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Degree

Doctor of Philosophy, Case Western Reserve University, Nursing, 1995.

Abstract

Designing and shaping environments facilitating the practice of professional nursing is a responsibility of nursing administrators in maximizing outcomes for an aggregate of patients. Structure and processes, occurring within the nursing care environment, influence patient outcomes. Yet the theoretical relationships between structure and process, as antecedents to outcomes, have not been evaluated. Donabedian's structure-process-outcome model guided this study. The purposes of this nonexperimental study were to determine whether variations in two dimensions of structure, decentralization and expertise, influence participation in three phases of the decision making process (identification, design, and selection) among nurses working in acute care hospitals, and to describe whether these relationships are different based on the nature of the decision. The stratified random sample consisted of 300 Registered Nurses who worked on medical/surgical units in 13 conveniently chosen hospitals representing three sizes of hospitals. Eligible nurses worked at least 18 hours per week and had been on their units for at least 6 months. Nurses were given a questionnaire containing the Participation in Decision Activities Questionnaire, Job Authority Scale, Job Expertise Scale and three single item measures evaluating the global nature of expertise. The findings of this study showed that the relationships between structure and process was supported. Among caregiving decisions, the model (decentralization, expertise, and the interaction of decentralization and expertise) explained 4% of the variance in participation in design and selection. Among condition of work decisions, the model explained 5% of the variance in identification, 6% for design and 8% for selection. In each test of the model, greater decentralization was associated with greater participation. Greater expertise was found to be associated with greater in participation for selection among caregiving decisions and for participation in all phases of condition of work decisions. Decentralization was relatively more important than expertise as evaluated by the magnitude of the standardized beta coefficient. The interaction of decentralization and expertise was nonsignificant. Although the findings supported the relationships between structure and process, the explanatory power of the model was low. These findings suggest that nurses' participation in decision making is more complex and evaluation of other factors is needed

Subject Headings

Health Sciences, Nursing

Keywords

Decision-making; nursing; Decentralization; expertise

Advisor

Patricia F. Brennan

Pages

251p.

Document number: case1062525361
Permalink: http://rave.ohiolink.edu/etdc/view?acc_num=case1062525361

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