Date of Degree

6-2020

Document Type

Dissertation

Degree Name

Ph.D.

Program

Nursing

Advisor

Arlene Farren

Committee Members

Donna Nickitas

William Gallo

Sherry Baron

Christine Elnitsky

Subject Categories

Interprofessional Education | Occupational and Environmental Health Nursing | Other Nursing | Other Public Health | Theory, Knowledge and Science

Keywords

Sustainability, Diffusion of Innovation, Safe Patient Handling, Sustainability Factors, Nursing Staff Injuries

Abstract

Healthcare organizations invest significant economic, physical, and human resources to implement changes and expect sustained benefits for their investments in the long term. Yet, few studies have examined long-term sustainability and factors contributingto sustainability. The primary aim of the study was to gain a better understanding of sustainability and five factors (champions, leadership support, policy, resources, and training and education) that might predict long-term sustainability within the context of one Safe Patient Handling and Mobility (SPHM) program implemented in a large, nationwide system more than 7 years ago. The secondary aim was to examine the number of nursing staff injuries, the most notable positive outcome of the program immediately post implementation. Rogers’ Diffusion of Innovation Theory (DOI) was the theoretical rationale. The DOI proposes four essential elements and five stages of the Innovation-Decision Process (IDP). The study focus is within the confirmation stage of the IDP and factors that reflect the DOI essential elements and the literature on sustainability. The methodology included a correlational design and group comparisons. After all necessary approvals, data were collected using mailed surveys and data accessed from the 2011study vdatabase. The participants (n= 73) were Veterans Administration Medical Center (VAMC) SPHM Coordinators. Study instruments included a demographic data form, Five Factor Survey, and the Sustainability Visual Analog Scale (SVAS). Study participants reported high perceived sustainability of the program in their facilities (M= 73.1,SD= 23.6). Multiple regression analyses demonstrated a three-factor model (champions, resources, and training and education), explaining a statistically significant 46% of the variance in sustainability. Statistically significant differences in nursing staff injuries showing continued decline in injuries were found. Study limitations included sample size, limited generalizability, and instrumentation. This research explored predictive factors of sustainability in the largest healthcare system in the United States. The research concluded that the VA SPHM program in the participating facilities and the decline in nursing staff injuries are sustained. Although each ofthe factors showed importance for long-term sustainability, champions, resources, and training and education contributed most significantly as predictors for long-term sustainability. Furthermore, the study supported the importance of DOI processes and elements and provided new information about the role of sustainability in the confirmation stage of the DOI. Recommendations for nursing and research are offered including expanding SPHM implementation, revision of instrumentation, and replication of the immediate post-implementation study.

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