Nurse-Sensitive Quality Care -(Conceptual Model)

Structureof Care

Nursing CareProcesses

PatientOutcomes

Donabedian Model

Quality Assessment

Antecedents Structure Process Outcome

Factors that can influence structure, process:Environmental factorsPatient factors (also influence outcomes)

Organiza-tional character-istics

Interactions between healthcare practitioner & patient

Changes (desirable or undesirable) in individuals & populations

Donabedian’s Structure – Process - Outcome

Example Measures for Nursing-Sensitive Care

Structure Process Outcome

• Size• Teaching status• Payer mix• Magnet status• CNO/manager• Practice environment (e.g., autonomy)• NHPPD• Staff mix• Use of agency staff• Education• Specialty Certification • Other credentials• Turnover

• Risk assessment• Implementation of prevention protocols• Pain management• Medication administration• Counseling • Communication, teamwork, decision making

• Injury falls• HAPUs• Nosocomial infections• “Failure to rescue”• Mobility• Satisfaction with care• Unplanned readmissions

Structure: Indicated by the supply, equipment, skill-level, facilities and education/ certification statusExample: Availability of physicians and/or nurses providing care.

Process: Measure aspects of nursing care such as frequency of assessment and intervention- how the system worksExample: Is tracheostomy care done as per policy?

Outcomes: Improve if there is a greater quantity or quality of care- the final productExample: What is the infection rate? How many tracheostomies block?

Structure Process Outcome

Donabedian’s Model for Improvement