Paper
Thursday, July 22, 2004
Are We Staffing Right? A Conceptual Model To Guide Decision-Making
Raquel M. Meyer, RN1, Linda O'Brien-Pallas, RN, PhD2, Donna Thomson, BScN, MScN3, Linda McGillis Hall, RN, PhD2, Sping Wang, PhD4, and Xiaoqiang Li, PhD4. (1) NRU, University of Toronto, Toronto, ON, Canada, (2) Faculty of Nursing, University of Toronto, Toronto, ON, Canada, (3) St. Peter's Hospital, University of Toronto, Hamilton, ON, Canada, (4) Nursing Effectiveness, Utilization and Outcomes Research Unit, University of Toronto, Toronto, ON, Canada
Objective: This paper reviews the key concepts and related variables in the Patient Care Delivery Model (PCDM) which frames the inquiry presented in this symposium. Developed by O’Brien-Pallas and colleagues since 1993, the PCDM is based on open systems theory and emphasizes that inputs to the patient care delivery system and throughput factors cross the patient care subsystem boundaries. A transformation occurs as a consequence of interactions and processes among system substructures that result in system outputs and feedback for the entire system. Results: Patient input characteristics included age, sex, medical diagnosis, caregiver support, SF-12 health status and nursing diagnoses and OMAHA9 knowledge, behaviour and status at admission. Nurse input characteristics included demographics, education, employment and professional status, clinical expertise and experience. Hospital size and teaching status, comprised system characteristics, whereas nurse-patient ratios, workload, proportion of RN worked hours, continuity of care, overtime and use of agency staff, unit stability and non nursing tasks were the system behaviors studied. Nurses’ perceptions of the care giving process 10 and the Environmental Complexity Scale11, 12, 13 were throughput variables. Intermediate system outputs included worked hours on a unit and daily P/U. Patient output variables included medical consequences, and changes in both SF-12 health status and OMAHA knowledge, behavior and status at discharge. The nurse output variables measured were burnout, effort and reward imbalance, satisfaction, intent to leave, nurse-physician relationships, SF-12 health status, violence and absenteeism. Length of stay, cost per Resource Intensity Weight, quality of nursing and patient care, and interventions delayed or not done comprised system outcomes. Conclusion: The PCDM proved robust for examining the patient care system Implications: The PCDM is useful not only for research, but also as a framework for managers to improve patient care delivery.
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Sigma Theta Tau International
July 22-24, 2004