Date of Award

2010-05-01

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Jane M. Georges, PhD, RN; Joan Burritt, DNSc, RN

Keywords

clinical mentor program, nurse-patient relationship, nursing, patient outcomes

Abstract

The increasing complexity of patient care requires an expert nurse to navigate the hospital stay, yet today's workforce brings a declining supply of seasoned nurses, creating a patient need/nurse expertise gap. The clinical mentor role was developed to bridge this gap and create a safety net, using expert nurses, relieved of a patient assignment, to provide oversight for quality patient care. Results reported elsewhere showed improvements in failure to rescue and pressure ulcers six months before and after implementation. The purpose of this study was to examine the long-term impact of this new care model over the subsequent three years on these nurse-sensitive indicators, and to explore the process by which patient outcomes were affected. A mixed-method embedded descriptive design made use of quantitative secondary data analysis of outcome measure data, along with qualitative situational analysis of data from 25 clinical mentor interviews. Results showed that failure to rescue maintained the initial gain post implementation, but did not decrease (or increase) further over the study period. Medical surgical unit hospital acquired pressure ulcers (HAPU) and fall rates showed statistically significant improvement over time; Intensive care unit HAPUs did not significantly change. Qualitative mentor interviews validated their affect on these patient outcomes as well as on staff nurse growth and development, practice improvement, patient satisfaction, error prevention and the development of effective communication. To identify problems or gaps in care, mentors looked for congruency between what they noted in report or chart checks with what they found on rounds when assessing the patient. Eleven themes emerged to describe the processes used to affect patient outcomes, which, when analyzed as a whole, were categorized into three areas of focus: improving effective communication, real time teaching, and taking the time for deeper, expert assessment and evaluation of patient situations. The study added to the general knowledge of expert/non-expert practice and the effect of a unit-based catalyst or guide on patient outcomes.

Document Type

Dissertation: Open Access

Department

Nursing

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