Implications for
Nursing Research
In addition to case study research by nurses who
worked at Loeb, an 18-month follow-up study of
the outcomes of care was funded by the Depart-
ment of Health, Education and Welfare. Alfano
(1982) presents a detailed description of the study.
The purpose of the longitudinal study was to com-
pare selected outcomes of two groups of patients
exposed to different nursing environments (the
Loeb program and a control group). Outcomes ex-
amined were cost of hospital stay, hospital readmis-
sions, nursing home admissions, mortality, and
return to work and social activities. Overall, find-
ings suggested that the Loeb group achieved better
outcomes at less overall cost.
Overall, findings suggested that the Loeb
group achieved better outcomes at less
overall cost.The findings of several other studies in nurse-
led units lend further support to the benefit of the
structure to patient outcomes, including preven-
tion of complications (Daly, Phelps, & Rudy, 1991;
Griffiths, 1996; Griffiths & Wilson-Barnett, 1998;
Rudy, Daly, Douglas, Montenegro, Song, & Dyer,
1995). There is a critical need for research examin-
ing the effect of professional nursing care on pa-
tient outcomes in all settings. In a recent study
involving 506 hospitals in 10 states, Kovner and
Gergen (1998) reported that patients who have sur-
gery done in hospitals with fewer registered nurses
per patient run a higher risk of developing avoid-
able complications following their operation. There
was a strong inverse relationship between registered
nurse staffing and adverse patient events. Patients
in hospitals with fewer full-time registered nurses
per in-patient day had a greater incidence of uri-
nary tract infections, pneumonia, thrombosis,
pulmonary congestion, and other lung-related
problems following major surgery. The authors
suggested that these complications can be pre-
vented by hands-on nursing practices and that this
should be considered when developing strategies to
reduce costs. Griffiths (1996) suggested the need
for further research and cautioned that although
clinical outcomes are important, it is equally im-
portant to study the processes of care in these units.
In doing so, we will begin to understand the re-
sources and methods of nursing care necessary to
ensure positive patient outcomes.Currently, nurses practice in a health-care en-
vironment driven by financial gain, where
quality is sacrificed and the patient is lost in a
world of mismanaged care. More than ever,
these alarming trends indicate a need to re-
turn to the basic premise of Hall’s philoso-
phy—patient-centered, therapeutic care.
According to Griffiths (1997a), however, the
Loeb Center presently reflects little resem-
blance to its former image. It now provides
part subacute and part long-term care and, in
fact, appears remarkably like the kind of sys-
tem that Hall was trying to alter. Nursing is
bogged down in a morass of paperwork, and
the enthusiasm generated by the Hall model
is no longer evident.
How would Lydia Hall react to these con-
ditions, and what response might we expect if
she spoke with us today? We believe she
would be appalled by the diminished pres-
ence of professional nurses in health-care fa-
cilities and the impediments confronting
those who remain. She would encourage us
to explore new ways to provide needed nurs-
ing care within an existing chaotic climate.
She would lead us in challenging the status
quo and speak of the necessity for nursing
leaders to have a clear vision of nursing prac-
tice and a willingness to advocate for nursing
regardless of external forces seeking to un-
dermine the profession.
She would foster scientific inquiry that ad-
dresses outcomes of care and validates the
impact of professional nursing, particularly
in long-term care settings. She would agree
that the improvement of care to elders in
nursing homes is a significant ethical issue
for society and that nurses, the largest group
of care providers to elders in nursing homes,
play a vital role in the improvement of care.
She would call upon us to develop profes-
sional models of care and demonstrate the
positive outcomes for the health and well-122 SECTION II Evolution of Nursing Theory: Essential Influences