The Relationship among structure, technology, autonomy, decision making, nurse characteristics and the decision to call a resuscitation code on the patient who needs cardiopulmonary resuscitatio

Abstract

In this study, the relationship among nursing unit structure, technology, autonomy, decision making, nurse characteristics and the timeliness of calling a resuscitation code was explored. The conceptual framework of the study was The Structural Interaction Model for Health Care Behavior (Colgrove, 1992), a model that combined and synthesized concepts from organizational theory, quality care, and patient-centered care. The hypothesized relationships were investigated using multivariate logistic regression and multiple regression analysis. A sample of 127 registered nurses and 127 patient resuscitation events from one hospital was used in the study. Nurses' perception of nursing unit structure, technology, autonomy and decision making were measured using four instruments. Nurse characteristics were obtained from the nurse demographic tool. Data required to stage the timeliness of calling a resuscitation code (early versus not early) was obtained from the patient's hospital record. Testing of the analytical model resulted in beginning support for elements that may contribute to the timeliness of calling a resuscitation code for the patient who may need cardiopulmonary resuscitation. These relationships pointed to the impact of structural factors and professional factors on the timeliness of calling a code. The findings were nurses with a baccalaureate degree or higher were more likely to call an early code as were nurses with less than a baccalaureate degree. Moreover, nurses that practiced on a unit with a more flexible nursing unit structure were more likely to call an early code than were nurses that practiced on a unit with a non- flexible unit structure. Nurses that were found to have a higher degree of normative decision making were more likely to call an early code than nurses that were found to have a lower degree of normative decision making. Further, there appeared to be a strong linear relationship between autonomy and the timeliness of calling a code. Nurses who perceived they were practicing with a higher degree of autonomy were more likely to call an early code than those who perceived they were practicing with a lower degree of autonomy.