Lynn M R, Kelley B
University of North Carolina at Chapel Hill 27599-7460, USA.
Image J Nurs Sch. 1997;29(3):237-41. doi: 10.1111/j.1547-5069.1997.tb00991.x.
To examine in 1995 the effects of case management on the context of nursing practice-perceived quality of care delivered, work satisfaction, and control over nursing practice-rather than the commonly studied effect on fiscal outcomes.
Prospective quasi-experimental. Sampled were nurses on four units at one community hospital where patients with DRG 107 (Coronary Artery Bypass Graft, with no cardiac catheterization) were traditionally hospitalized.
Registered nurses on these units completed quality of care, satisfaction, and practice-control scales before and 1 year after implementation.
Significant positive differences were found in several aspects of perceived quality of care for both staff nurses and case managers, with specific increases found in nurses' perceived ability to develop relationships with patients, ability to be therapeutic, and support for good care from the institutional structure and administration. A significant decrease in nurses' satisfaction with their pay and other rewards as well as respect from colleagues was found. Case managers were found to have significantly increased perceptions of control over their practice.
Case management was found to have a primarily positive effect on nurses-staff and case managers alike. There were significant increases in several aspects of the nurses' perceptions of the quality of care delivered. Additionally, case managers were more satisfied with the administration, the respect they received, and their pay and rewards in the institution. Most strikingly, case managers perceived themselves to have more control over their practice. Some negative effects of the program were a decrease in satisfaction with the pay and rewards by the staff who were not case managers.
1995年研究病例管理对护理实践环境的影响——即所提供护理的感知质量、工作满意度以及对护理实践的掌控度，而非通常所研究的对财务结果的影响。
前瞻性准实验研究。样本来自一家社区医院四个科室的护士，该医院传统上收治诊断相关分组（DRG）为107（冠状动脉搭桥术，无心脏导管插入术）的患者。
这些科室的注册护士在实施前和实施后1年完成护理质量、满意度和实践掌控度量表。
在护理人员和病例管理人员对护理质量的感知的几个方面均发现显著的积极差异，具体表现为护士在与患者建立关系的感知能力、治疗能力以及来自机构结构和管理层对优质护理的支持方面有所提高。发现护士对薪酬和其他奖励以及同事尊重的满意度显著下降。发现病例管理人员对其实践的掌控感显著增强。
发现病例管理对护理人员和病例管理人员都有主要的积极影响。护士对所提供护理质量的感知在几个方面有显著提高。此外，病例管理人员对机构的管理、所获得的尊重以及薪酬和奖励更满意。最显著的是，病例管理人员认为自己对其实践有更多的掌控。该项目的一些负面影响是未担任病例管理人员的员工对薪酬和奖励的满意度下降。
