Biomedical subjects
Publications and source records attributed to C A Allred.
The analysis of multidimensional constructs presents a challenge. The challenge is to combine the information from the dimensions relating to the construct in a meaningful way. This article examines a complex construct known as the nursing practice environment and describes the use of cluster analysis to combine information from three dimensional measurements to operationalize the construct.
Although the concept of coordination is not new to nursing, little is known about how it contributes to cost-effective patient care outcomes. The authors examined the mechanisms used by staff nurses to coordinate patient care services in practice environments characterized by low, moderate, and high levels of uncertainty. Regardless of practice environment conditions, nurses used the same mechanisms to coordinate patient care. These findings suggest a potential for inadequate communication among providers, poor coordination of services, and lost efficiency. Strategies to improve coordination of patient care services are discussed.
Development of a quality index allows a quantifiable synthesis of selected patient-care outcomes and service costs. The quality index provides potential buyers of healthcare a way to judge the costs associated with a particular level of quality and thus, compare the value of alternative services.
The purpose of this study is to evaluate the preliminary psychometric properties of the Perceived Environmental Uncertainty Questionnaire (PEUQ). Environmental uncertainty (EU) refers to times when within the organization unanticipated events and problems occur with frequency and cannot be predicted by members of the organization due to a lack of critical information. The PEUQ was designed as a measure of EU and was tested with 375 patient-care and nonpatient-care hospital employees. Internal consistency as measured by Cronbach's alpha was .81. Confirmatory factor analysis supported two of the PEUQ's hypothesized three factors: state and effect EU. These two factors accounted for 61.1% of the variance in subjects' level of uncertainty. Factor analysis failed to confirm response uncertainty as a subconstruct of EU. Contrasted group analysis found expected differences in the level of perceived EU between workers on different hospital units (t = -5.02, p < .001). This study provides evidence of the PEUQ's beginning reliability and validity as a measure of EU. Failure to identify response uncertainty as a salient subconstruct of EU warrants further exploration. The design of nursing care delivery structures (NCDS) to minimize EU first requires a means to measure hospital units' EU. The establishment of the PEUQ's psychometric soundness is antecedent to measuring EU and improving the efficacy of our NCDS.
In this paper, the authors describe the development and validation of an inventory of preventive cardiology at the University of Virginia. The inventory contains two instruments designed to measure medical students' preinstructional and postinstructional knowledge of and attitude toward preventive cardiology. The knowledge test subscales provide unique and significant information about knowledge in preventive cardiology and can discriminate among groups differing in level of instruction and expertise in preventive cardiology. The attitude survey provides information about two attitude factors: cardiovascular disease prevention and cardiovascular disease research priorities. In the study reported here, attitudes appeared not to differ among groups of students with different preventive cardiology instructional levels and expertise. Both instruments were demonstrated to be useful measures of medical students' knowledge and attitudes concerning preventive cardiology educational programs.
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With anticipated changes in healthcare delivery systems, nursing faculty members need to redefine the faculty role and scholarship as a product of that role. The authors describe the development of appointment, promotion, and tenure criteria that value scholarly outcomes generated from both practice and research within the educational model.
In response to increasingly uncertain practice environments, case management structural dimensions of role differentiation, task coordination, and decentralization remained constant, while nurse participation in decision making increased significantly.
Case management was more cost effective in a moderately uncertain practice environment than in either a low or a high uncertainty environment. The environmental state, case manager role differentiation, and information coordination contributed most strongly to these outcomes.
Analysis of one academic medical center revealed three distinct nursing practice environments distinguished by increasing levels of complexity, change, unpredictability, and uncertainty. Designing practice models to accommodate these conditions will facilitate more efficient and effective patient outcomes.