The proposed study addresses NINR's mission of eliminating health disparities due to geographic location. Rural hospitals are absent from existing studies that identify community factors (i.e. level of poverty) and organizational factors (i.e. the nurse work environment and hospital characteristics) that influence quality of care and clinical outcomes. In this proposed K01, structural contingency theory is used to conceptualize the association between the nurse work environment, rural community characteristics, hospital and nursing unit characteristics, quality of care, and clinical outcomes (Ml mortality). The goals of this proposed mentored research are to: a) develop a nurse assessed quality indicator and test this measure against established quality indicators (hospital collected, and large public data sets); b) evaluate the relationship between quality indicators and clinical outcomes in small rural hospitals; c) examine characteristics of the community, hospital, nursing unit, and nurse work environment that may influence quality of care indicators and Ml mortality in small rural hospitals. To accomplish this, the candidate will pursue a career development program, and will gain knowledge and proficiency in designing, developing, and using Web surveys; using large secondary public data bases; negotiating the special challenges that rural health research poses; and acquiring advanced knowledge of statistical methods and computer applications needed to do large scale studies using multilevel data. The candidate will be prepared to assume a lead role in planning and conducting complex rural nursing health studies. The training will be applied to the proposed study where small rural hospitals in two states will be invited to participate through their chief nursing officer. Data will be collected from multiple sources: Web-based staff nurse surveys, hospital administrative data, and large public data bases (i.e. Hospital Compare and state discharge data). The data will be analyzed using multilevel modeling and regression techniques. This study will form the basis for future research that includes an expansion of quality of care in the hospital to patient's quality of life after discharge. Findings from this study may inform administrators and policy makers on how quality of care and Ml mortality rates for patients in small rural hospitals are influenced by factors in the nurses' work environment as well as characteristics of the rural community, hospital, and nursing unit. ? ? ?
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| Baernholdt, Marianne; Jennings, Bonnie Mowinski; Lewis, Erica Jeané (2013) A pilot study of staff nurses' perceptions of factors that influence quality of care in critical access hospitals. J Nurs Care Qual 28:352-9 |
| Campbell, Cathy L; Baernholdt, Marianne; Yan, Guofen et al. (2013) Racial/ethnic perspectives on the quality of hospice care. Am J Hosp Palliat Care 30:347-53 |
| Baernholdt, Marianne; Hinton, Ivora; Yan, Guofen et al. (2012) Factors associated with quality of life in older adults in the United States. Qual Life Res 21:527-34 |
| Baernholdt, Marianne; Yan, Guofen; Hinton, Ivora et al. (2012) Quality of life in rural and urban adults 65 years and older: findings from the national health and nutrition examination survey. J Rural Health 28:339-47 |
| Baernholdt, Marianne; Jennings, Bonnie Mowinski; Merwin, Elizabeth et al. (2010) What does quality care mean to nurses in rural hospitals? J Adv Nurs 66:1346-55 |
| Baernholdt, Marianne; Mark, Barbara A (2009) The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. J Nurs Manag 17:994-1001 |
