Biomedical subjects

Claudia E Schmalenberg

Publications and source records attributed to Claudia E Schmalenberg.

5 recordsLinked to original sources

PubMed2007

Excellence through evidence: structures enabling clinical autonomy.

Autonomy is a multidimensional process. Clinical autonomy, the dimension in which patients are the primary beneficiaries, is the focus of this study. Despite high valuation and persistent challenges to nurses to function autonomously, the relationship between autonomous practice and patient outcomes has not been empirically established due, in large measure, to a lack of correspondence between concepts and measurement of autonomy and to a lack of knowledge of enabling structures. The purpose of the research reported here is to identify the structures, practices, elements in the environment, and interventions that nurses, nurse managers, and physicians identify as promoting staff nurse clinical autonomy. Implementation of these interventions would then enable clinical decision making at the frontline and would foster studies to determine whether the expected linkage between clinical autonomy and positive patient outcomes prevails.

Nurse Administrators↗

PubMed2006

Excellence through evidence: the what, when, and where of clinical autonomy.

Despite high valuation and persistent challenges to nurses to function autonomously, neither the structures fostering clinical autonomy nor the relationship between autonomous practice and positive patient outcomes has been empirically established. Much of this is caused by the lack of precision in definition and measurement of the concept and identification of autonomy-enabling structures. The goal of this multisite, evidence-based management practice study is to provide an in-depth analysis of the concept and an articulation of a grounded theory of clinical autonomy preparatory to the identification of structures supporting autonomy. This article describes the research design and methodology and explicates the grounded theory by answering the following questions: What is clinical autonomy? When and where does it occur? Suggestions and recommendations for what could be done to clarify the concept and promote clinical autonomy are provided.

Decision Making↗

PubMed2003

Magnet hospital nurses describe control over nursing practice.

Staff nurses describe control over nursing practice (C/NP) as a professional nursing function made up of a variety of activities and outcomes. Greater acclaim, status, and prestige for nursing in the organization are viewed as a result, not a precursor, of C/NP. Interviews with 279 staff nurses working in 14 magnet hospitals indicated that effective C/NP requires some kind of empowered, formal organizational structure, extends beyond clinical decision making at the patient care interface, and is the same as or highly similar to what the literature describes as professional autonomy. From constant comparative analysis of nurses' descriptions of C/NP activities, five ranked categories of this real-life event emerged. The basis for the categories and ranking was "who owned the problem, issue, and solution" and the "degree of effectiveness of control" as reflected in visibility, viability, and recognition of a formal structure allowing and encouraging nurses' control over practice. Hospital mergers and structural reorganization were reported to negatively affect the structure needed for effective C/NP. Almost 60% of these magnet hospital staff nurses stated and/or described little or no C/NP.

Health Knowledge, Attitudes, Practice↗

PubMedDate not supplied

Magnet hospital staff nurses describe clinical autonomy.

BACKGROUND: Considerable and longstanding confusion abounds as to what is meant by the concept "autonomy." The 2 dimensions of autonomy-rooted in the clinical act and the autonomy of the discipline or profession-are used interchangeably and measured with the same tools. PURPOSE: The purpose of this research was to ascertain staff nurses' concept of autonomy, to empirically quantify nurse autonomy, and to determine the relationship between degree of autonomy and staff nurses' rankings of quality care on their units and their own job satisfaction. METHOD: Two hundred seventy-nine volunteer staff nurses from 14 magnet hospitals were interviewed individually with the open-ended question and request, "Can you practice autonomously? Give an example of a typical situation that illustrates that you practice autonomously," and with two 10-point rating scales on job satisfaction and quality of care given on their units. Responses were subjected to constant comparative and thematic analyses. On the basis of 3 themes-frequency, organizational sanction, and scope-a 5-category ranked autonomy scale was developed. These magnet hospital staff nurses restrict the concept of autonomy to the clinical act. There is a strong relationship between degree of autonomy as measured by the ranked scale and rankings of job satisfaction and quality of care. An unexpected finding was that 26% of these nurses working in magnet hospital reported situations of unsupported or no autonomy. DISCUSSION: This research is particularly meaningful for nurse managers and researchers. Nurse managers must empower nurses, provide support, provide opportunities for nurses to increase competence, and reward and sanction staff nurse autonomy. After further refinement, the ranked-category scale will be useful in studying the effect of educational efforts and organizational support on the development of clinical autonomy.

Decision Making↗

PubMedDate not supplied

Best quality patient care: a historical perspective on Magnet hospitals.

Donabedian's Structure-Process-Outcome paradigm is used to analyze the evolution and research on the concept of magnetism through 4 phases. The identifying foci of the original 1983 study were 4 outcomes. A large number and array of structural features were derived from the identified Magnet hospitals. The quest for excellence in nursing care continued with the Gold Standard of Magnetism case studies utilizing all identified Magnet structures, processes, and outcomes. The advent of the American Nurses Credentialing Center Magnet Recognition Program stimulated much valuable and insightful research related to outcomes associated with the large group of magnetic structures. Magnet hospital staff nurses (SNs) identification of processes/functions most essential to quality patient care highlights the Process phase. Many of the vast array of structural features attributed to Magnet hospital in 1983 are outdated and differentially defined and have not been tested for their relationship to either processes or outcomes. Identification of magnetism from an SN perspective has lagged. Recommendations include updating and clarifying structural criteria; increasing focus on the SN perspective of magnetism by continuing identification of processes; and challenging leadership in Magnet hospitals to initiate multisite evidence-based practice initiatives to link structures with process-enabling outcomes. Now may well be the time for nursing to exert leadership in expanding the Magnet concept to the total patient-care operation in a hospital.

Awards and Prizes↗