The CNS's impact on process and outcome of patients with total knee replacement

This study was designed to determine whether differences exist between patients with total knee replacement on hospital units with or without clinical nurse specialists (CNSs) in terms of selected process and outcome variables. The charts of 128 randomly chosen patients who had undergone total knee replacement were reviewed. Sixty-four patients were from orthopedic units with CNSs and 64 were from orthopedic units without CNSs. This study was based on Donabedian's framework for assessment of quality of care using structure, process, and outcome variables. Structural variables were collected on institutional and unit demographics. Data were gathered on nursing care interventions (process variables) using process instruments designed by the investigator. Length of stay, total length of stay, which included rehabilitation length of stay, and complications were the outcome variables used. Patients on units with CNSs had significantly higher process scores, shorter total length of stay, and fewer complications than patients on units without CNSs. In addition, significant negative correlations were found between process instrument scores and total length of stay. Higher scores on the process instruments (with CNS units) were correlated with shorter total length of stay. The number of complications was also negatively correlated to the process instrument scores.