Assessing Staff Nurses' Engagement with the Professional Practice Model Four Years after Implementation

Purpose:

A Nursing Professional Practice Model provides a framework that addresses the essential characteristics, values and performance expectations of nurses (Jacobs, 2010; Jost and Rich, 2010). When nurses can articulate the caring concepts, performance behaviors, and delivery practices contained in the practice model, the model guides them to achieve the highest quality patient outcomes. Nursing excellence, as measured by the Magnet Recognition Program^, requires that nurses be able to communicate their Professional Practice Model and define how it relates directly to their practice.

A Nursing Professional Practice Model (NPPM) was developed and implemented four years ago at a regional medical center in the southeastern United States.  Staff nurses were involved in the development and implementation of the NPPM. The model consists of three components:  Care Model, Performance Model, and the Delivery Care Model. The Care Model (Amendolair, 2011), based on Swanson’s Care Theory (1999), includes five concepts: being with, doing for, knowing, enabling, and maintaining belief. The Performance Model consists of three statements which explain how Care Model concepts apply to behaviors and actions of the nurse (nursing knowledge, nursing skills, nursing care).  The Delivery Care Model describes the organizational context in which nurses’ practice.  The purpose of this study is to determine to what extent the staff nurses that provide direct patient care have internalized the concepts included in the NPPM, and to assess if their patient care demonstrates the concepts, beliefs, behaviors, attributes and performance expectation outlined in the Nursing Professional Practice Model.

Models assist nurses to think critically about how to practice nursing and to identify the relationship between nursing actions and patient outcomes. Boykin, Smith, and Aleman (2003) believe that the model creates a work environment for nurses that supports their commitment to nurture and care. This model displays the important values that nurses identify as critical to their practice. Having a model to guide consistent nursing practice improves nurse and patient satisfaction (Berger, 2012) and enhances patient outcomes. A model provides a framework that offers the nurse a clear understanding of the nurses’ role. The concepts and statements displayed in the model help the nurse to accomplish the prescribed behaviors of professional practice and within the context of the organization’s values and beliefs. Validating the existing Nursing Professional Practice Model, which currently defines what nurses believe and what nurses do, is important because defining the role and responsibilities of the nurses it strengthens their practice, provides critical information for strategic planning and supports nurse satisfaction (Basol, Hilleren-Listerud, and Chimielewski, 2015).

Significance. A Professional Practice Model provides a framework that addresses the essential characteristics, values and performance expectations of nurses. When nurses can articulate the caring concepts, performance behaviors, and delivery practices nurses are guided it to achieve the highest quality outcomes. Nursing excellence, as measured by the Magnet Recognition Program^, requires nurses be able to communicate the Professional Practice Model and define how it related directly to their practice. The purpose of the study is to assess if staff nurses who provide direct patient care demonstrate the concepts, beliefs, behaviors, attributes and performance expectation outlined in the Nursing Professional Practice Model.

Methods:

Research Design and Question: A quantitative-descriptive correlational research design will be utilized in this study. There are two research questions: 

1. Will Staff Nurses who provide direct patient care, through self-reporting, be able to identify the concepts of the Nursing Professional Practice Model?
2. Will patients, at the time of discharge, be able to identify the concepts of nursing care as identified in the Nursing Professional Model (Care Model component)?

Sample. A convenience sample of all Registered Nurses who provide direct patient care in acute care nursing units will be utilized. Non-registered nurses and nurse managers will be excluded from participation.   All patients or immediate family members will be asked to participate in completing the survey at discharge to home. Patients that are discharged to another healthcare facility, and patients with dementia or other mental disorders that do not have a family member present at the time of discharge will be excluded from survey participation. The sample size, based on a power analysis, for nurses is 185 for each instrument (CDI, NWI-R) and for patients is 174. The Institutional Review Board (IRB) of the medical center has approved this research study

Data Collection Procedures.Data Collection will be accomplished using a self-reporting survey method for both the nurse and patient participants. Two instruments will be used to solicit information concerning staff nurses ability to identify the concepts of the NPPM and one for patients to solicit information about how the patients sees these behaviors being exhibited. 

Nurses will be asked to complete the Care Dimension Inventory and the Nursing Work Index surveys.  The Care Dimension Inventory (CDI) is a 25-item survey which measures the perception of the underlying structure of caring by nurses.  The survey consists of operationalized statements, caring behaviors and actions.  The nurses indicate their level of agreement that these behaviors and actions found caring. The 5-point Likert scale lists caring behaviors and selected actions from an intensive review of the literature on nursing care (Watson and Lea, 1997; Watson, Deary, and Lea, 1999).The instrument, based on Leininger Major Caring Taxonomic constructs (Watson, R., and Lea, A., 1997, p. 88), identifies the core concepts of caring nurse-patient relationships, nursing interventions, nursing attitudes, nursing skills, and communication. R. Watson, the author of this instrument has given permission (Personal email communication: r.watson@hull.ac.uk, 17 September, 2014).

The Nursing Work Index –revised (NWI-R) is a tool to measure the organizational context in which nurses deliver care.  The instrument developed and revised by Aiken and Patrician (2000) “measures characteristics of professional nursing practice environments” (p.146). This instrument is a 57–item, 4-point, Likert scale that investigates the nurses’ perceptions as to the organizational characteristics that influence the delivery of nursing care. The NWI-R includes four major areas: autonomy, control over the work environment, relationships with physicians, and organizational support.  The AnMed Health Professional Practice Model under the Delivery Care component also identifies these work characteristics. The reported reliability of the instrument using Cronbach alpha =.81 to .96. The instruments take about 5 to 10 minutes to complete. This is a Copyright ^©1997 Linda H. Aiken, but reproduction of this instrument for noncommercial use does not require permission from the authors (Aiken, 2000).

Patients will be asked to complete the Caring Professional Scale (CPS).  The CPS is a 15-item self-reporting survey to measure a patient’s perceptions of the nurses’ caring behaviors and actions.  The instrument, based on the Care Theory (Swanson, 1991), is a 15-item self-reporting survey derived from the theoretical concepts of being with, doing for, knowing, enabling, and maintaining belief.  The instrument consists of two sub-scales: the compassionate healer and the competent practitioner.   Watson (2002) reported construct and content validity of Cronbach’s alpha 0.76 to 0.96 for this instrument The author K. Swanson as given permission to use this instrument (Personal email communication: swansonk@seattleu.edu, 18 September, 2014).

Data collection will be facilitated by members of the medical center’s Nursing Research Council. Council members who volunteer to assist in the data collection will be provided a packet of either the CDI, NWI-R, or CPS instruments. The council members will distribute their assigned packets to the direct care nurses and or patients throughout the organization.  A brief description of the purpose of the study and instructions for returning the surveys, will be included with the survey instruments, questions related to basic demographic information will be included with the nursing surveys, but will be separated from the survey to assure anonymity. The patient’s instrument (CPS) will be distributed by the nursing personnel at the time of discharge with information concerning the study. The nurse will collect the instruments once the patient has completed the survey. No patient demographic information will be collected.

Results:

The results of this survey will be available by early spring. 

Conclusion:

If the findings support the current model, no action will be needed.  If the data does not support the model, two actions will be implemented. First, the nursing staff will be re-educated on the current model.  Secondly, the model will be re-visited to align the model concepts better with current nursing practices.