Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling

University of Alberta, Edmonton, Canada.
International journal of nursing studies (Impact Factor: 2.25). 01/2011; 48(1):81-93. DOI: 10.1016/j.ijnurstu.2010.06.002
Source: PubMed

ABSTRACT Hospital organizational culture is widely held to matter to the delivery of services, their effectiveness, and system performance in general. However, little empirical evidence exists to support that culture affects provider and patient outcomes; even less evidence exists to support how this occurs.
To explore causal relationships and mechanisms between nursing specialty subcultures and selected patient outcomes (i.e., quality of care, adverse patient events).
Martin's differentiation perspective of culture (nested subcultures within organizations) was used as a theoretical framework to develop and test a model. Hospital nurse subcultures were identified as being reflected in formal practices (i.e., satisfactory salary, continuing education, quality assurance program, preceptorship), informal practices (i.e., autonomy, control over practice, nurse-physician relationships), and content themes (i.e., emotional exhaustion). A series of structural equation models were assessed using LISREL on a large nurse survey database representing four specialties (i.e., medical, surgical, intensive care, emergency) in acute care hospitals in Alberta, Canada.
Nursing specialty subcultures differentially influenced patient outcomes. Specifically, quality of care (a) was affected by nurses' control over practice, (b) was better in intensive care than in medical specialty, and (c) was related to lower adverse patient events; nurses in intensive care and emergency specialties reported fewer adverse events than did their counterparts in medical specialties.
Understanding the meaning of subcultures in clinical settings would influence nurses and administrators efforts to implement clinical change and affect outcomes. More research is needed on nested subcultures within healthcare organizations for better understanding differentiated subspecialty effects on complexity of care and outcomes in hospitals.

Download full-text


Available from: Anastasia A Mallidou, Nov 24, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose This paper reports an analysis of the concept of patient outcomes. Methods The Walker and Avant concept analysis approach was applied. Results The attributes of patient outcomes include (1) patient functional status (maintained or improved), (2) patient safety (protected or unharmed), and (3) patient satisfaction (patient reporting of comfort and contentment). These attributes are influenced by the antecedents of individual patient characteristics and health problems, the structure of healthcare organizations and received health interventions. Additionally, patient outcomes do significantly impact the quality of nursing care, the cost of effective care and healthcare policy making formulation. Conclusion Providing good nursing care to all patients is a central goal of nursing. Patient outcomes in nursing are primarily about the results for the patient receiving nursing care. This analysis provides nurses with a new perspective by helping them to understand all the components within the concept of patient outcomes.
    03/2014; 1(1):69–74. DOI:10.1016/j.ijnss.2014.02.006
  • [Show abstract] [Hide abstract]
    ABSTRACT: The present study addressed the associations among various indicators of effort expenditure at work and recovery opportunities (perceived job demands and job control, hours worked overtime, hours worked according to one's contract), work – home interference, and well-being (exhaustion and enjoyment) in a cross-sectional study among 117 male and 82 female managers. Drawing on effort-recovery theory, we expected that high job demands, low job control, a high number of hours worked overtime, and a full-time appointment would be associated with high levels of work – home interference, low levels of enjoyment, and high levels of exhaustion. Stepwise regression analysis largely supported the hypothesis that high job demands and low job control are associated with adverse work outcomes. However, the effects of the number of hours worked overtime and according to one's contract were usually weak and insignificant, suggesting that high effort expenditure does not necessarily have adverse health consequences.
    European Journal of Work and Organizational Psychology 06/2006; 15(2):139-157. DOI:10.1080/13594320500513889 · 2.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There are few validated measures of organizational context and none that we located are parsimonious and address modifiable characteristics of context. The Alberta Context Tool (ACT) was developed to meet this need. The instrument assesses 8 dimensions of context, which comprise 10 concepts. The purpose of this paper is to report evidence to further the validity argument for ACT. The specific objectives of this paper are to: (1) examine the extent to which the 10 ACT concepts discriminate between patient care units and (2) identify variables that significantly contribute to between-unit variation for each of the 10 concepts. 859 professional nurses (844 valid responses) working in medical, surgical and critical care units of 8 Canadian pediatric hospitals completed the ACT. A random intercept, fixed effects hierarchical linear modeling (HLM) strategy was used to quantify and explain variance in the 10 ACT concepts to establish the ACT's ability to discriminate between units. We ran 40 models (a series of 4 models for each of the 10 concepts) in which we systematically assessed the unique contribution (i.e., error variance reduction) of different variables to between-unit variation. First, we constructed a null model in which we quantified the variance overall, in each of the concepts. Then we controlled for the contribution of individual level variables (Model 1). In Model 2, we assessed the contribution of practice specialty (medical, surgical, critical care) to variation since it was central to construction of the sampling frame for the study. Finally, we assessed the contribution of additional unit level variables (Model 3). The null model (unadjusted baseline HLM model) established that there was significant variation between units in each of the 10 ACT concepts (i.e., discrimination between units). When we controlled for individual characteristics, significant variation in the 10 concepts remained. Assessment of the contribution of specialty to between-unit variation enabled us to explain more variance (1.19% to 16.73%) in 6 of the 10 ACT concepts. Finally, when we assessed the unique contribution of the unit level variables available to us, we were able to explain additional variance (15.91% to 73.25%) in 7 of the 10 ACT concepts. The findings reported here represent the third published argument for validity of the ACT and adds to the evidence supporting its use to discriminate patient care units by all 10 contextual factors. We found evidence of relationships between a variety of individual and unit-level variables that explained much of this between-unit variation for each of the 10 ACT concepts. Future research will include examination of the relationships between the ACT's contextual factors and research utilization by nurses and ultimately the relationships between context, research utilization, and outcomes for patients.
    BMC Health Services Research 10/2011; 11(1):251. DOI:10.1186/1472-6963-11-251 · 1.66 Impact Factor