Round 3 Grants
Round 3 Grants
The Robert Wood Johnson Foundation (RWJF) awarded the third round of grants through its Interdisciplinary Nursing Quality Research Initiative (INQRI) program on September 1, 2008. Eight teams of nurse scholars and scholars from other disciplines were selected to conduct two-year research projects to examine the link between nurses' contributions and the safety and quality of patient care.
The Impacts of Nurse Staffing, Skill Mix, and Experience on Quality and Costs in Long-Term Care
Palo Alto Institute for Research and Education
Menlo Park, CA
Dr. Patricia Stone
Dr. Ciaran Phibbs
This project will examine whether there is a causal relationship between nursing input (ie. staffing and human capital characteristics) and patient outcomes in long-term care (LTC) facilities, and will analyze efficiency by studying the tradeoffs between nursing personnel costs and cost savings due to improved patient outcomes. Using a unique longitudinal database of the entire population of LTC facilities operated by the Veterans Administration in fiscal years 2003-2007, the team will link a variety of patient outcomes to detailed measures of the nursing input, controlling for other factors that can influence patient outcomes. Site visits will also be conducted and multivariate fixed-effect regressions will be estimated using monthly data. This project is co-led by Ciaran Phibbs, PhD, an economist and Patricia Stone, PhD, a nurse researcher.
The Effect of Off-peak Hospital Environments on Nurses' Work: an Institutional Ethnography
Midwestern State University
Wichita Falls, TX
Dr. Patti Hamilton
Dr. Gretchen Gemeinhardt
This project uses Institutional Ethnography (IE) to situate nursing in the center of an interdisciplinary approach to learn how and why off-peak work environments are different, and how they affect nurses' work and patient care. Two types of data will be collected. Level I data will be transcripts from individual and focus-group interviews. Level II will include managerial policies, documents, and other texts, used to improve quality and efficiency by standardizing and controlling the work of nurses. This project will provide researchers with insight into how to account for temporal variations in nurses' work environment when specifying causal models linking nursing care to patient outcomes. The project also will provide stakeholders with materials that help them identify, evaluate, and anticipate effects of initiatives to improve efficiency, effectiveness, quality and cost on nursing care provided during off-peak periods. This team is co-led by Patti Hamilton, PhD, RN, a nurse researcher, and Gretchen Gemeinhardt, PhD, MBA, a psychologist with a background in management and organizational behavior.
Impact of Medical Surgical Acute Care Microsystem Nurse Characteristics and Practices on Patient Outcomes
University of California, San Francisco
San Francisco, CA
Dr. Nancy Donaldson
Dr. Carolyn Aydin
The aim of this project is to develop an empirically derived predictive model examining individual and collective effects of unit level nurse workload, staff nurse characteristics and selected risk assessment and preventive intervention processes of care on variance in nurse sensitive outcomes of acute care medical-surgical units. The study uses "community-based action" research methods in a non experimental design that integrates quantitative and qualitative (observational) methods. As a secondary aim, the team will add a new measure, Hospital Acquired Stage 3-4 Pressure Ulcer Incidence, to the CalNOC dataset. This team is co-led by Nancy Donaldson, RN, DNSc, a nurse researcher, and Carolyn Aydin, PhD, a scholar with a background in humanities and communication theory research.
The Res-Care-AL Intervention Study
University of Maryland, Baltimore
Baltimore, MD
Dr. Barbara Resnick
Dr. Sheryl Zimmerman
This project is a randomized controlled trial to test a restorative care intervention for assisted living (AL). The project incorporates patient centered outcomes (falls); nursing centered outcomes (restorative care services); and system-centered outcomes (staff turnover) as designated by the National Quality Forum. The primary aim of this study is to maintain or improve the residents' physical activity, physical status, function, and length of stay in the facility. The secondary aim related to residents focuses on mood, life satisfaction, resilience, self-efficacy and outcome expectations, social-support for exercise, and person-environment fit. This team is co-led by Barbara Resnick, PhD, CRNP, a nurse researcher, and Sheryl Zimmerman, PhD, MSW, a social worker.
Multidisciplinary Organization and Outcomes for Chronic Heart Failure Patients in the VA
University of Minnesota
Minneapolis, MN
Dr. Joanne Disch
Dr. Douglas Wholey
This research team will test a theory of the effect of nurse-physician co-leadership, the effective modeling by nurses and physicians of individual role behaviors and a strong shared inter-professional relationship, in chronic heart failure (CHF) care groups in Veterans Health Administration (VHA) medical centers. The outcomes will be waste in care processes, patient outcomes of receiving dietary and medication instructions at discharge, adult smoking cessation advice/counseling, and readmissions and provider outcomes of nurse burnout and CHF knowledge. The unit of analysis is patients and providers nested in VHA CHF care groups. The project has an observational design, with patient outcomes being followed for a year after a survey of CHF care groups. The project is being co-led by Douglas Wholey, PhD, MBA, a scholar with a background in Mathematics, General Management and Organizational Behavior/Industrial Relations, and Joanne Disch, PhD, RN, a nurse scholar.
The Effects of Nurse Presenteeism on Quality of Care and Patient Safety
University of North Carolina, Greensboro
Greensboro, NC
Dr. Susan Letvak
Dr. Christopher Ruhm
The primary aim of this project is to evaluate the influence of presenteeism (decreased productivity due to health problems) on hospital Registered Nurses' (RNs) quality of patient care. A secondary aim is to assess economic costs to the healthcare system associated with presenteeism. The study will use a mixed methods (quantitative survey and qualitative focus groups) design of RNs in North Carolina. This team is co-led by Susan Letvak, PhD, a nurse researcher, and Christopher Ruhm, PhD, an economist.
Small Troubles, Adaptive Responses [STAR]: Fostering a Quality Culture in Nursing
University of Texas Health Science Center, San Antonio
San Antonio, TX
Dr. Kathleen Stevens
Dr. Robert Ferrer
This project aims to improve nursing units' quality and efficiency. The research question is whether a program designed to identify and address small problems encountered by nurses in patient care occurring about once per hour per nurse and managed with workarounds in 95% of cases can lead organizational learning that will drive large improvements in safety, quality, and efficiency. The intervention, adapted from theoretically-based programs proved effective in other settings, combines a methodology for enhancing the underlying performance improvement capability of nursing units with a toolbox of quality improvement strategies relevant for tackling the small problems encountered in practice. This team is co-led by Kathleen Stevens, EdD, RN, FAAN, a nurse researcher, and Robert Ferrer, MD, MPH, a medical doctor with a background in family medicine and biology.
Empowering Home Care Nurses to Efficiently Resolve Medication Discrepancies
Washington State University
Spokane, WA
Dr. Cynthia Corbett
Dr. Stephen Setter
To contribute to a better understanding of the potential for home care nurses to lead in the identification and resolution of medication discrepancies during transitions between hospital and home care providers, this team will conduct a clinical trial that investigates a new nurse-led, informatics-based intervention. They hypothesize that with this improvement in their environment, home care nurses already on staff can enhance patients' outcomes, reduce healthcare costs, and eliminate the need for duplicative services by external consultants or specialty providers. Data analytic strategies will include analysis of variance, multifactor analysis of co-variance, and linear regression analysis. This team is co-led by Cynthia Corbett, PhD, RN, BA, a nurse researcher, and Stephen Setter, PharmD, PharmB, DVM, BS, a scholar with a very diverse background: crop & soil sciences, veterinary medicine, pharmacy, geriatrics.