The Verran Professional Governance Scale: Confirmatory and Exploratory Analysis.

This article describes psychometric testing and refinement of the Verran Professional Governance Scale (VPGS), which measures behaviors associated with professional governance. Phase 1 reduced the items on the scale based on floor and ceiling effects and redundancy of items. Phase 2 examined structural construct validity using exploratory (EFA) and confirmatory factor analysis (CFA).

Professional Governance Scale: Instrument Development and Content Validity Testing.

Instrument development and content validity testing resulted in a new instrument to measure the relatively new concept of professional governance. Professional governance is defined as the accountability, professional obligation, collateral relationships and decision making of a professional, foundational to autonomous practice and achievement of exemplary empirical outcomes. Fourteen experts with subject matter expertise either in measurement development or in creating professional practice environments assessed the validity of the proposed items and the instrument.

Consensus achievement of leadership, organisational and individual factors that influence safety climate: Implications for nursing management.

Aim: To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects.

Background: Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research.

Methods: A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety.

Evolution of Structural Empowerment: Moving From Shared to Professional Governance.

Objective: The aim of this study is to describe the maturation of the concept of shared governance to professional governance as a framework for structural empowerment.

Background: An analysis of the literature and concept clarification of structural empowerment and shared governance demonstrate that the concept and attributes of shared governance have evolved toward professional governance.

Methods: A comprehensive, deductive literature review and concept clarification of structural empowerment, shared governance, and related constructs was completed.

Development of an Instrument to Measure the Unintended Consequences of EHRs.

This article augments the existing body of literature through examining the creation and design of an instrument measuring unintended consequences (UCs) of electronic health records (EHRs). Data from a previous qualitative study that explored nurses' perceptions of EHR effectiveness as a communication system were analyzed using a theoretical model focused on decision making. The qualitative data, informed by the model, were then organized into an instrument seeking to quantitatively measure nurses' experiences with UCs of EHRs.

Measuring nursing unit environments with four composite measure.

Understanding the context in which nurses work is an important step to designing work environments in which nurses can achieve targeted quality. Developing a usable instrument for describing the work environment and the relationship to staffing is essential for the development of evidence-based staffing decisions. The major implications of the research reported here are that the work environment of nurses, while complex, can be modeled with composite variables that reflect various dimensions of that environment.

Simulating nursing unit performance with OrgAhead: strengths and challenges.

In this article, we briefly describe our use of a computational modeling tool, OrgAhead, details of which have been reported previously, then discuss several of the challenges computational modeling presented and our solutions. We used OrgAhead to simulate 39 nursing units in 13 Arizona hospitals and then predict changes to improve overall patient quality and safety outcomes. Creating the virtual units required (1) collecting data from managers, staff, patients, and quality and information services on each of the units; (2) mapping specific data elements (eg, control over nursing practice, nursingworkload, patient complexity, turbulence, orientation/tenure, education) to OrgAhead's parameters and variables; and then (3) validating that the newly created virtual units performed functionally like the actual units (eg, actual patient medication errors and fall rates correlated with the accuracy outcome variable in OrgAhead).

Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow.

Purpose: To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain.

Using ORA to explore the relationship of nursing unit communication to patient safety and quality outcomes.

Purpose: We used ORA, a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units.

Methods: Using a survey methodology, we collected communication network data from nursing staff on seven patient care units on two different days.

Correlations of nursing communication network metrics with patient outcomes.

Communication problems have been implicated in many safety and quality issues, but tools to examine communication networks and their impact on patient outcomes are only beginning to become available. We used *ORA, an organizational risk analyzer that allows the dynamic analysis of organizational networks to explore the communication networks among staff on seven nursing units in three Arizona hospitals. The results showed correlations between a number of *ORA metrics and patient safety and quality outcomes.

Nurse managers' decisions: fast and favoring remediation.

How do nurse managers make decisions about quality issues on their units? We asked 10 nurse managers in 3 Arizona hospitals to describe how they resolved a recent quality issue. The managers tended to use a linear, but cognitively expensive strategy, often jumping from problem to solution without a clear goal and selecting solutions biased toward remedial education. Decision support tools should help managers think more systemically and efficiently, while encouraging consideration of more alternatives to reach targeted goals.

Accurate assessment of clinical nurses' work environments: response rate needed.

Improvement of hospital unit work environments is key to quality patient care, productivity, nurse retention, and job satisfaction. Accurate measurement of such environments is necessary prior to introduction and evaluation of improvement structures and strategies. Characteristics and attributes of work environments are group level phenomena.

Social relations modeling in telehomecare.

Telehomecare usage requires that patients, home-helpers and nurses interact as a group using remote communication technology. Group interaction produces many levels of social variance that contribute to outcomes. It is unknown how social variances in remote interaction influence outcomes.

The Systems Research Organizing Model: a conceptual perspective for facilities design.

Purpose: The purpose of this article is to (1) demonstrate the utility of the Systems Research Organizing Model (SROM) for evidence-based design; (2) explicate the SROM; and (3) demonstrate how the SROM can advance the science of healthcare design.

Background: Grounded in systems science and adapted from the Quality Health Outcomes Model, the SROM was originally designed to assist in the organization of nursing systems research. It is useful for research in other fields as well because it serves as a potential framework for new investigations, allows delineation of key factors in previous research studies, and allows for the synthesis of a body of research knowledge.

Using OrgAhead, a computational modeling program, to improve patient care unit safety and quality outcomes.

As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we used a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 32 units in 12 hospitals in Arizona. Validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units.

Using computational modeling to improve patient care unit safety and quality outcomes.

As part of ongoing research to investigate the impact of patient characteristics, organization characteristics and patient unit characteristics on safety and quality outcomes, we are using a computational modeling program, OrgAhead, to model patient care units' achievement of patient safety (medication errors and falls) and quality outcomes. We tuned OrgAhead using data we collected from 16 units in 5 hospitals. Subsequent validation studies demonstrated acceptable levels of correspondence between actual and virtual patient units.

Using computational modeling to study the impact of workplace characteristics on patient safety outcomes.

How do patient characteristics, organization characteristics and patient care unit characteristics interact to affect quality, safety, and cost outcomes? What changes can nurse managers make on their units that will optimize outcomes for their patients? To answer these questions, we are collecting data from 35 nursing units in 12 hospitals in Arizona, and using the results as a basis for computational modeling. Although it has been used in clinical research, until now computational modeling has had little application to healthcare or nursing organizations. In this poster session, we describe our application of Orgahead, a computational modeling program.

Using computational modeling to transform nursing data into actionable information.

Transforming organizational research data into actionable information nurses can use to improve patient outcomes remains a challenge. Available data are numerous, at multiple levels of analysis, and snapshots in time, which makes application difficult in a dynamically changing healthcare system. One potential solution is computational modeling.

Public health nursing: the generalist in a specialized environment.

In implementing a generalist model of public health nursing (the Comprehensive Multi-level Nursing Practice Model) in a rural county health department, a research team encountered critical challenges. The framework for the model was a philosophy of public health nursing practice and action research to support the public health nurse generalist role. Challenges in implementing the model stemmed from conflicts between the research team and the health department that were rooted in philosophical differences about how to implement care and the nature of nursing and the public health nursing role.