Sorting advocacy from outcome research comes before any grading in the NU507 Unit 5 review, which then rates what studies show for primary nursing, team nursing and skill mix. Searches like "nu 507 unit 5 assignment example", "nu507 unit 5 sample" and "nu507 unit 5 example" land here.
Advocacy Set Aside, Then Counted: An Outcome Evidence Review of Nursing Care Delivery Models for Readmitted Older Adults
[Student Name]
Purdue University Global
NU507: Promoting Optimal Models and Systems for Health Care Delivery
Unit 5 Assignment
[Instructor Name]
[Date]
Review of published sources; certainty ratings by outcome are the writer's, following GRADE.
Why Sorting Comes First
Advocacy and outcome research answer different questions. An implementation account can show that a model is feasible, that staff like it and how to introduce it. It cannot show that patients fared better, because it has no comparison. Outcome research compares patients or units under different conditions and measures what happened to them. Counting both together would inflate the evidence for any model with enthusiastic adopters.
Search and Selection
Sources were located in CINAHL and PubMed with terms for primary nursing, team nursing, Relationship-Based Care, nursing care delivery model, skill mix and continuity of nursing care, combined with terms for readmission, mortality, adverse events and patient experience, and by following references from the Cochrane review. Books and implementation guides from model developers were located through the unit's library and the consulting organizations' own lists. Transitional care trials were added because the population profile identified the discharge handoff as the point where most failures cluster, and a review that looked only inside the unit would miss the strongest readmission evidence.
The Sorting Exhibit
Advocacy, each with the reason for its placement:
1. Manthey (2002), a book by primary nursing's developer. It describes the model's principles and how to implement it; it reports no comparison of outcomes.
2. Koloroutis (2004), the text defining Relationship-Based Care, published by the model's consulting organization. Principles and implementation; no outcome comparison.
3. Cropley (2012), a single rural hospital's report comparing aggregate satisfaction, length of stay and readmission rates in the year before and the year after adopting Relationship-Based Care. Placed under advocacy as a borderline case: it has a before-and-after comparison, but no control group, aggregate data only, and one year on each side, so any change could reflect other events that year. It is noted, not counted as outcome evidence.
Outcome research:
4. Butler et al. (2019), Cochrane systematic review of hospital nurse staffing models.
5. Aiken et al. (2017), cross-sectional study of skill mix and outcomes in European hospitals.
6. Stifter et al. (2015), analysis of nurse continuity and hospital-acquired pressure injuries using electronic record data.
7. Naylor et al. (1999), randomized trial of advanced practice nurse transitional care for older adults.
8. Coleman et al. (2006), randomized trial of a care transitions coaching intervention.
Evidence Table
Butler et al. (2019). Design: systematic review of 19 studies, 17 analyzed. Setting: hospitals in five countries. Interventions: advanced or specialist nurses, assistive personnel, primary nursing and staffing models. Outcomes: mortality, readmission, length of stay, costs, turnover. Findings relevant here: for primary nursing, it was uncertain whether it reduced staff turnover or costs, with very low certainty evidence; high risk of bias across studies.
Aiken et al. (2017). Design: cross-sectional. Setting: hospitals in six European countries. Outcomes: mortality, patient ratings, quality. Findings: for every 10 points more professional nurses in the staffing mix, the odds of death were lower (odds ratio 0.89). Cross-sectional, so association only.
Stifter et al. (2015). Design: retrospective analysis of electronic record data. Setting: nine units. Outcome: hospital-acquired pressure injuries. Findings: nurse continuity was poor on all nine units, but after controlling for patient characteristics, continuity was not significantly associated with pressure injury.
Naylor et al. (1999). Design: randomized trial, 363 older adults. Intervention: advanced practice nurse discharge planning and home follow-up. Outcome: readmission by 24 weeks, 20.3 percent against 37.1 percent with usual care.
Coleman et al. (2006). Design: randomized trial. Intervention: transitions coaching for older adults and caregivers. Outcome: rehospitalization at 30 days, 8.3 against 11.9 percent, and at 90 days, 16.7 against 22.5 percent.
