Friday, September 27, 2002: 3:00 PM-4:30 PM

Nursing Role Effectiveness Model: Conceptualizing to Theory Testing

Current health care accreditation standards compel hospitals to demonstrate their impact on patient outcomes (Jones, 1993). Nurses are being asked to demonstrate their contribution through the identification of nursing-sensitive patient outcomes, as evidenced by the American Nurses Association nursing report card (ANA, 1997, 2000). However, identifying outcomes for which individual nurses can be held accountable is a challenge because of the multifaceted nature of patient outcome achievement. For this reason the identification and investigation of nursing-sensitive patient outcomes must be guided by a conceptual framework that establishes specific relationships between the factors in a nursing care situation and outcome achievement. Irvine, Sidani, and McGillis Hall (1998a) developed a conceptual model to guide the assessment of nurses' contribution to health care. The Nursing Role Effectiveness model was based on the structure-process-outcome model of quality care. The structure component consists of nurse, patient, and nursing unit variables that influence the processes and outcomes of health care. The process component consists of the independent, interdependent and medical-care related role functions of nurses. Nurses' independent role includes the activities of patient assessment, decision-making, nursing intervention, and follow-up. Nurses' interdependent role comprises the role functions and responsibilities which nurses share with other members of the health care team. It includes the activities and functions in which nurses engage that promote continuity, coordination, and the integration of patient care. Nurses' medical-care related role comprises the clinical judgments and activities associated with the implementation of medical orders and medical treatments. The outcome component of the model includes the patients' health status, the patients' perceived health benefit from nursing care, and the direct and indirect costs associated with nursing care. The conceptual model has guided the development of a program of research aimed at identifying and measuring nursing-sensitive outcomes (Irvine Doran et al., in press). It has also been used as a framework to guide nurses' quality improvement activities (Irvine, Sidani, & McGillis Hall, 1998b) and serves as an organizing framework for the curriculum of a graduate course on the theoretical basis for quality improvement of nursing services. Purpose and learning objectives: The purpose of this symposium is to illustrate the value of carefully theorizing about the relationships among variables within the nursing practice situation that can influence the outcomes of nursing care through the use of a particular conceptual model. Methods: Four papers will be presented which describe the development of the model and the results of empirical work testing the propositions within the Nursing Role Effectiveness model. The first paper discusses the strategies for building and testing the model and provides an overview of the propositions in the model. The second paper describes the results of a study that examined the impact of work design, unit experience, and nurses' educational preparation on their independent role performance, using two different methods for conceptualizing and measuring role performance. The third paper examines the effect of nursing staff mix on nurses' interdependent role performance. The study results demonstrate that nurses' interdependent role performance operates as a mediator of the relationship between staff mix and improvements in patient functional status and self-care outcomes following hospitalization. The fourth paper demonstrates the use of the Nursing Role Effectiveness model as a framework for examining the development, implementation, and contribution of the case management role and tests the influence of structural variables on role performance. The four papers reflect the work of nurse scientists and graduate students who have contributed to the development, testing, and refinement of the Nursing Role Effectiveness Model. Together, the four papers provide an illustration of how to build theory through inductive and deductive processes and empirical testing.
Organizer:Diane Irvine Doran, RN, PhD, associate professor
Development of the Nursing Role Effectiveness Model
Diane Irvine Doran, RN, PhD, associate professor
Nurse Case Management Role Effectiveness
Jennifer Carryer, RN, MN, research officer, Diane Irvine Doran, RN, PhD, associate professor, Souraya Sidani, RN, PhD, associate professor
Nurses' Interdependent Role in Coordinating Care and Patient Outcome Achievement
Linda McGillis Hall, RN, PhD, assistant professor, Diane Irvine Doran, RN, PhD, associate professor
The Impact of Nurses' Independent Role on Patient Health Outcomes
Souraya Sidani, RN, PhD, associate professor, Diane Irvine Doran, RN, PhD, associate professor

The Advancing Nursing Practice Excellence: State of the Science