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Social Structures Among Inpatient Nursing Units and Healthcare Outcomes: Exploring the Independent and Combined Effects of Nurse Managers' Leadership Practices and Social Network Properties of the Nursing Staff on Nurse-Sensitive Outcomes.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Social Structures Among Inpatient Nursing Units and Healthcare Outcomes: Exploring the Independent and Combined Effects of Nurse Managers' Leadership Practices and Social Network Properties of the Nursing Staff on Nurse-Sensitive Outcomes./
Author:	Parnell, James Michael.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2020,
Description:	210 p.
Notes:	Source: Dissertations Abstracts International, Volume: 81-10, Section: B.
Contained By:	Dissertations Abstracts International81-10B.
Subject:	Management. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=27741167
ISBN:	9798607322779

Social Structures Among Inpatient Nursing Units and Healthcare Outcomes: Exploring the Independent and Combined Effects of Nurse Managers' Leadership Practices and Social Network Properties of the Nursing Staff on Nurse-Sensitive Outcomes.
Parnell, James Michael.

Social Structures Among Inpatient Nursing Units and Healthcare Outcomes: Exploring the Independent and Combined Effects of Nurse Managers' Leadership Practices and Social Network Properties of the Nursing Staff on Nurse-Sensitive Outcomes. - Ann Arbor : ProQuest Dissertations & Theses, 2020 - 210 p.

Source: Dissertations Abstracts International, Volume: 81-10, Section: B.

Thesis (Ph.D.)--The University of Mississippi Medical Center, 2020.

This item must not be sold to any third party vendors.

At over $3 trillion annually, healthcare is the largest and fastest growing sector of the United States (U.S.) economy. Despite the disproportionate spending, wellness indicators are not improving. As an attempt to contain these trends, hospital reimbursement is shifting to performance-based compensation where payments are based on outcomes. Therefore it is critical that healthcare organizations understand how their workforces can produce better outcomes at lower costs. The most expensive care is delivered in hospitals where the nursing organization comprises the largest number of patient care professionals. Thus, nurses are well-positioned to improve outcomes and drive down the cost of care.Prior literature suggests that certain leadership characteristics among managers have been linked to better outcomes. Overwhelmingly, these characteristics center on practices that influence culture and promote positive exchange among coworkers and supervisors. However, since these leaders are not usually providing direct patient care, little is known about how the leadership practices of the nurse manager or the social network properties of the nursing staff influence outcomes. The purpose of this study was to explore associations among nurse leaders, the social network of the staff they lead, and outcomes that impact patients and costs to hospitals. This was done by assessing and testing the leadership practices of managers, conducting a social network analysis of their staff, and comparing to nurse-sensitive outcomes.The central research question explored was: What social structures among the nursing organization better predict patient and organizational outcomes? The specific aims of this study were: (1) Determine the association between nurse managers' leadership practices, previously identified by Kouzes and Posner (2008), and quantifiable social network properties of employees they lead, (2) Determine the association between social network properties within inpatient nursing units and outcomes reflected in their National Database of Nursing Quality Indicators (NDNQI) data, and (3) Examine the combined relationships of leadership practices and social network properties with NDNQI data.An exploratory non-experimental, cross-sectional design study was conducted in a 722-bed academic medical center consisting of four conjoined hospitals. Twenty-two nursing units likely to have patients with the nurse sensitive outcomes of interest were selected to participate through convenience sampling. Both primary and retrospective data were collected. The collection period was October 1, 2019 to December 31, 2019 and linked with nurse-sensitive outcomes that occurred between October 1, 2018 and September 30, 2019. The hospital was conceptualized as a complex adaptive system using complexity theory. To examine the complex social processes of manager, nurse, and outcomes, Turkel and Ray's theory of Relational Complexity (2000) served as the mid-range theoretical framework for this study.Among the three aims, significant associations were found in Aim 1 and Aim 3. In Aim 1, leadership practices exhibited by the LPI domain of Encourage the Heart were significantly correlated with social network connectedness (p=.031, r=.622.). This suggests that managers who openly recognize the accomplishments of their staff may influence staff inclusion by promoting social network connectedness. This domain has been linked to transactional leadership styles and four of the eighteen responding managers scored highest in this domain. Inspire a Shared Vision, which is characterized by exhibiting leadership practices that enlist others in a common vision by appealing to shared aspirations, approached significant correlation with social network density among staff (p=.056, r=.564). Inspire a Shared Vision has been associated with transformational leadership styles and no nurse managers had this as their highest-scoring domain. Despite being only marginally significant, this could suggest inspirational leaders influence staff cohesion as measured by social network density. Aim 3 considered the combined effects of the nurse managers' leadership practices with their social network properties. Reduced patient falls was the only nurse-sensitive outcome that was significantly associated with a combined effect. This study found that a reduction in patient falls can be predicted when leadership practices, irrespective of LPI domain, are more frequent and social network properties are more cohesive as measured by network density. A post-hoc correlation analysis of density and the five LPI domains revealed that only Challenge the Process alongside density had a significant effect on patient fall reduction (p=.044, r=.615). (Abstract shortened by ProQuest.).

ISBN: 9798607322779Subjects--Topical Terms:

516664
Management.
Subjects--Index Terms:

Nurse managers

Social Structures Among Inpatient Nursing Units and Healthcare Outcomes: Exploring the Independent and Combined Effects of Nurse Managers' Leadership Practices and Social Network Properties of the Nursing Staff on Nurse-Sensitive Outcomes.
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