ABSTRACT
The impact of nursing on patient and organizational outcomes has received significant attention from researchers in the past 10 years. Although some research has been based on a theoretical framework, to date, there has not been one, consistent framework that can guide this research. In addition, the frameworks that have been used do not identify nursing as the pivotal concept in the model. The purpose of this article is to identify a framework to guide such research with an emphasis on nursing as the essential concept. Unit culture, nurse staffing, staffing mix, and other variables do not have a direct effect on outcomes. It is only through these variables' influence on the delivery of nursing care that outcomes are affected.
Subject(s)
Models, Nursing , Nursing Administration Research/organization & administration , Nursing Care/organization & administration , Nursing Evaluation Research/organization & administration , Outcome Assessment, Health Care/organization & administration , Clinical Competence/standards , Decision Making, Organizational , Forecasting , Health Facility Environment/organization & administration , Humans , Interprofessional Relations , Leadership , Nurse-Patient Relations , Nursing Care/psychology , Nursing Staff/organization & administration , Nursing Staff/psychology , Personnel Staffing and Scheduling , Personnel Turnover , Professional Autonomy , Quality Indicators, Health Care/organization & administration , Quality of Health Care/organization & administration , Research Design , Total Quality Management/organization & administrationABSTRACT
With an increasingly complex healthcare system, the need to coordinate the care for chronically ill patient often goes unmet. This results in increased utilization of services at significant costs. In addition, providing patients with the tools to manage their own disease processes over the long term is also lacking in the healthcare environment. The Veterans Health Administration (VHA) approached these challenges by creating a Care Coordination program using technology to promote self management for veterans. Although a relatively new program, the Veterans Integrated Services Network (VISN) 7, has shown substantial gains in both decreasing the use of high cost care, such as emergency department (ED) visits and hospitalizations, as well as improving clinical outcomes with better glycemic control for patients with diabetes and improved lipid management for all patients.