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The Effects of Structured Health Policy Education on Connecticut Registered Nurses' Clinical Documentation

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The Effects of Structured Health Policy Education on Connecticut Registered Nurses' Clinical Documentation Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 The ffecE ts of Structured Health Policy Education on Connecticut Registered Nurses' Clinical Documentation Rosale Lobo Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Higher Education Administration Commons, Higher Education and Teaching Commons, Nursing Commons, and the Public Policy Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Rosale Lobo has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Steven A. Matarelli, Committee Chairperson, Public Policy and Administration Faculty Dr. Hazel Dennison, Committee Member, Public Policy and Administration Faculty Dr. Kirk Williams, University Reviewer, Public Policy and Administration Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract The Effects of Structured Health Policy Education on Connecticut Registered Nurses’ Clinical Documentation by Rosale Constance Lobo MSN, Hunter College, 1989 BSN, Long Island University, 1986 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy Administration Walden University November 2017 Abstract Registered Nurses use clinical documentation to describe care planning processes, measure quality outcomes, support reimbursement, and defend litigation. The Connecticut Department of Health, guided by federal Conditions of Participation, defines state-level healthcare policy to include required care planning processes. Nurses are educated in care planning process standards, however no policy-required competency verification processes in academia or employers exists. Guided by the advocacy coalition framework, the purpose of this quasi-experimental study was to determine if the quality of nurse coalition actors’ clinical documentation, a relatively stable parameter, would increase after attending policy-centered structured education. Data were extracted from 272 electronic medical records (136 pre - 136 post attendance) and mean quality scores were computed using the Müller-Staub Q-DIO scale from 17 nurse coalition actors. A two group dependent t test was used to examine quality score differences and linear regression was used to isolate process education subsections that significantly predicted post mean score improvements. Findings indicate a statistically significant difference between pre and post education quality scores ( p < .001) and improvement drivers of the post-education quality scores were identified in the subscales of ‘diagnosis as a process’ (p < .001) and ‘interventions’ ( p < .001). Implications for positive social change include recommendations to state-level policy makers to mandate confirmation of graduating nurses’ documentation quality and to install continuing education requirements as a condition of bi-annual license renewal; each area acting to reduce non-compliant clinical documentation in light of federal Conditions of Participation rules. The Effects of Structured Health Policy Education on Connecticut Registered Nurses’ Clinical Documentation by Rosale Constance Lobo MSN, Hunter College, 1989 BSN, Long Island University, 1986 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy Administration Walden University November 2017 Dedication I dedicate this dissertation to the following people who have been invaluable to my life. My partner, spouse, and father of my children, Barrie Lobo, who has been a constant source of undying support. The countless sacrifices cannot be replaced; however, they will be replenished in abundance. My mother, Ivy Young-Scott, I inherited your grit, your optimism, and your ability to laugh at it all. Without those attributes, my path would have taken a different turn. My father, Roy Scott, although you no longer walk this earth, I still hear you talking about the importance of education, I know you would be proud. My first born, Brian Scott your resilience is noteworthy, a true testament of leadership and an inspiration to me and my ambitions. My second born, Joaquim Laurence, your pursuit for answers to questions not yet asked is a driving force, I also seek to discover. My youngest, Roy Conrad, your impeccable timing and passion for living, despite what some might consider a nuisance, inspires me. Ilona and Brigitte, you have provided me with undying love, trust, and understanding. I am truly grateful for sisters like you who are silly, supportive and wise. Cheryl Braham, you've been hanging with me the whole time, thanks for your support and continued interest in the progress towards our nursing goals. Lastly, this work is dedicated to all nurses. Thank you for all you do. May this paper initiate the conversation to mandate policy on nursing documentation as a part of education beginning in nursing school and moving throughout our professional lives. Acknowledgments Dr. Steven A. Matarelli, I am not certain how I received such great fortune as to have you as my chairperson. You have taught me so much about so many things. One of your most famous analogies "you are the bus driver, we are simply giving you directions." I am still baffled with how you put up with me after all these years. Your patience and intelligence are a dangerous combination. You forced me to understand concepts I didn't think I was capable of and I'm eternally grateful. Dr. Hazel Dennison, I couldn't have asked for a more complimentary committee member. You perfectly aligned with this team. You have been so supportive, approachable, and clever. Your intuitive spirit to our nursing climate has been invaluable. Thank you. Dr. Kirk Williams, thank you for being able to understand a topic based on the context of the prose. Your expertise is appreciated. Yale New Haven Hospital and Yale University, thank you for allowing me to conduct my research at your facility. Dr. Lori Salgado, your camaraderie and newly found expertise have been indispensable. Much appreciated. Table of Contents List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1: Introduction of the Study ...................................................................................1 Background of the Study ...............................................................................................3 Problem Statement .........................................................................................................8 Nature of the Study, Research Questions, and Hypotheses .........................................10 Purpose of the Study ....................................................................................................14 Theoretical Base...........................................................................................................16 Definitions of Terms ............................................................................................. 19 Operational Definitions of Research Variables .................................................... 20 Assumptions .................................................................................................................21 Limitations ...................................................................................................................21 Scope and Delimitations ..............................................................................................22 Significance of the Study .............................................................................................23 Summary ......................................................................................................................26 Chapter 2: Literature Review .............................................................................................28 Introduction ..................................................................................................................28 Background ..................................................................................................................29 The Fundamentals of Nursing Documentation ............................................................32 The Evolution of the Nursing Care Planning Process .......................................... 35 Regulatory Oversight ............................................................................................ 38 i Federal Government Oversight ............................................................................. 41 National Nursing Organizations ........................................................................... 46 Connecticut Nursing Oversight............................................................................. 49 Documentation, Care Planning, and Healthcare Policies and Procedures
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