gerontologic) and unit-level nursing quality indicators (falls, injuries, restraint use, pressure ulcers), controlling for nurse (nursing hours per patient day, skill mix, RN education, voluntary nurse turnover rate, and percentage of agency/contract RNs), unit (bed size, average daily census, percentage of patients age 65 and above, average age, unit type, total number/percentage of Geriatric Resource Nurses), and hospital (bed size, teaching status, and Magnet Recognition Program® status) characteristics. The sample will be medical and medical-surgical units in NICHE (Nurse Improving Care of Healthsystem Elders) hospitals. The results will be used to support a larger prospective study that will investigate the relationship between nurse certification and nursing quality indictors in all types of hospital units (medical, surgical, critical care, and emergency departments) serving mostly older adults in both NICHE hospitals and hospitals employing patient safety initiatives not specific to older adults.
2007
No award was made in 2007.
2006
Andrew C. Mills, PhD, MSN(R)
Associate Professor of Nursing
Saint Louis University School of Nursing
Doisy College of Health Sciences
St. Louis, MO
Title: Effect of Magnet Hospital Designation on Patient Outcomes
Abstract. Concerns continue to surface about the patient safety and quality of care in U.S. hospitals. As a result, increasing numbers of hospitals are seeking formal recognition as “Magnet hospitals” to certify that they meet professional nursing standards of excellence in providing patient care. Magnet hospital characteristics that create and sustain professional nursing practice should translate to superior patient outcomes. While studies have shown lower rates of mortality in the elderly in Magnet hospitals and decreased likelihood that patients with AIDS will die, evidence is lacking that clinical outcomes differ in adult patients with a broad range of medical-surgical conditions. Thus, the effectiveness of Magnet hospital status in improving patient outcomes has not been established. Therefore, the aim of the proposed study is to determine the extent to which patient outcomes differ in Magnet hospitals and non-Magnet hospitals. The study will compare two nursing-sensitive patient outcomes in two types of hospitals: (a) failure-to-rescue and (b) decubitus ulcers. A prospective cohort design will use secondary data analysis of national databases from the Agency for Healthcare Research and Quality with all-payer patient data. To determine the extent to which rates of failure-to-rescue and decubitus ulcers differ between Magnet and non-Magnet hospitals, two multivariate logistic regression models will estimate the odds ratios of their predicted occurrence after controlling for covariates. It is hypothesized that Magnet hospitals will have significantly lower risk-adjusted rates of failure-to-rescue and decubitus ulcers among adult, medical-surgical patients.
2005
Elizabeth Ann Coleman, PhD, RNP, AOCN
Professor and Cooper Chair in Oncology Nursing
College of Nursing
University of Arkansas for Medical Sciences
Little Rock, AR
Title: Effect of Certification on Nursing Sensitive Outcomes
Abstract. Quality of care for patients with cancer is a concern and nursing care that provides effective symptom management can improve care quality. Certification is one method of assessing competency but research is needed for validation. There is a need to show whether certification makes a difference in nursing sensitive outcomes. Specific aims of this proposed study are to compare certified nurses with non-certified nurses for symptom management of nausea and vomiting and pain in patients with cancer, patient satisfaction with nursing care, and nurse job satisfaction. The study has a prospective, descriptive design using six oncology areas, 102 nurses, and 408 patients at a large university medical center. Instruments include chart audit tools and patient questionnaires for auditing management of pain and nausea/vomiting, nurse surveys to assess knowledge and attitudes about management of pain and nausea; patient satisfaction questionnaires; nurse job satisfaction questionnaires and a demographic form for nurses. After informed consent has been obtained, research assistants, trained by the investigators, will collect data from the nurses and from the patients and their medical record. We will use descriptive statistics to describe the sample and data distributions, and independent t-tests to determine differences in symptom management, patient satisfaction, and nurse satisfaction. If results show that compared to non-certified nurses, certified nurses have better outcomes in symptom management, patient satisfaction, and nurse satisfaction, this information can help health care delivery systems improve the quality of patient care through recruitment and retention practices that favor certified nurses.
