Globalization

Nursing Practice Models: Research on Patient Outcomes
Carol S. Weisman, Ph.D.

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This paper examines the state of knowledge regarding the effects of nursing practice models on patient outcomes. Many hospitals, and to some extent other care facilities, are experimenting with innovative models of nursing practice, and some of these models are the subject of evaluation research. This paper will attempt to summarize what is known from studies in which the practice model is the independent variable, an element of the “structure” of health care settings (Donabedian, 1988), and patient outcomes are dependent variables. The paper will present an overview of innovative nursing practice models; will summarize the types of patient outcome measures employed in studies of these models and present some examples of findings; will discuss some of the methodological issues that arise in this type of research; and will suggest future research needs in this area. Since many models are still in the formative stages and evaluations are ongoing, much of the evaluation research on practice models has not yet been reported. Nevertheless, the studies represent a significant departure from earlier research on patient outcomes. Previous research on patient outcomes rarely had included variables representing the organization of nursing services. Hospital studies frequently considered attributes of medical staff but neglected attributes of nursing staff. Figure 1 provides some information on four studies that did consider aspects of nursing service or-

ganization as predictors of mortality among surgical patients, intensive care patients, and Medicare patients. In these studies, the measures of nursing organization were somewhat crude and did not reflect practice model issues.

Overview of Nursing Practice Models For purposes of this paper, the term “nursing practice model” refers to operational models for redesigning nursing practice for the provision of patient care in...