Paper
Monday, November 14, 2005
Nurse Motivation, Cognitive Style and Perceptions of Safety Culture in Medical Surgical Units: Evidence Toward the Development of a Human Performance Quality Nursing Care Delivery Model
Roseanne C. Moody, RN, MSN1, Daniel J. Pesut, PhD, APRN, BC, FAAN1, Janet Bingle, RN, MS2, Melodi Bauer, RN, BSN3, Eleanore Wilson, MA, BSN, RN4, Rhea Oliver, BSN, RN, BC5, Carla Smith, RN3, Mary Browning, MS, RN, CRRN6, Patti Eisenberg, MSN, APRN, BC7, and Charles F. Harrington, PhD8. (1) Department of Environments for Health, Indiana University School of Nursing, Indianapolis, IN, USA, (2) Chief Nursing Officer, Community Health Network, Indianapolis, IN, USA, (3) Clinical Director - Community Hospital East, Community Health Network, Indianapolis, IN, USA, (4) Director, Acute Care Services - Community Hospital North, Community Health Network, Indianapolis, IN, USA, (5) Clinical Director, Medical-Surgical Units - Community Hospital North, Community Health Network, Indianapolis, IN, USA, (6) Director of Nursing - Community Hospital East, Community Health Network, Indianapolis, IN, USA, (7) Clinical Nurse Specialist for Advanced Practice Nursing, Community Health Network, Indianapolis, IN, USA, (8) University of Southern Indiana, Evansville, IN, USA
| Learning Objective #1: Explain the variables of the Human Performance Quality Nursing Care Delivery model |
| Learning Objective #2: Discuss the role of motivation and cognitive decision-making style in relationship to perceptions of unit safety culture and reported medication errors |
This research reports on relationships among five variables within a model of Human Performance Quality Nursing Care Delivery (HPQNCD) (Moody & Pesut). The factors that were explored in this research were: motivational and cognitive decision making styles of nurses, perceptions of safety culture in relation to productivity and reported medication errors on medical surgical units in two hospitals within a health system. Empirically derived models of nurses' work that incorporate nurse performance factors in relation to patient outcomes, cost, quality and productivity are needed
Method: A 109 item, cross-sectional, safety culture and nurse performance styles survey was created by combining three operational measures: 1) Kirton Adaptation-Innovation Inventory – cognitive decision-making 2) Behavioral Activation-Inhibition Scales –behavioral motivation and 3) Hospital Survey on Patient Safety –safety culture. Nursing unit productivity and nurses' reported medication errors were used as dependent measures. Unit productivity in this study was defined as nursing care hours per patient day. Completing the survey were 158/186 staff nurses from two acute care hospitals in a metropolitan health care system (85% response rate).
Results: Multiple regression and path analysis provide evidence that nurses' cognitive decision-making style is significantly correlated to behavioral motivation (activation [r=.236, p=.003] and inhibition [r=-.272, p=.001]). Behavioral inhibition is significantly correlated across multiple dimensions of nursing unit safety culture and frequency of medication error reporting.
Conclusions: When creating nursing unit safety culture, nurses' intrapersonal cognitive and motivational styles are important nursing management and leadership considerations in service of achieving safe, high quality patient care.
Implications: The Human Performance Quality Nursing Care Delivery model and evidence derived from the testing of the model helps explain the role of both system and human performance factors that contribute to patient safety in hospital contexts.