Saturday, September 28, 2002

This presentation is part of : Methodological Issues in Intervention Research

Influence of nurse characteristics in effectiveness research

Patricia Moritz, RN, PhD, FAAN, associate professor and director, University of Colorado Health Sciences Center, National Center for Children, Families and Communities, Denver, CO, USA, Souraya Sidani, RN, PhD, associate professor, Faculty of Nursing, University of Toronto, Toronto, ON, Canada, and Dana Epstein, RN, PhD, associate chief nurse for research, Department of Veterans Affairs, Carl T. Hayden VA Medical Center, Phoenix, AZ, USA.

Objective: In intervention evaluation research, the implementation of the intervention is entrusted to one or more nurses. The nurses are chosen for their relevant expertise, given intensive training, and are required to adhere to the intervention in an attempt to deliver the intervention in a consistent way across all clients assigned to the experimental group. Consistent intervention implementation enhances the validity of statistical conclusions. In this paper, we demonstrate that nurses’ characteristics and intervention implementation fidelity play an important role in intervention evaluation research, and suggest strategies for exploring their role. Design and Method: The information presented is obtained from a review of pertinent conceptual and empirical literature, and from the authors’ research experience. Concepts or Issues: Nurses who deliver the intervention in a research project vary in their personal characteristics and their professional qualifications. This variability may influence, to some extent, the way in which they deliver the intervention. Personal characteristics influence the interpersonal processes that serve as the medium through which most nursing interventions are delivered to clients. These processes, in turn, can alter the clients’ response to treatment. Professional qualifications affect the nurses’ ability to deliver the intervention as originally designed. The nurses’ education and experience could contribute to their technical skills in delivering the intervention. Their professional and ethical obligations could interfere with the decision to strictly adhere to the intervention protocol; that is, nurses may adopt the intervention implementation to meet the individual needs of the clients. Thus, the nurses’ characteristics have direct effects on clinical processes and outcomes and can moderate the effectiveness of the intervention. Ignoring the potential influence of nurses’ characteristics weakens the validity of conclusions, and limits the ability to generalize the results across nurses, and to apply and/or replicate the findings in clinical settings. Quantitative and qualitative research methods can be used to investigate the nurses’ contribution in experimental research. Examples from a state-wide evaluation that examined the effectiveness of a public health prenatal and child development program will be used to illustrate the points of discussion. Conclusions and Implications: Careful selection and adequate training of nurses enhance their interpersonal and clinical skills required for delivering nursing interventions. Such practice does not, however, guarantee that nurses will strictly adhere to the prescribed protocol. Researchers need to recognize that nurses’ characteristics influence intervention implementation fidelity and outcome achievement, as is often done in health services research. They are encouraged to assess their influence in order to gain a comprehensive understanding of what exactly contributes to outcome achievement, and of who would best be positioned to deliver the intervention successfully.

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