This study provides some of the first evidence to demonstrate the existence of barriers and differences in barrier perception related to role.https://digitalcommons.centracare.com/nursing_posters/1012/thumbnail.jp

Beckel, Jean

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CentraCare HealthDigitalCommons@CentraCare HealthNursing Posters Posters and Scholarly Works2013Demonstrating Nurse-Sensitive Outcomes: DoBarrier Perceptions Differ By Role?Jean BeckelFollow this and additional works at: https://digitalcommons.centracare.com/nursing_postersPart of the Other Nursing CommonsThis Book is brought to you for free and open access by the Posters and Scholarly Works at DigitalCommons@CentraCare Health. It has been acceptedfor inclusion in Nursing Posters by an authorized administrator of DigitalCommons@CentraCare Health. For more information, please contactschlepers@centracare.com.Recommended CitationBeckel, Jean, "Demonstrating Nurse-Sensitive Outcomes: Do Barrier Perceptions Differ By Role?" (2013). Nursing Posters. 13.https://digitalcommons.centracare.com/nursing_posters/13Jean Beckel, DNP, RN, MPH, CNML St. Cloud Hospital, St. Cloud, Minnesota Demonstrating Nurse-Sensitive Outcomes:  Do Barrier Perceptions Differ By Role? What are the differences in perception of barriers to comprehensively addressing demonstration of nursing practice outcomes related to Magnet designation requirements between Chief Nursing Officers, Magnet Program Directors, Nursing Leaders, and Direct Care Registered Nurses? Research Question Conclusions/ Implications Study provides some of the first evidence to demonstrate existence of barriers and differences in barrier perception related to role. Barriers Identified: • Identifying and allocating needed resources to support outcome reporting • Ensuring understanding of, and accountability for, outcome demonstration at all levels of the organization • Optimizing MPD role and knowledge to facilitate relationship-building and communication specific to Magnet Recognition Program® requirements Implications for Practice: • Design of MPD roles to ensure integration of Magnet process knowledge into hospital data collection and reporting • Opportunity for MPDs to ensure CNO and direct care RN enculturation of Magnet outcome reporting requirements • Design data collection and reporting methodologies/templates to optimize increasingly challenged nursing resources     Scan for St. Cloud Hospital web site.           Email: beckelj@centracare.com • Survey instrument developed Expert input from CNOs, MPDs, and DC RNs • 3 parts:  7 Demographic questions 21 Likert scale items 1 open ended question on best practices • Cronbach’s α = 0.838: tool reasonably reliable and valid • Design: Descriptive, cross-sectional survey • Setting: 2012 national Magnet conference • Sample: Administered to 526 Magnet conference attendees n = 331 (62.9% return) 12 (3.6%) to 16 (4.8%) missing responses per question • Analysis: alpha = .05 SPSS and Minitab Frequencies, Chi Square, ANOVA, post hoc Tukey HSD • Limitations: Recent recognition of barriers to outcome demonstration, No existing reliable and valid survey tool, Convenience sample, Cross-sectional study design,       Methods 1. Donabedian, A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966;44(3): 166 – 203.  2. Doran, D., Mildon, B. & Clarke, S. Towards a national report card in nursing: A knowledge synthesis. Nurs Leadersh. 2011;24(2): 38 – 57. 3. Lundmark, V. Chapter 46: Magnet environments for professional nursing practice: In: Hughes, RG, ed. Patient Safety and Quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality, US Department of Health and Human Services; 2008: Available from: http://www.ncbi.nlm.nih.gov/books/NBK2667/.  4. Nembhard, I.M., Alexander, J., Hoff, T., & Ramanujam, R. Why Does the Quality of Health Care Continue to Lag? Insights from management research. Acad Manage Perspect. 2009;23(1): 24 – 42. 