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Greta G Cummings

Publications and source records attributed to Greta G Cummings.

8 recordsLinked to original sources
PubMed2006

Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review.

AIM: This paper reports a systematic literature review examining relationships between contextual factors and research utilization in nursing, examining the strength of these relationships, and mapping the contextual factors to the Promoting Action on Research Implementation in Health Services model of research implementation. BACKGROUND: Healthcare organizations have long struggled with how to improve clinical care outcomes. Understanding which contextual factors enhance nursing research utilization may support organizations in creating environments that facilitate the uptake of evidence in nursing practice to improve these outcomes. METHODS: A search of five electronic bibliographic databases and a manual search of specific journals were conducted for studies that were published in English and examined contextual factors as independent variables and research utilization as the dependent variable from the perspective of nurses working in clinical practice. The studies were assessed for quality of design, sample, measurement and statistical analysis. RESULTS: Ten papers met the search criteria. Six contextual factors were identified as having a statistically significant relationship with research utilization, namely the role of the nurse, multi-faceted access to resources, organizational climate, multi-faceted support, time for research activities and provision of education. The contextual factors could successfully be mapped to the dimensions of context in the Promoting Action on Research Implementation in Health Services framework (context, culture, leadership), with the exception of evaluation. CONCLUSION: The strength of the relationship between the six contextual factors and research utilization by nurses is still largely unknown as (a) few studies were found of sufficient quality because of methodological limitations and (b) the results in reviewed studies were mixed. More robust methods in future work would yield a better understanding of the full impact of contextual factors on nurses' use of research.

Attitude of Health Personnel↗
PubMed2005

Structural equation model testing and the quality of natural killer cell activity measurements.

BACKGROUND: Browne et al. [Browne, MacCallum, Kim, Andersen, Glaser: When fit indices and residuals are incompatible. Psychol Methods 2002] employed a structural equation model of measurements of target cell lysing by natural killer cells as an example purportedly demonstrating that small but statistically significant ill model fit can be dismissed as "negligible from a practical point of view". METHODS: Reanalysis of the natural killer cell data reveals that the supposedly negligible ill fit obscured important, systematic, and substantial causal misspecifications. RESULTS: A clean-fitting structural equation model indicates that measurements employing higher natural-killer-cell to target-cell ratios are more strongly influenced by a progressively intrusive factor, whether or not the natural killer cell activity is activated by recombinant interferon gamma (rIFN gamma). The progressive influence may reflect independent rate limiting steps in cell recognition and attachment, spatial competition for cell attachment points, or the simultaneous lysings of single target cells by multiple natural killer cells. CONCLUSIONS: If the progressively influential factor is ultimately identified as a mere procedural impediment, the substantive conclusion will be that measurements of natural killer cell activity made at lower effector to target ratios are more valid. Alternatively, if the individual variations in the progressively influential factor are modifiable, this may presage a new therapeutic route to enhancing natural killer cell activity. The methodological conclusion is that, when using structural equation models, researchers should attend to significant model ill fit even if the degree of covariance ill fit is small, because small covariance residuals do not imply that the underlying model misspecifications are correspondingly small or inconsequential.

Child↗
PubMed2003

Implementing advanced nurse practitioner roles in acute care: an evaluation of organizational change.

Medical shortages are seen as the driving force behind the recent implementation of the advanced nurse practitioner (ANP) role in some Canadian hospitals. The authors analyzed the implementation of the ANP role in one tertiary care teaching hospital from the organizational change perspective. Despite successful implementation, issues of role definition, scope of practice boundaries, and staff reactions remain unresolved. Recommendations are discussed for implementing ANP roles in other acute care facilities.

Acute Disease↗
PubMedDate not supplied

The impact of hospital nursing characteristics on 30-day mortality.

BACKGROUND: Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professional practice, namely nurse education and skill mix, continuity of care, and quality of the work environment. OBJECTIVE: To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics. METHOD: A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals. RESULTS: Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance = .044, p < .001). Patient comorbidities and age explained 44.2% of the variance in 30-day mortality. After adjustment for patient comorbidities and demographic factors, and the size, teaching, and urban status of the study hospitals in a fixed-effects model, the odds ratios (95% confidence interval) of the significant hospital nursing characteristics that predict 30-day mortality were as follows: 0.81 (0.68-0.96) for higher nurse education level, 0.83 (0.73-0.96) for richer nurse skill mix, 1.26 (1.09-1.47) for higher proportion of casual or temporary positions, and 0.74 (0.60-0.91) for greater nurse-physician relationships. The institutional and hospital nursing characteristics explained an additional 36.9%. DISCUSSION: Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.

Acute Disease↗
PubMedDate not supplied

Is the Nursing Work Index measuring up? Moving beyond estimating reliability to testing validity.

