Anthony M K
Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue, Cleveland, OH 44106-4904, USA.
Res Nurs Health. 1999 Oct;22(5):388-98. doi: 10.1002/(sici)1098-240x(199910)22:5<388::aid-nur5>3.0.co;2-b.
Redesigning health care environments has occurred in response to cost and quality pressures. Efforts to redesign the nursing practice environment have focused on the structure and process of nursing care delivery. When redesign efforts address the structure of nursing practice systems to facilitate one important process, nurses' participation in decision making, better patient and organizational outcomes are expected. The purpose of this study was to determine if two dimensions of structure: administrative (decentralization) and professional authority (expertise) influence the process of participation in decision making for two kinds of decisions (caregiving and condition-of-work) that nurses make. The stratified sample consisted of 300 registered nurses working on medical-surgical units. Administrative and professional authority accounted for a small but significant amount of variation in participation in decision making. Because the extent of explained variation was small, the findings may challenge the prevailing assumption that greater authority for decision making results in the exercise of that authority. Redesign of the practice environment therefore must incorporate multiple factors in achieving greater participation in decision making.
为应对成本和质量压力，医疗保健环境已进行了重新设计。重新设计护理实践环境的努力主要集中在护理服务提供的结构和流程上。当重新设计的努力针对护理实践系统的结构以促进一个重要流程——护士参与决策时，预计会有更好的患者和组织成果。本研究的目的是确定结构的两个维度：行政（分权）和专业权威（专业知识）是否会影响护士做出的两种决策（护理和工作条件）的参与决策过程。分层样本包括300名在内科和外科病房工作的注册护士。行政和专业权威在参与决策方面占了一小部分但显著的差异。由于解释的差异程度较小，这些发现可能会挑战普遍的假设，即更大的决策权会导致该权力的行使。因此，实践环境的重新设计必须纳入多个因素，以实现更大程度的参与决策。
