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Effects of patient delivery models on nurse job satisfaction, quality of care and patient safety

Effects of patient delivery models on nurse job satisfaction, quality of care and patient safety
Effects of patient delivery models on nurse job satisfaction, quality of care and patient safety
Background; a patient care delivery model describes a method of allocating work at hospital ward level. Four classical models are articulated which involve different work allocation paradigms. Research findings are varied in regard to the association between these models of care and outcomes. This study aimed to (1) describe current approaches to the delivery of nursing care to hospital based patients and (2) examine the association between patient care delivery models and nurse job-satisfaction, quality of care and patient safety.

Method: a cross-sectional survey was conducted in two phases: (1) a pilot study and a preliminary survey; and, (2) the main study. Data were collected from general medical and surgical wards in 11 regional hospitals in Thailand from July 2013 to October 2014.

Findings: The pilot study (9 wards, 1 hospital) demonstrated that the chosen data collection procedures are feasible and confirmed the reliability of the instruments. The preliminary survey (42 wards, 6 hospitals) suggested that there was a degree of incongruence between the models of care reported by the ward managers and the actual patterns of care delivery as well as dissonance with the classical model‘s characteristics derived from the literature. A revised classification, using the ward managers‘ reported current methods of care delivery was made. The majority of the wards (62%) can be classified as team nursing. However, all characteristics of the classical task allocation, and the patient allocation model existed in wards classified as following the team nursing paradigm. The main study (1,193 staff nurses and their 76 ward managers; 83% and 95% response rate) confirmed that current approaches to care delivery are not based on any single classical model; instead, the approaches observed are eclectic, combining the classical team nursing model with a hybrid assignment of tasks as well as patients, and the duration of responsibility lasting for one shift. Hierarchical modelling was performed. After controlling for nurse-to-patient ratio, skill mix ratio and work environment, it was demonstrated that work allocation patterns derived from the team nursing and patient allocation models were found to be independently significant associated with a likelihood of nurse reported good quality of care (odds ratio 3.1 and 1.5, 95% confidence interval: 1.4-6.7 and 1.1-2.1). No supportive evidence for any benefits of implementing work allocation patterns derived from the primary nursing and task allocation models has been found.

Conclusion: The results provided both more accurate knowledge and a better understanding of work allocation mechanisms, at the micro level, within the nursing team. Shifting the emphasis from an evaluation of the patient care delivery model to the components of work allocation is suggested, as the pure classical model no longer exists. However, work allocation patterns that emphasise the formation of explicit nursing sub-teams with the ward compliment (elements of ?team nursing‘) and explicit assignment of nurses to individual patients (elements of ?patient allocation‘) based on nurses skills and patient need appear to be associated with better outcomes than patterns that involve task allocation or those which emphasise continuity of nurse to patient assignment.
Maneejiraprakarn, Phattharamanat
fbd6ed24-1eee-430a-81d7-c579dea75fc1
Maneejiraprakarn, Phattharamanat
fbd6ed24-1eee-430a-81d7-c579dea75fc1
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Giordano, Richard
13c61925-de2b-48ae-beab-6aedac3ed14c

(2016) Effects of patient delivery models on nurse job satisfaction, quality of care and patient safety. University of Southampton, Faculty of Health Sciences, Doctoral Thesis, 233pp.

Record type: Thesis (Doctoral)

Abstract

Background; a patient care delivery model describes a method of allocating work at hospital ward level. Four classical models are articulated which involve different work allocation paradigms. Research findings are varied in regard to the association between these models of care and outcomes. This study aimed to (1) describe current approaches to the delivery of nursing care to hospital based patients and (2) examine the association between patient care delivery models and nurse job-satisfaction, quality of care and patient safety.

Method: a cross-sectional survey was conducted in two phases: (1) a pilot study and a preliminary survey; and, (2) the main study. Data were collected from general medical and surgical wards in 11 regional hospitals in Thailand from July 2013 to October 2014.

Findings: The pilot study (9 wards, 1 hospital) demonstrated that the chosen data collection procedures are feasible and confirmed the reliability of the instruments. The preliminary survey (42 wards, 6 hospitals) suggested that there was a degree of incongruence between the models of care reported by the ward managers and the actual patterns of care delivery as well as dissonance with the classical model‘s characteristics derived from the literature. A revised classification, using the ward managers‘ reported current methods of care delivery was made. The majority of the wards (62%) can be classified as team nursing. However, all characteristics of the classical task allocation, and the patient allocation model existed in wards classified as following the team nursing paradigm. The main study (1,193 staff nurses and their 76 ward managers; 83% and 95% response rate) confirmed that current approaches to care delivery are not based on any single classical model; instead, the approaches observed are eclectic, combining the classical team nursing model with a hybrid assignment of tasks as well as patients, and the duration of responsibility lasting for one shift. Hierarchical modelling was performed. After controlling for nurse-to-patient ratio, skill mix ratio and work environment, it was demonstrated that work allocation patterns derived from the team nursing and patient allocation models were found to be independently significant associated with a likelihood of nurse reported good quality of care (odds ratio 3.1 and 1.5, 95% confidence interval: 1.4-6.7 and 1.1-2.1). No supportive evidence for any benefits of implementing work allocation patterns derived from the primary nursing and task allocation models has been found.

Conclusion: The results provided both more accurate knowledge and a better understanding of work allocation mechanisms, at the micro level, within the nursing team. Shifting the emphasis from an evaluation of the patient care delivery model to the components of work allocation is suggested, as the pure classical model no longer exists. However, work allocation patterns that emphasise the formation of explicit nursing sub-teams with the ward compliment (elements of ?team nursing‘) and explicit assignment of nurses to individual patients (elements of ?patient allocation‘) based on nurses skills and patient need appear to be associated with better outcomes than patterns that involve task allocation or those which emphasise continuity of nurse to patient assignment.

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Final copy of thesis 2016-11-25.pdf - Other
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Published date: November 2016
Organisations: University of Southampton, Faculty of Health Sciences

Identifiers

Local EPrints ID: 404586
URI: http://eprints.soton.ac.uk/id/eprint/404586
PURE UUID: d3a6d052-4c9a-4897-b863-d30a0b23d2b7
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857
ORCID for Richard Giordano: ORCID iD orcid.org/0000-0002-2997-9502

Catalogue record

Date deposited: 27 Jan 2017 16:12
Last modified: 06 Jun 2018 12:32

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Contributors

Author: Phattharamanat Maneejiraprakarn
Thesis advisor: Peter Griffiths ORCID iD
Thesis advisor: Richard Giordano ORCID iD

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