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Monday, November 2, 2009: 2:40 PM
Learning Objective 1: describe an evidence-based approach to assess decision-making among staff nurses.
Learning Objective 2: explain the results of a pilot influencing staff nurse decisional involvement and systematic deployment of evidence-based assessment and implementation strategies
In 2006, a team was formed at a pilot facility after reviewing the results from the 2005 NDNQI RN Satisfaction Survey demonstrating below-national-benchmark scores in decision making. Best practice (Advisory Board, 2005) was identified and the team chose to use the Decisional Involvement Scale (DIS) (Havens, Vassey, 2003) to address needed improvements. The DIS is a diagnostic tool to evaluate staff nurse decisional involvement. Major themes described within decisional involvement: concordance, dissonance, and mixed. Concordance results when the staff and manager have a narrow gap between actual and desired state and desired minimal movement. In contrast, dissonance is characterized by staff response illustrating a wider gap between actual and desire state in contrast to manager’s response with a narrow gap between actual and desired state. Mixed theme simply suggests the levels of concordance and dissonance vary by subset. Findings suggest that nursing units with low dissonance have higher staff satisfaction with their clinical manager consistent with the NDNQI Nurse Satisfaction Survey. The tool and results-based improvement strategies were implemented at a pilot facility resulting in scores assessing decision making that soared above the national benchmark. System-wide spread was initiated and included the recruitment of nationally recognized expertise to assist in program design and implementation. Outcomes include but are not limited to: a) data capable of directing interventions at the unit, service and system level; b) emphasized the importance of creating a supportive environment that is unique to each practice setting; and c) study has provided the content to have meaningful dialogue and conversations that might not have occurred. In response to the pilot, the DIS survey has been completed by other system facilities and results-based improvement strategies have been implemented increasing decisional-involvement across the system.