Learning Objective #1: Identify the major components of nursing care

Learning Objective #2: Describe the associations between organizational characteristics, nursing care, and outcomes

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Professional nursing care is the principal reason that patients are admitted to acute care hospitals. Hospital restructuring and re-engineering, which took place in the 1990's, caused both public and professional groups to focus attention on the quality of nursing care. Efforts to replace costly professional nurses with less expensive unlicensed staff resulted in a significant decrease in the amount of direct patient care provided by RNs. As a result, researchers began studying the effects of professional nursing care on patient and organizational outcomes. Although some work has been tied to conceptual or theoretical frameworks, to date there has not been one broad and inclusive framework focusing on the effects of nursing care. The purpose of this paper is to suggest such a framework to guide future research. Central to any framework designed to study the impact of nursing on patient and organizational outcomes must be the concept of nursing care. Unit culture, nurse staffing, staffing mix and other variables do not have a direct effect on outcomes. It is only through their influence on the delivery of nursing care that outcomes are affected. Although current models in the literature encompass organization, patient, and nurse variables, they do not emphasis the delivery of nursing care as the pivotal concept. This model suggests six major constructs: health facility environment, unit qualities, nurse qualities, patient qualities, nursing care and outcomes. It is proposed that the health facility environment had a direct association with unit, nurse and patient qualities. These qualities, in turn, directly influence nursing care. Nursing care then has a direct influence on organizational, unit, patient and nurse outcomes.