Measurement of nursing practice models using multiattribute utility theory: relationship to patient and organizational outcomes

Workforce shortages are challenging administrators in the health care environments to examine existing models of providing care. Although characteristics of nursing care delivery contribute in important ways to the success or failure of hospital care, factors common to all practice models have not been identified nor have measurement strategies been designed that assess the impact of care on patient and organizational outcomes. The purpose of this study was to test a measurement model of nursing practice that was developed using multiattribute utility theory. A total of 24 factors identified by expert nurse administrators as being common to all nursing practice models were mathematically formulated into a multidimensional composite index that represented the degree to which a practice model on a nursing unit approached the professional ideal. The index was tested with 298 registered nurses working on 28 medical surgical nursing units in 3 hospitals. The model was evaluated in 2 ways: first by comparing the composite index scores to a qualitative appraisal of the nursing unit's practice model and patient and organizational outcomes. Secondly, individual factors in the model were evaluated in the same manner. While the composite index was not fully validated, there is strength in the evidence of the relationship between individual factors and outcomes. Specifically, factors that addressed interactions among health care team members were most often related to outcomes.