An instrument for measuring the influence of nursing care on the length of stay in heart failure hospitalizations of African Americans

Abstract Introduction: The impact of guideline-directed medical therapy (GDMT) has not fully translated to decreases in the disproportionate rates of hospitalization and lengths of stay in African Americans with congestive heart failure (CHF). GDMT is optimized by registered nurses (RNs) and their use of clinical information. Yet, there are no instruments for measuring the influence of clinical information use and nursing care. The study assessed an instrument’s ability to measure the influence of RN performance of social, technical, and socio-technical care tasks on length of stay in the CHF hospitalizations of African Americans. Methods: A sample of 200 RNs, who cared for 5060 African Americans with 14,123 heart failure hospitalizations, were surveyed. Descriptive statistics, Cronbach’s alpha, and a generalized linear regression assessed the instrument’s reliability and predictive validity. Results: The Cronbach’s alpha was 0.95 (95% CI: 0.94–0.96). The corrected item-total correlations for the 22 items ranged from 0.44 to 0.80. For an increase of one to four points per item in a RN’s performance, the estimated reductions in the patient’s length of stay were 3.34% (6.11,0.5), 6.58% (11.84,1), 9.70% (17.22,1.49), and 12.72% (22.28,1.99), respectively ( P = 0.004). Conclusions: Increases in a RN’s performance of social, technical, and socio-technical care tasks were significantly associated with clinically meaningful decreases in their patients’ length of stay. The instrument has strong potential for addressing the disproportionate impact of CHF by measuring and tailoring interventions to optimize nursing care and the use of clinical information in the provision and receipt of GDMT.