The management of nursing homes is a pressing problem in the U.S. Nationally there are 23,000 nursing homes with 1.5 million residents. The U. S. Senate recently estimated that almost one-half of U.S. nursing homes are providing substandard care. Most research efforts to improve patient outcomes in nursing homes have focused on clinical aspects of nursing home operations. Little is yet know about the influence of nursing management processes (NMPs) and contextual factors on outcomes in nursing homes. This study is designed to investigate the impact of NMPs on patient outcomes, staff outcomes, and financial outcomes, while also accounting for the influence of case mix and contextual factors. Having knowledge about what, how, and why NMPs influence outcomes in nursing homes will provide valuable information for nurse managers to use in planning for better nursing management outcomes. The long range goal of this research is to develop nursing management interventions that improve patient, staff, and financial outcomes and that will serve as the basis for future intervention research.
The aims of this 5 year, two-phase study are to: 1) explore the relationship between NMPs and contextual factors and their independent and joint influence on patient outcomes, staff outcomes, and financial outcomes in nursing homes; 2) identify additional NMPs and contextual factors that lead to better outcomes; 3) identify what conditions promote the use of, or pose barriers to, effective NMPs; and 4) develop an explanatory model of the linkages between NMPs, contextual variables, and outcome variables by comparing and integrating Phase I and Phase II results. In Phase I, a correlational study of 150 randomly selected nursing homes, using quantitative methods, will be used to accomplish Aim I. The result of Phase I will be basic understanding of what NMPs and contextual factors are related to outcomes. To develop nursing management interventions that will lead to better outcomes, however, requires additional knowledge and understanding about why the variables are related and why some nurse managers have been able to develop and implement NMPs successfully while others have not. Therefore in Phase II, 4 case-studies using qualitative methods will be conducted to extend Phase I by accomplishing Aim II - Aim IV. Multiple sources of data will be used in Phase II including interviews, documentation, and informal observations. To obtain a detailed picture of the relationships among the variables, multiple triangulation will be employed throughout Phase I and Phase II.
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