Nursing Surveillance on the Workshift: Model Testing

Purpose:
The purposes of this study were to (a) establish the psychometric properties of a measure developed to operationalize the surveillance process as it was conceptualized in a grounded theory study, and (b) determine the reproducibility of the surveillance model using quantitative data.

Background/Significance:
Nursing surveillance has a key role in keeping patients safe. As a nursing care process, surveillance occurs between a nurse and his/her assigned patients during a workshift. Yet, this phenomenon has not been the focus of research using the workshift as the unit of analysis. A grounded theory study of this process resulted in a substantive theory with Making Sure emerging as the core category. The next step to advance knowledge related to surveillance was to test the validity of that theory.

Methods:
A cross-sectional, model testing design was employed. Data were collected through a mail survey from inpatient registered nurses employed in an acute care hospital in Florida. A measure to operationalize concepts of the Making Sure theory was developed. Participants reported data from their most recent workshift and used that workshift as the reference point for their survey responses. Psychometric evaluation of the measure was undertaken. Model testing of the theory using structural equation modeling was completed.

Results:
616 registered nurses (42% response rate) provided data. Adequate psychometric evidence was obtained for the measure. The pattern of survey responses suggested two models needed to be tested, one for nurses working in medical-surgical nurse assignment patterns and one for nurses working in critical-care nurse assignment patterns. The core surveillance process model was tested. With slight modifications, but still consistent with the original conceptualization, the model fit the data well in both groups. Further analysis revealed a strong relation between the Making Sure process and Protecting patients from harm.

Conclusions and Implications for Practice:
Evidence of the surveillance process by registered nurses was tested and verified with quantitative data. Further study of the factors that promote or inhibit this process from occurring, and the relation between this shift based process and patient outcomes, needs to be undertaken.