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The relationships among the context, structure, and performance of nursing units in hospitals
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Dissertation
The relationships among the context, structure, and performance of nursing units in hospitals
1995
Overview
The purpose of this study was to test the information processing theory of organizational design (Galbraith, 1973; Tushman & Nadler, 1978) for effective decision making (Huber & McDaniel, 1986). Hypotheses tested the extent to which variations in information processing requirements (nursing unit context: nursing unit size and technological indeterminance) and information processing capacity (nursing unit structure: decentralization, nursing participation in decision making, formalization, and nursing care plans) corresponded with variations in nursing unit performance (medication error rate; patient fall rate; licensed staff vacancy rate; licensed staff turnover rate; patients' perception of supportive nursing behaviors; nurses' perception of the unit's ability to provide technical quality of care; and nurses' perception of the unit's ability to meet family member needs) while controlling for resource allocation (nurse-patient ratio). Forty-six medical-surgical nursing units (representing 15 hospitals) from four regions of the United States participated in this cross-sectional, correlational study. Hierarchical multiple regression was used to test the following hypotheses: (1) that resource allocation is related to nursing unit performance (supported for the three perceptual measures but not for the four objective measures of nursing unit performance); (2) that nursing unit context is related to nursing unit performance (supported for vacancy rate); (3) that nursing unit decision making structures are related to nursing unit performance (supported for meeting family member needs); (4) that nursing unit context and decision making structures are related to nursing unit performance (not supported); and (5) that the fit between nursing unit context and decision making structures is the best predictor ofnursing unit performance (not supported). Thus, the theory was not supported. The findings suggest a greater capacity for information processing than the demand for information processing warrants. The healthcare industry and professional organizations are pressuring hospitals and nurse administrators to conform to certain structural forms which may result in excess information processing capacity. Thus, nursing units are not structuring to meet their information processing demands but industry and professional norms.
Publisher
ProQuest Dissertations & Theses
Subject
ISBN
9798209298465
