Nurses Watching Over Their Patients: Test of a Theoretical Model

Wednesday, July 13, 2011: 10:30 AM

Lee A. Schmidt, RN, PhD
Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL

Learning Objective 1: Explain the watching over process as it is performed by registered nurses during a work-shift

Learning Objective 2: Relate the watching over process to patient safety and quality

Purpose: Nursing surveillance has a key role in keeping hospitalized patients safe.  However, this process has not been studied at the patient-nurse interface on a work-shift. A grounded theory study of this process resulted in a substantive theory with Making Sure emerging as the core category. The next step was to subject this theory to quantitative testing.

Methods: A measure to operationalize concepts of the theory was developed and subjected to content adequacy assessments. Data were collected from inpatient registered nurses through a mail survey with actions taken to enhance response rate.  Participants reported data from their most recent work-shift as the reference point for their survey responses. Psychometric evaluation of the measure and model testing of the theory using structural equation modeling were undertaken.

Results: 616 registered nurses (42% response rate) provided data. Adequate psychometric evidence was obtained for the measure. The pattern of survey responses suggested two models needed to be tested, one for medical surgical nurse assignment patterns and one for critical care nurse assignment patterns. The core Making Sure model was tested, and with slight modifications, the model fit the data well in both groups.  Further analysis revealed the strong relation between the Making Sure process and Protecting patients from harm.

Conclusion: Evidence of a key nursing care process that was generated through qualitative research has been tested quantitatively and found to fit the data in a sample of inpatient registered nurses.  Further study of the factors that promote or inhibit the process from occurring and the relation between this shift-based process and patient outcomes needs to be undertaken.