BACKGROUND: The Nursing Work Index (NWI) provided the foundation for three published instruments, each presented as a valid measure of the nursing practice environment. Aiken and Patrician [Aiken, L. H., & Patrician, P. A. (2000). Measuring organizational traits of hospitals: The Revised Nursing Work Index. Nursing Research, 49, 146-153] revised the NWI to the Revised Nursing Work Index (NWI-R), reporting four conceptually derived subscales. Lake [Lake, E. T.(2002). Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing and Health, 25,176-188] used factor analysis to empirically derive five subscales with a composite overarching practice environment factor. Estabrooks et al. [Estabrooks, C. A., Tourangeau, A. E., Humphrey,C. K., Hesketh, K. L., Giovannetti, P., Thomson, D., et al. (2002). Measuring the hospital practice environment: A Canadian context. Research in Nursing and Health, 25, 256-268] reported a single empirically derived factor solution that represented the nursing practice environment. OBJECTIVE: To examine the validity of three instruments (based on the NWI) as measures of the nursing practice environment. METHODS: The measurement models underlying the three instruments were reconstructed from the information provided by each author in published manuscripts and then were estimated using structural equation modeling (SEM), the chi-square test of model fit, and data from the 1998 Canadian Nurse Survey. RESULTS: Each of the three underlying measurement models was factor analytic in design (multiple indicators of each concept) and failed significantly when compared with the data (Aiken & Patrician; chi2 = 939.12, p <.001, df = 50; Lake, chi2 = 17,872.73, p <.001, df = 319; Estabrooks et al., chi2= 38,590.29, p <.001). This lack of model fit with the data raises questions about the validity of these instruments as measures of the nursing practice environment. DISCUSSION: The nursing practice environment is complex and has been examined inadequately by factor-analytic approaches, largely because insufficient attention has been paid to implicit underlying theory. The development and testing of robust theory using powerful research methods available to examine causal relationships in complex theoretical models will advance understanding of constructs such as the nursing practice environment.

Canada↗
PubMedDate not supplied

Development and validation of a derived measure of research utilization by nurses.

BACKGROUND: Theoretical models are needed to guide strategies for the implementation of research into clinical practice. To develop and test such models, including analyses of complex theoretical constructs and causal relationships, rich datasets are needed. Working with existing datasets may mean that important variables are lacking. OBJECTIVE: The aim of this study was to derive a nursing research utilization variable and validate it using the Promoting Action on Research Implementation in Health Services (PARIHS) conceptual framework on research implementation. METHODS: This study was based on data from two surveys of registered nurses. The first survey (1996; N = 600) contained robust research utilization variables but few organizational variables. The second (1998; N = 6,526) was rich in organizational variables but contained no research utilization variables. A linear regression model with predictors common to both datasets was used to derive a research utilization variable in the 1998 dataset. To validate these scores, four separate procedures based on the hypothesis of a positive relationship between context and research utilization were completed. Mutually exclusive groups reflecting various levels of context were created to accomplish these procedures. RESULTS: The derived research utilization variable was successfully mapped onto the cases in the 1998 dataset. The derived scores ranged from 0.21 to 21.40, with a mean of 10.85 (SD = 3.23). The mean score per subgroup ranged from 8.28 for the lowest context group to 12.75 for the highest context group. One of the validation procedures showed that significant differences in mean research utilization existed only among four conceptually unique context groups (p < .001). These groups showed a positive incremental relationship in research utilization (p < .001; the better the context, the higher the research utilization score). The validity of the derived variable was supported by using the three remaining validation procedures. DISCUSSION: The successful creation and validation of a derived research utilization variable will enable advanced modeling of the relationships between research utilization and individual and organizational characteristics. The findings also support the construct validity of the context element of the PARIHS theoretical framework.

Adult↗
PubMedDate not supplied

Hospital restructuring and nursing leadership: a journey from research question to research program.

The 1990s brought new fiscal realities to healthcare, leading to nursing job loss estimates in tens of thousands following widespread hospital restructuring to manage costs and improve efficiency. This research aimed at examining (a) how multiple episodes of hospital restructuring leading to layoff of nurses affected nurses who remained employed and (b) whether and how nursing leadership mitigated or intensified the negative effects of hospital restructuring on nurses. This dissertation comprised 3 empirical studies leading to 5 publications. The first study was a systematic literature review; the second and third used structural equation modeling to develop and test theoretical models addressing nursing practice environments and effects of hospital restructuring on nurses. The combined findings in this dissertation illustrate that hospital restructuring had significant negative physical/emotional health effects on nurses who remained employed. Nurses who worked for resonant (emotionally intelligent) leadership reported positive health and well-being, and opportunities to provide quality patient care. Nurses who worked for dissonant leadership reported greater negative effects of hospital restructuring. These findings led to a beginning theory of relational energy--a mechanism of mitigation whereby resonant nursing leaders invest energy into collaborative relationships with nurses, thereby positively influencing health and well-being, and, ultimately, outcomes for patients.

Alberta↗