The effectiveness of nursing practice patterns in acute care nursing sub-units

This descriptive case study explored the effects of nursing practice patterns on effectiveness, measured by patients' health at discharge from a tertiary medical center hospital in North Carolina. A nursing practice pattern is the structure of nursing personnel assignments for direct care and management of patients within a nursing unit. Structural contingency theory proposes that organizational effectiveness depends on context, especially the knowledge-work required (technology) and the organizational environment.; Are nursing practice patterns of care management accountability or continuity associated with patient health care effectiveness of acute care nursing sub-units in selected contexts? Hierarchical linear models (HLM) analysis examined these relationships within technology or sub-unit contexts, controlling for patients grouped within units, study history, patient demographics, unit census and nurse staffing.; Eight adult medical-surgical units in one large non-profit NC teaching hospital were study sites during August, 1999-February, 2000. Patients were randomly sampled within each unit. Alert oriented adults who agreed to complete the SF-36 Acute Care Health Status Survey for admission and discharge were enrolled (N = 110). Unit nurses received a survey on technology (response rate 25%, N = 67). The investigator collected other data concurrently from medical and unit records. The small sample limits generalizing the findings beyond the study population.; Major findings were: Nursing accountability and continuity had significant fixed effects on patient health status change for physical and mental health composite scores (p ≤ 0.05). In particular, accountability by an Advanced Practice Nurse for patients with lower physical health scores, and continuity of Staff Nurses who managed daily care, had significant fixed effects on health status change (p ≤ 0.05), although the change itself was not significant. Unit census and patient race, sex, age, and unit length of stay also had significant fixed effects on health status, along with practice pattern effects (p ≤ 0.05). Unit environment provided better-fitting models than technology.; This study supports other research demonstrating the value of differentiated nursing practice roles and staff nurse continuity in hospitals. More accessible systematic data about practice structures is needed for improving effectiveness. The combination of contingency theory plus HLM analysis provides a promising approach for research on unit structures and effectiveness of care.