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Biomedical subjects

L R Lutjens

Publications and source records attributed to L R Lutjens.

9 recordsLinked to original sources
PubMed1994

Hospital payment source and length-of-stay.

The primary aim of the research reported here is to examine elements of the theory of social organizations as adaptive systems as derived from Roy's model by investigating the ability of hospital payment source to predict length-of-stay. A retrospective review was conducted of 3,297 records of patients discharged under 1 of 10 frequently occurring diagnosis-related-groups. Two groups were formed to isolate the contextual stimuli-patients whose hospital care was paid for under a diagnosis-related-group payment system and patients whose hospital care was paid for under a per diem payment system. The Tilton 0 statistic indicated a high degree of similarity between the two patient groups. Thus, length-of-stay could not be effectively predicted based on the source of payment to the hospital.

Diagnosis-Related Groups↗
PubMed1994

Evaluating planned change theories.

A criterion-referenced instrument was developed for determining to what extent a planned change theory meets predetermined criteria of significance, agreement with nursing's perspective, clarity and consistency, economy, generality, practicality and testability. These criteria form the basis of a quantitative instrument composed of 31 evaluation questions to determine a planned change theory's suitability for nursing situations. This instrument combines well with qualitative evaluations of theory goodness and with change theorists' ratings of their own theories. Psychometric evaluation of the instrument is in progress.

Nursing Service, Hospital↗
PubMed1993

Determinants of hospital length of stay.

An example of the inefficiency of cost-based reimbursement is that wide variations were observed between hospitals and between regions in the cost of treating similar diagnoses, with no apparent differences in quality. To correct these variations, the Tax Equity and Fiscal Responsibility Act and its concomitant prospective payment system based on DRGs was implemented. However, wide variations continued to exist among hospitals and regions in the United States. The attempt by the medical profession to refine the prospective payment system by severity adjustments has received lukewarm support. The work by Halloran et al on the relationship between nursing diagnosis and length of stay shows some promise. Studies on nursing intensity have produced mixed results. Recently, the Prospective Payment Assessment Commission decided to discontinue efforts to develop nursing intensity adjustments for DRG weights. Additionally, institutional characteristics, except for discharge planning programs, and patient characteristics have exhibited mixed results in attempts to explain hospital length of stay. Concern over continuing variations that DRGs and their proposed adjustments have been unable to correct led to the formation of the Agency for Healthcare Policy and Research, which was brought about by the Omnibus Budget Reconciliation Act of 1989. This agency seems to believe that practice patterns offer the greatest hope of reducing excessive hospital lengths of stay and concomitant costs.

Diagnosis-Related Groups↗
PubMed1992

Derivation and testing of tenets of a theory of social organizations as adaptive systems.

Management and organizational theories are commonly used to design nursing administration studies. This article proposes a nursing theory as a viable alternative and demonstrates its utility in the conduct of nursing administration research. The purpose of the research was to determine the explanatory power of the environmental stimuli of medical condition, nursing condition, nursing intensity, and medical severity on length-of-stay (LOS). Twenty-three percent of the variance in LOS was accounted for by the environmental stimuli with nursing acuity contributing 14%. The focal stimulus, medical condition (diagnosis-related groups), uniquely explained only one percent of the variance. The theory of social organizations as adaptive systems, derived from the Roy adaptation model, provides an attractive nursing framework to guide and design studies that will contribute to nursing administration science and address practical problems confronting nurse administrators.

Adaptation, Psychological↗
PubMedDate not supplied

Nursing theory in nursing education: an educational imperative.

Nursing has accepted theory as basic to its practice; however, the use and development of nursing theory is constrained by the approach used in nursing education. It is not appropriate or sufficient to isolate theory in one course. Moreover, confining nursing theory courses to graduate curricula, which is the custom in many schools of nursing, suggests that to focus on theory in the profession is esoteric. These curricular approaches inhibit socialization of students to the value of theory as essential to practice. It is imperative that nursing education engage students in theory-related content at all levels. This article presents a scheme to achieve systematic integration of theory-related content in curricula at all levels of nursing education from associate degree to doctorate. Through theory-based practice, nursing will come to realize its full potential as a discipline.

Curriculum↗
PubMedDate not supplied

The nature and use of nursing diagnosis in hospitals.

This descriptive study examined the frequency of types of diagnoses formulated by RNs. Ten patient charts were randomly selected from each of 10 frequently occurring diagnosis-related groups (DRGs) (N = 100). Findings indicated the majority of diagnoses (N = 1,504) were made in the Exchanging (55.33%) Human Response Pattern by two groups of nurse raters--RN caregivers and CNSs. Differences in number of diagnoses made by the nurse groups were statistically significant for all Human Response Patterns. Overall, the CNSs made more diagnoses than the caregivers (944 vs. 560), and their diagnoses were of a broader nature.

Diagnosis-Related Groups↗