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Measuring Dosage in Case Management

Diane L. Huber, PhD, RN, FAAN, CNAA, BC, Professor, College of Nursing, University of Iowa, Iowa City (


Researchers at the University of Iowa have developed a method for measuring the dose of a behavioral health intervention specific to case management. Using a conceptual model, measures were constructed for 4 major dosage variables and tested with a large data set from a clinical trials design research project investigating models of case management in substance abuse treatment. Measuring the actual dose of case management helps to assess quality and provide guidance as to the correct amount of the intervention that is needed, which helps to better manage services and target outcomes more precisely.


Predicting Real-time Nurse Staffing Needs in Hospitals: A New Tool to Measure Nursing Intensity

Laurie Zone-Smith, MSN, RN, Manager of Special Projects and Magnet Recognition, Medical University of South Carolina Clinical Services, Medical University of South Carolina, Charleston (


The Medical University of South Carolina Medical Center's nurse researchers and staff nurses designed a computerized system that provides unit- and patient-specific data to charge nurses for shift-to-shift, staffing-level adjustments. Intensity (time and complexity) is entered by the assigned nurse based on individual patient care needs and patient safety concerns, promoting optimal patient health care outcomes.


Domestic Violence Response Project

Jacqueline Dienemann, PhD, RN, CNAA, FAAN, Interim Chair, Adult Health Nursing, School of Nursing, UNC Charlotte, NC (


An innovative domestic violence response project in a major teaching hospital improved domestic violence outcomes. In the first year, 2 professionals trained 240 staff members and 22 volunteers to screen and provide 24-hour follow-up to 161 women who disclosed domestic violence at screening. Telephone follow-up at 2 days found that most of the women contacted used their safety plan and reported a safer living situation. Other evaluation measures were chart reviews for screening compliance and telephone follow-up at 2, 6, and 12 weeks for safety and support. The score from the Agency for Healthcare Research and Quality-sponsored Cobin Assessment of hospital domestic violence programs increased from 71 to 570. This tool is valuable for ideas for program improvement and measurement.


An Evaluation of the Role and Skills of Contemporary Nurse Managers

Mary K. Anthony, PhD, RN, CS, Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (


Four focus groups consisting of 32 nurse managers identified that to retain staff, nurse managers need leadership skills such as flexibility, risk taking, and communication. Identification of nurse manager roles and skills differed among managers with varying educational backgrounds; however, the study concluded that many of the key roles of nurse managers are related to the structural aspects of their jobs. These roles are also the most time-consuming.


Answering the "Why" Questions: Understanding and Improving Healthcare Delivery Through Case Study Methods

Ruth A. Anderson, PhD, RN, FAAN, Associate Professor, School of Nursing, Duke University, Durham, NC (


Nurse researchers at Duke University discovered that complexity theory, partnered with case study method, provides new insights into the quality of healthcare systems. This approach has enabled researchers to look beyond just "the clinician" for new answers to wide-scale quality improvement that lie in the patterns of relationships and interactions among the system's staff.


Impact of Unit Characteristics on Patient Outcomes

Joyce A. Verran, PhD, RN, FAAN, Professor and Director, Nursing Systems Division, College of Nursing, The University of Arizona, Tucson (


Based on a study of 32 nursing units, researchers at the University of Arizona found that the higher the nursing culture, as measured by 4 instruments on control, job satisfaction, and communication, and the lower the turbulence, the fewer the medication errors and patient falls. Team culture, as measured by communication, self-regulation, and team relationships, functioned similarly to turbulence, possibly indicating the effect of increased turbulence due to the presence of additional team members. Researchers also demonstrated the feasibility and cost-effectiveness of creating virtual units to test the impact of specific quality improvement strategies before their implementation on actual units. Five papers on various topics were presented as part of the symposium.