5. Wolf, G., Triolo, P., & Reid Ponte, P. Magnet recognition program: The next generation. J Nurs Adm. 2008;38(4): 200 – 204. * Additional references available upon request  Key References CharacteristicOther: 93 (28.1%)Missing: 4 (1.2%)Assoc/Diploma: 27 (8.2%)Bachelors: 133 (40.2%)Masters: 146 (44.1%)Doctoral: 19 (5.7%)Missing: 9 (1.8%)CNO: 18 (5.4%)MPD: 81 (24.5%) Direct Care RN: 86 (26.0%)Leader: 49 (14.8%)Bachelors: 68 (20.5%)Masters: 45 (13.6%)0 - 9 yrs: 48 (14.5%)10 - 19 yrs: 72 (21.8%)1 - 49: 5 (1.5%)SE US: 40 (12.1%)50 - 99: 6 (2.7%)NE US:47 (14.2%) Midwest US:95 (28.7%)Hospital Location100 - 199: 46 (13.9%)200 - 299: 41 (12.4%)300 - 499: 103 (31.1%)Number of Beds in Your HospitalMagnet: 178 (53.8%) Not Magnet, Non-Journey:21 (6.3%)Not Magnet, Active journey: 115 (34.7%)500+: 105 (34.7%)Non-hospital: 3 (0.3%)Hospital Magnet StatusMissing: 9 (2.7%)South US: 40 (12.1%)SW US: 74 (22.4%)NW US: 8 (2.4%)Outside US: 15 (4.5%)Missing: 12 (3.6%)Years of Nursing Experience20 - 29 yrs: 86 (26.0%)Highest Non-Nursing Ed ti  L lDoctoral: 8 (2.4%)30 - 39 yrs: 96 (29.0%)40 - 50 yrs: 20 (6.0%)Highest Nursing Education LevelMissing: 210 (63.4%)Missing: 9 (2.7%)Missing: 9 (5.1%)Response Category: n (%)Your Current PositionAcknowledgements/ Funding • Capstone Committee: Gail Wolf, PhD, RN, FAAN; Roxanne Wilson, PhD, RN; & Susan Hoolahan, MSN, RN, NE-BC • Randy Kolb & Sara Brodeur, St. Cloud State University Statistical Consulting and Research Center, St. Cloud, MN: thoughtful comments & statistical methodological consultation • St. Cloud Hospital Volunteer Auxiliary: research grant support  Summary of barrier perceptions by role   CNO = Chief Nursing Officer MPD = Magnet Program Director NL = Nurse Leader DC RN = Direct Care RN Perceive less of a barrier Barrier Perceive more of a barrier  DC RNs Coordination of quality data management system MPDs  DC RNs Ease in obtaining needed EHR quality outcome reports MPDs  CNOs Presence of dedicated support personnel to analyze, report, and articulate outcome data DC RNs  MPDs & DC RNs Too many personnel hours are needed to meet Magnet quality indicator requirements CNOs and NLs  CNOs & DC RNs Multiple competing priorities make it difficult to complete Magnet outcome requirements MPDs  DC RNs, CNOs, & NLs Direct Care RNs plan projects with meaningful before and after measures MPDs  DC RNs, CNOs, & NLs Hospital establishes defined outcome measures before initiating projects MPDs   Summary of best practice hospital processes to reduce barriers Organizational • Engaged senior leadership • Commitment as an organizational priority • Communication is crucial: early, ongoing, and frequent • Resources dedicated to collecting data and producing reports • Unit level data displays • Accountability process for displaying, discussing, and submitting trended, benchmarked results • Differentiation between Magnet and other external quality reporting requirements and traditional performance improvement processes • Frequent and repeated educational meetings to facilitate leader and staff process understanding Magnet Program Director • Relationship-building with nursing leaders and unit quality contacts • Comprehensive understanding of hospital units, required indicators by unit, and benchmarking  • Facilitate fit between organizational and Magnet processes • Establish timely processes for units to communicate required outcomes Chi Square Results By Category  X2, df, significance Resource Availability 40.711, 8, p=0.000** Perceived Organizational Value 5.987, 8, p=0.649 Benchmarks 4.084, 8, p=0.849 Competing Priorities 21.938, 8, p=0.005** Process Understanding 25.851, 8, p=0.001** Interpreting  Significance:  * = p ≤ 0.05 ** = p ≤ 0.001 • 1855: Florence Nightingale conducts first nursing outcomes research in Scutari, Turkey • 1966: Donabedian introduces structure, process, and outcome • 1980s to present: evolution to outcome focus • Evidence demonstrates barriers to change, use of research, EBP, and