Page 248 - Encyclopedia of Nursing Research

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focus on administration and the organiza- training programs with funding available
tion, such as differences in quality of care in from a variety of sources including AHrQ,
home health agencies of different sizes and the robert Wood Johnson Foundation, the H
service areas or the differences in cost of care Veterans Administration, and the National
provided in the home versus nursing home. Institute of Nursing research (ricketts, 2009).
Systematic studies examine the characteris- Health services researchers use a num-
tics of the health care system as they relate to ber of frameworks to guide their studies
the interrelationships between the demand (Mullner, 2009). Avedis Donabedian’s struc-
for health care services, providers, and health ture–process–outcome framework examines
care institutions. System characteristics of how structures of health care organizations
interest may be the type of financing, regula- impact the processes of care and patient and
tory programs, or practice sites. The aims of nurse outcomes (such as satisfaction and
environmental studies are to understand the retention). Anderson’s Behavioral Model
larger political, social, and economic contexts measures how predisposing, enabling, and
that shape the health services system and need factors at the individual and organiza-
define its societal functions. These include tional level contribute to access, patient sat-
studies of the legal and ethical responsibili- isfaction, and quality of care. Hochbaum’s
ties of health care organizations and the pop- Health Belief Model focuses on factors that
ulation’s expectations of the health services lead to individual motivation health-related
(IOM, 1979) behavioral changes. The Theory of reasoned
Health services research does not call for Action has been used to guide studies that
a specific mix of disciplines, rather research- focus on behavioral attitudes and their effect
ers from multiple disciplines bring compli- on intention to act.
mentary skills to address the questions being Health disciplines conduct the major-
studied (ricketts, 2009). There is an overlap ity of health services research. Nursing has
of health services research with a number of more recently been recognized as a signifi-
other fields, such as environmental health, cant contributor to health services research.
behavioral sciences, biomedical research, russell and Fawcett’s (2005) conceptual
and epidemiological research (IOM, 1979). model provides a framework that can be
The uniqueness of health services research used in discussing nursing and health pol-
can be exemplified by looking at smoking icy. each of the models’ four interacting
research. Biomedical research informed us levels addresses concepts of human beings,
of the effect of smoking on health, whereas environment, health, and nursing and can be
health services research provided data on the used to evaluate access, cost, and quality that
financial impact of health problems related to are outcomes of concern to health services
smoking. Data were then used to support the researchers. levels focus on the individual,
argument for smoke-free legislation. family, group, or community (level 1); the
AcademyHealth, the professional home nursing practice subsystem or health care
for health services researchers, has recently delivery system (level 2); the health care sys-
held several conferences to identify compe- tem (level 3); and the world health adminis-
tencies in health services research education. trative practice (level 4).
consensus on core training requirements has A review of nursing and health services
not been reached (ricketts, 2009). preparation research on health care organizations (level
to conduct health services research var- 2—the nursing practice subsystem) between
ies. There are more than 124 health services 1950 and 2004 shows that the majority of
research graduate programs in the United nursing’s research contributes to health ser-
States and canada, pre- and postdoctoral vices research in the area of the organization
training programs, and clinician-specific and how organizational factors impact care