Date of Award

2009

Document Type

Dissertation - Restricted

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Bobay, Kathleen

Abstract

Collaboration is one of the primary vehicles through which hospital staff can address the extraordinary challenges present in today's complex environments. Collaboration has the potential to reform discharge-related care processes, including patient teaching, and address many of the issues hindering the effective preparation of patients for their return home. Despite the importance of collaboration in healthcare processes, there are no published studies addressing collaboration among Registered Nurses (RNs), and very few studies investigating RN-MD collaboration in general medical-surgical units where 87% of inpatient care is provided.

Donabedian's framework of health care quality and Meleis' Transition Theory were employed to investigate relationships among collaborative behavior, both RN-RN and RN-MD, RN experience, and patients' perception of discharge teaching quality. The patient sample was comprised of 1500 randomly selected adults hospitalized on one of 16 medical-surgical units within four acute care hospitals located in the greater metropolitan region of a Midwestern city (USA). Patient-level scores for discharge teaching quality were derived from patient responses on the Quality of Discharge Teaching Scale.

Unit-level scores for collaborative behavior were obtained from a sample of 244 RNs practicing on the 16 inpatient units. RN scores on the modified Collaborative Behavior Scales: RN-MD and RN-RN were aggregated to create unit-level scores for RN-RN and RN-MD collaboration. Self-reported data were used to create unit-level scores for RN experience. Multiple regression, using data clustered by nursing unit, was employed to analyze relationships among study variables.

The hypotheses that collaborative behavior and RN experience would be positively related to perceived discharge teaching quality were not supported. The small number of participating nursing units and insufficient variability among unit-level scores for collaborative behavior may have affected study results. A post hoc exploratory analysis, using a composite variable for collaborative behavior, revealed a positive and statistically significant relationship between collaborative behavior and perceived quality of discharge teaching.

The findings of this exploratory study suggest that collaboration may have important implications for care delivery. These preliminary findings will inform future research investigating relationships between collaborative behavior and patient outcomes, and may have implications for health care leaders, clinicians, and researchers across settings.

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