Developing methods and research instruments for assessing physical and psychosocial outcomes of patient care as a function of nursing staff mix.

This paper describes a study which assesses a wide variety of both physical and psychosocial outcomes of patient care against nursing care standards, and as a function of two different staff mixes--an 80% registered nurse (RN) 20% enrolled nurse (EN) mix and an all-RN staffing regimen. The study is divided into three stages: Stage I which concerned the design of the investigation and development of research instruments and procedures; Stage II which concerned the field-testing of all research procedures and assessment of the reliability of research instruments and Stage III which will constitute the main study and is presently being conducted in an acute medical and an acute surgical ward. This paper is confined to a report on Stages I and II and provides the conceptual framework for the study, a description of the research instruments and the ways they were developed and a description of the research methods. The results from Stage II show that the principal research instruments are highly reliable with coefficients always in excess of 0.80, and that all of the research methods and procedures are practical and feasible. The study is significant because outcome-based evaluations, while attractive in principle, are in their infancy and little guidance appears in the literature about how to conduct these types of investigations. This paper attempts to address this deficiency.