Relationship Based Model of Care Delivery: Evidence for Human Capital Linking Caring to Outcomes

Anthony, Mary K.

Saturday, 29 October 2011

Mary K. Anthony, PhD, RN¹
Kathleen Vidal, MSN, RN¹
Amany A. Farag, PhD, RN²
Christina Reeber, BSN, RN¹
Bethany Lukosavich, BSN, RN¹
(1)Department of Nursing, University Hospitals Case Medical Center, Cleveland, OH
(2)School of Nursing, Alexandria University, Alexandria, Egypt

Learning Objective 1: Describe a model of care delivery based on establishing caring relationships

Learning Objective 2: Describe elements of human capital in predicting outcomes

Background: Safe patient discharge is a national priority that hospitals struggle to achieve. Though many patient, system and provider characteristics influence quality discharge, one unexplored factor is how models of care that emphasize nurses’ relationships with patients and team members impact discharge. Relationships, as human capital, create opportunities for individualized exchanges of information that pave the way for patient centered decisions and actions. Although four of the ten IOM recommendations for changing health care relate to relationships, little progress is made linking building relationships to outcomes.

Purpose: To assess the structural factors, the process activities of care delivery that impact nurses perceptions of patient’s readiness for discharge.

Conceptual Model: Duffy’s Quality- Caring Model which blends Donabedian's structure, process and outcome with Watson Human Caring Model.

Setting/Sample: A convenience sample of 222 RNs working on 22 medical-surgical units in six hospitals within one large healthcare system responded to a survey (40% response rate).

Measures: Standardized measures were used to assess structural and outcome variables. Investigator developed items were used to assess nurse priorities and behavior for discharge.

Results: Participants mean age was 36.2 years with an average of 7.8 years of experience: A hierarchical regression model was tested. In step one, structural variables were entered (Caring, RN expertise, experience, work uncertainty; relational coordination). In step two, process variables were entered (priorities for discharge planning, focused relational conversations with patients). The final model accounted for 19.2% (p< .0001) of the variance in nurses’ perception of how ready patients are for discharge. Significant predictors included caring, relational coordination, nurse priority for discharge planning and focused conversations with patients.

Implications: Structure and processes that support building relationships (relational capital) offer opportunities to obtain and exchange information, mobilize resources and build collaborations, all of which are more likely to achieve a quality discharge.

Supported by Kent State University and University Hospital Case Medical Center

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