dissemination of research outcomes in public health • No existing evidence on barriers to outcome demonstration • Demonstration of healthcare intervention effectiveness required • Magnet established standards for excellence and expectations for outcome demonstration • Nurses must understand and demonstrate the value nursing practice adds to the business of health care   Introduction   Demographic Results  Results Likert Scale Mean Responses1=strongly disagree, 2= disagree, 3=neutral,4=agree, 5=strongly agreeChief Nursing OfficerMagnet Program DirectorNurse LeaderDirect Care RN Other All SigResources (Q 1, 3, 4, 5, 8, 17)Q1: Our hospital has a coordinated system for managing quality data. 2.556 2.383 2.714 2.860 2.581 2.624 p=0.001Q3. It is easy to get quality indicator reports from the Electronic Health Record. 1.500 1.444 1.612 1.942 1.548 1.633 p=0.001Q4. Our hospital has dedicated support personnel to analyze, report, and articulate data. 1.944 2.148 2.326 2.721 2.387 2.382 p=0.000Q5. Our hospital has a culture of continuous quality improvement in place. 2.833 2.864 2.878 2.930 2.774 2.856 p=0.248Q8. Too many personnel hours are needed to meet Magnet quality indicator requirements. 1.722 2.037 1.694 2.058 2.097 1.991 p=0.031Q17. The cost required to comprehensively manage Magnet quality outcomes is too high. 1.556 1.840 1.816 1.860 1.968 1.862 p=0.314RESOURCES TOTAL 2.018 2.119 2.174 2.395 2.226 2.225 p=0.000Meaningful (Q 2, 10, 20)Q2. Magnet quality indicator data influences nursing practice changes in my hospital. 2.722 2.691 2.735 2.826 2.634 2.719 p=0.325Q10. Measuring Magnet quality indicators is valuable to our hospital. 2.778 2.926 2.898 2.942 2.882 2.905 p=0.402Q20. The only reason we track some indicators is to meet Magnet requirements. 1.389 1.691 1.551 1.651 1.763 1.664 p=0.389MEANINGFUL TOTAL 2.279 2.434 2.382 2.463 2.416 2.420 p=0.383Benchmarks (Q 11, 12 14, 19)Q11. Our practice area has benchmarks available. 2.833 2.728 2.735 2.663 2.527 2.661 p=0.190Q12. Benchmark databases provide meaningful feedback on quality indicators. 2.889 2.716 2.837 2.872 2.806 2.810 p=0.366Q14. Current Magnet indicators are not meaningful for quality care improvement. 1.278 1.173 1.184 1.233 1.301 1.232 p=0.594Q19. External vendors exist that provide unit-based indicator benchmarks needed for Magnet.2.278 2.358 2.082 2.151 2.108 2.186 p=0.220BENCHMARKS TOTAL 2.328 2.244 2.206 2.228 2.183 2.222 p=0.539Priorities (Q 6, 13, 16)Q6. Multiple competing quality initiatives make it difficult to complete Magnet requirements. 2.056 2.346 2.286 1.977 2.280 2.205 p=0.036Q13. Increasing regulatory obligations limit our resources to measure outcomes. 2.167 2.173 2.102 2.046 2.075 2.101 p=0.885Q16. Daily operating priorities limit administrative participation in Magnet quality processes.2.167 2.370 2.163 2.186 2.237 2.242 p=0.606PRIORITIES TOTAL 2.134 2.300 2.201 2.078 2.209 2.192 p=0.223Process Understanding (Q 7, 9, 15, 18, 21)Q7. Staff RNs plan projects that include use of meaningful “before” and “after” measures. 2.222 1.790 2.000 2.477 1.903 2.058 p=0.000Q9. Our hospital is able to create trend charts with axis labels, data labels, and data tables. 2.611 2.790 2.796 2.779 2.871 2.801 p=0.418Q15. Staff RNs understand why “before” and “after” quality outcome measurement is important.2.167 2.037 2.286 2.198 2.032 2.122 p=0.351Q18. There is clear communication to RNs about required Magnet quality indicators. 2.333 2.111 1.959 1.930 2.011 2.024 p=0.378Q21. Our hospital consistently establishes defined outcome measures before initiating projects.2.278 1.802 2.265 2.477 2.194 2.186 p=0.000PROCESS TOTAL 2.322 2.106 2.260 2.371 2.201 2.238 p=0.025

Demonstrating Nurse-Sensitive Outcomes: Do Barrier Perceptions Differ By Role?

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Demonstrating Nurse-Sensitive Outcomes: Do Barrier Perceptions Differ By Role?

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