2004
Jeanine Seguin, MS, APRN,BC
Doctoral Candidate
Widener University
Chester, PA
Title: A Psychometric Analysis of an Instrument that Tests Genetic Knowledge Patterned on the International Society of Nurses in Genetics (ISONG) Standards of Genetic Clinical Practice
Abstract. The traditional method of determining competence, thus attaining a professional credential, is the passing of standardized, criterion-referenced examination. A new approach to advanced practice nurse credentialing has recently emerged which is based on the review of a professional portfolio. However, this portfolio approach needs validation as a means of determining specialty knowledge. In this study an instrument to test advanced practice clinical genetic nursing knowledge will be developed and evaluated. Later, the instrument may be used to compare portfolio pass/fail outcomes to instrument pass/fail outcomes. This methodological psychometric study will address the research question of interest: Is the Criterion-Referenced Measurement Tool for Genetics (CRMTG) a valid and reliable indicator of advanced practice genetic clinical nursing competence? This study will be based on Lenburg’s Competency Outcomes and Performance Assessment (COPA) Model. Waltz, Strickland, and Lenz’s stages of development and validation of criterion-referenced measures will be used for instrument development. An instrument will be constructed using the steps outlined by Waltz, Strickland and Lenz. A review by an expert panel will assess content validity of the tool. Masters prepared genetic nurses, with and without the Advanced Practice Nurse in Genetics credential; masters prepared nurses who do not specialize in genetics; and non-advanced practice nurses; both in and out of the genetics specialty will be given the instrument. The instrument will be administered via the Internet format. A factor analysis will be performed to verify construct validity. An item analysis and calculation of Cronbach’s alpha will test internal consistency reliability. Spearman correlation will be performed to verify concurrent validity. Divergent validity will be calculated using ANOVA matching and comparing various response patterns of the sample. Demographic characteristics will be considered apart from dependent variables related to validity. Once the tool has been found to be valid and reliable, it will be used by the Genetic Nurses Credentialing Commission, Inc. (GNCC) to evaluate the portfolio process for the awarding of genetic nursing credentials.
2002
Kathleen L. Bobay, MSN, RN, CS
Doctoral Candidate
School of Nursing
University of Michigan
Ann Arbor, MI
Title: Defining and Measuring Expertise in Clinical Nursing Practice
Abstract. Although expertise has been discussed extensively in the nursing literature, there exists no clear definition of what nursing expertise is or how to measure it. As a result, it is difficult to identify clinical nursing experts or to know how to promote the development of expertise in those nurses with the ability and desire to become experts. The proposed model of clinical expertise for this study differs from the traditional nursing model (Benner, 1984). It is not based on a continuum, but rather compares the differences between experienced nonexpert and expert nurses. Few studies have been successful at measuring these differences. This will be a mail survey of emergency nurses who have taken the Certified Emergency Nursing (CEN) examination within the past calendar year. Mail surveys would be sent to 1000 randomly selected nurses, including those who passed the exam and those who did not pass. Structural equation modeling (SEM) will be used for data analysis for this nonexperimental study. Methodology will follow the Dillman (2000) Tailored Design Method, which demonstrated return rates of 55-78% using this method. Implications from completing this research might include: determining the importance of credentialing in the development of clinical expertise, improved design of continuing education programs tailored to developing expertise, and future ability to link clinical expertise and patient outcomes.
2002
Susan Tullai-McGuinness, MSN, MPA, RN
Doctoral Candidate
Frances Payne Bolton School of Nursing
Case Western Reserve University
Cleveland, OH
Title: Exploring the Home Healthcare Nursing Practice Environment
Abstract. Home healthcare (HHC) administrators face two major challenges: a nursing shortage and a recent change to a prospective payment system that apply increasing pressure to improve quality but with fewer visits. These challenges have forced administrators to evaluate their nurse practice models (NPMs), but there is limited evidence to guide their decision-making since most of the research has been conducted in acute care. For the proposed descriptive correlational study, professional ideals and Donabedian’s Structure Process Outcomes framework form the conceptual model depicting how the nursing value of autonomy is translated into the NPM. Structural attributes of interest are nurse characteristics: certification, education, and experience. The Process attribute is the exercise of autonomous practice: control over decisions related to practice and the practice setting. The Outcomes attribute is RN satisfaction. The purpose of the study is threefold: (1) to examine the extent of autonomous practice in HHC (2) explore the relationship between the exercise of autonomous practice and satisfaction and (3) explore the relationship between nurse characteristics and the exercise of autonomous practice. A convenience sample of 90 RNs from six Medicare home healthcare agencies in northeast Ohio will be surveyed. Descriptive, bivariate, and multivariate analysis will be performed. The proposed study is important to nursing science and practice because it provides the first empirical data post-prospective payment system about the nurse practice environment in home healthcare.