Influence of Registered Nurse Stress Resiliency on Psychological Empowerment, Job Stress, and Job Satisfaction

June H. Larrabee, PhD, RN, Associate Professor and Clinical Investigator, West Virginia University Hospitals, School of Nursing, West Virginia University, Morgantown (


Nurse researchers at West Virginia University report preliminary findings that nurses' stress resiliency influences their perceptions of empowerment in the work-place. In findings using a sample of 142 registered nurses (RNs) in 2 acute care hospitals, the more that nurses reported recognizing their own skills and the less they focused on their deficiencies when facing a challenge, the higher was their perception of empowerment. Educators and administrators should consider ways to enhance RNs' stress resiliency because psychological empowerment is a major predictor of RN job satisfaction, the major factor influencing RNs' intent to stay in their jobs.


Leadership Style, Span of Control, and Performance

Amy McCutcheon, PhD, RN, Director, Trauma/Neuro/Ortho/Plastic Programs, St. Michael's Hospital, Toronto, Ontario, Canada (


The manager's leadership style and span of control influence the work environment. Transformational leadership style is the most significant predictor of staff satisfaction; however, there is no leadership style that can overcome a wide span of control. There is a need to develop guidelines regarding the number of staff members a nurse manager can supervise and lead effectively.


Nurse Education and Patient Care Outcomes

Edward J. Halloran, RN, MPH, FAAN, Associate Professor, and H. Lee Bastin, EdD, RN, Senior Clinical Research Associate, ICON Clinical Research, University of North Carolina at Chapel Hill, NC (


Our research on 535 nurses and 2505 patients they cared for found that less well-educated and less-experienced nurses were assigned to patients most in need of complex care from the best nurses. These less-than-optimal assignments of nurses to patients suggest a need for better monitoring of care processes so evidence-based transitional care can be initiated to improve the quality of patient care and reduce institutional costs.


Evaluating Clinical Credibility of Registered Nurses

Claudia D. Smith, MSN, RN, CAN, DSN Student, University of Texas Health Science Center at Houston (


Beginning research is being performed to evaluate the clinical credibility of RNs as the basis for a long-term approach to nurse retention. Clinical credibility is the perception that a nurse is believable and consistently emanates a caring attitude, competence, word-action congruence, and trustworthiness. Clinical credibility may provide the basis for accurate, productive, respectful communication among professionals. Understanding how to recognize and develop clinical credibility may improve nurse-physician relationships and interdisciplinary communication, which may ultimately improve patient outcomes. Clinical ladders that recognize and reward RNs who are perceived to have clinical credibility may increase nurses' job satisfaction and keep "good nurses" at the bedside.


Nursing Unit Characteristics and Patient Outcomes

Suzanne Mulvey Boyle, DNSc, RN, Director, Center for Professional Practice Excellence, Yale-New Haven Hospital, New Haven, Conn (suzanne.


An exploratory cross-sectional study examined how organizational characteristics at the nursing unit level influenced adverse events and failure to rescue. Results suggest that a relationship between work environment characteristics and nurse-sensitive adverse events exists at the nursing unit level in hospitals. The Nursing Work Index (Revised) measured unit characteristics. Autonomy and collaboration were associated with pressure ulcer prevalence and failure to rescue, practice control was associated with nosocomial urinary tract infections, and continuity/specialization was associated with mortality. Findings validated the powerful effect of nursing unit work environment on nurses and safe, quality patient outcomes.


Substance Abuse Treatment in Two Managed Care Structures

Donna McNeese-Smith, EdD, RN, CNAA, Associate Professor and Coordinator, Nursing Administration Graduate Program, School of Nursing, University of California at Los Angeles (


This health services research compared substance abuse treatment within managed care, in both a residential treatment program (RTP) (N = 82) and an outpatient (OP) program (N = 78). Preliminary results showed that these insured, primarily employed clients had drug severity scores of 4.2 in the residential setting and 3.14 in the OP treatment program, on a scale of 0 to 8, with higher scores being more severe. Treatment in the RTP provided an average of 188 hours of therapy, whereas the OP program provided an average of 49 hours of therapy. Days of sobriety after treatment were positively related to intensity of treatment, whereas relapses during treatment had negative relationships to intensity and completion. In both settings, quality-of-life scores and drug use scores were significantly improved with treatment, and 88% completed treatment. Women and ethnic minority clients did as well as white men. Costs for an average course of treatment were $4344 in the RTP and $1903 in the OP program.