How Do Professional Practice Model Components Influence Patient and Nurse Outcomes?

How Do Professional Practice Model Components Influence Patient and Nurse Outcomes?


Name: Patricia Patrician

Rank: COL (ret)

Presenter/Poster: Presentation and Poster

Year: 2018


Objective: To evaluate various components of the Patient CaringTouch System (PCTS) of professional nursing practice and their association with patient and nurse outcomes in military hospitals.
Background: The PCTS development was based on the scientific literature and exemplar organizations. Of the ten components that make up the PCTS, six were implemented at the hospital and/or unit level. Their implementation and sustainment were tracked with site visits. These six components were designed to facilitate: understanding the Core Values (CV) of the enterprise, Skill Building (SB) activities, unit-based Shared Accountability (SA) (governance) councils, mechanisms for Peer Feedback (PF) on performance, Care Teams (CTs) led by registered nurses, and staff use of Optimized Performance (OP) metrics.
Methods: This analysis was part of a longitudinal program evaluation of the PCTS at 10 MTFs. Site visits were conducted using a reliable implementation and sustainment checklist developed and tested (kappa=.91) for this project. Existing administrative data were used to measure the outcomes. Mixed effects models were used to analyze the associations the components with patient falls, medication errors, and pain reassessment and nurses’ job dissatisfaction, intent to leave (ITL), and potentially preventable loss (PPL), or nurse turnover that may have been prevented.
Findings: Units with higher scores on CV implementation were associated with lower patient falls with injury (-.30, p<.05), higher pain reassessment rates (.18, p<.05), lower nurses’ PPL (-.22, p<.05), but slightly higher job dissatisfaction (.05, p<.05). Units with higher SB scores had lower nurses’ PPL (-.27, p<.05). Higher SA scores were associated with lower nurses’ ITL (-.40, p<.05) and lower nurses’ PPL (-.29, p<.05). Lower nurses’ job dissatisfaction (-.04, p<.05) and lower ITL (-.06, p<.05) were associated with higher PF scores. Higher CT scores were problematic in that they were related to higher ITL (.10, p<.05) and higher nurses’ PPL (.22, p <.05). Finally, units with higher OP scores paradoxically had higher falls with injury rates .40, p<.05), lower pain reassessment (-.18, p<.05) and higher PPL (.37, p<.05).
Implications for Military Nursing: This analysis provided evidence that while some components of the PCTS were improving outcomes, others were not; this suggests the need for modification. Nursing models must be evaluated by component periodically to ensure relevance and effectiveness.