Synthesis by Outcome
Mortality and skill mix. The strongest signal in the nursing workforce literature is an association between a richer share of registered nurses and lower mortality (Aiken et al., 2017). It speaks to skill mix, which primary nursing changes, rather than to the model itself, and it is cross-sectional. Certainty: low.
Continuity and harm. Continuity is the mechanism primary nursing claims, yet the one study that measured continuity directly found it low everywhere and not associated with pressure injury once patient factors were considered (Stifter et al., 2015). The model's central mechanism is therefore plausible but largely untested, and the one direct test found no effect on the harm it examined. Certainty: very low.
Readmission. This is the outcome the population profile cares about most, and it is where nursing model studies are nearly silent: the Cochrane review did not report readmission outcomes for primary nursing (Butler et al., 2019). The strongest readmission evidence comes instead from transitional care models that extend past discharge: nurse-led follow-up at home and coaching of patients and caregivers both reduced rehospitalization in randomized trials (Naylor et al., 1999; Coleman et al., 2006). Certainty for unit care delivery models: very low; for transitional care that crosses the discharge boundary: moderate.
Patient experience. Advocacy sources report high satisfaction, but the outcome research located here does not compare the models on validated experience measures. Certainty: very low.
Limits of This Review
One reviewer located, sorted and rated the sources, so judgments about placement and certainty were not checked by a second person. The search was limited to English. The certainty ratings follow GRADE's logic but were applied informally to a small body of heterogeneous studies rather than through a formal systematic review. And the transitional care trials are more than fifteen years old; readmission practices and Medicare incentives have changed since, which may reduce the size of effect a new program would see.
What the Review Means for the Model Decision
The evidence does not show that primary nursing on the unit, by itself, would reduce readmissions for this population, because no study has tested that. It does show that interventions extending accountability across the discharge boundary reduce readmissions, and that richer registered nurse skill mix is associated with better outcomes. Those findings point in the same direction as the comparative analysis: if the unit changes its model, the change should include a handoff that reaches past the door, and it should be evaluated with a clear comparison rather than reported as an implementation success. A pilot with a concurrent comparison section, or at minimum a long baseline and a prespecified decision rule, would add more to this literature than another before-and-after report.
References
Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., Maier, C. B., Moreno-Casbas, T., Ball, J. E., Ausserhofer, D., & Sermeus, W. (2017). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality and Safety, 26(7), 559-568. https://doi.org/10.1136/bmjqs-2016-005567
Butler, M., Schultz, T. J., Halligan, P., Sheridan, A., Kinsman, L., Rotter, T., Beaumier, J., Kelly, R. G., & Drennan, J. (2019). Hospital nurse-staffing models and patient- and staff-related outcomes. Cochrane Database of Systematic Reviews, 2019(4), CD007019. https://doi.org/10.1002/14651858.CD007019.pub3
Coleman, E. A., Parry, C., Chalmers, S., & Min, S.-J. (2006). The care transitions intervention: Results of a randomized controlled trial. Archives of Internal Medicine, 166(17), 1822-1828. https://doi.org/10.1001/archinte.166.17.1822
Cropley, S. (2012). The relationship-based care model: Evaluation of the impact on patient satisfaction, length of stay, and readmission rates. The Journal of Nursing Administration, 42(6), 333-339. https://doi.org/10.1097/NNA.0b013e31825738ed
Koloroutis, M. (Ed.). (2004). Relationship-based care: A model for transforming practice. Creative Health Care Management.
Manthey, M. (2002). The practice of primary nursing (2nd ed.). Creative Health Care Management.
Naylor, M. D., Brooten, D., Campbell, R., Jacobsen, B. S., Mezey, M. D., Pauly, M. V., & Schwartz, J. S. (1999). Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA, 281(7), 613-620. https://doi.org/10.1001/jama.281.7.613
Stifter, J., Yao, Y., Lodhi, M. K., Lopez, K. D., Khokhar, A., Wilkie, D. J., & Keenan, G. M. (2015). Nurse continuity and hospital-acquired pressure ulcers: A comparative analysis using an electronic health record "big data" set. Nursing Research, 64(5), 361-371. https://doi.org/10.1097/NNR.0000000000000112
How this NU507 Unit 5 example is structured
Sorting precedes appraisal, because advocacy and outcome research answer different questions. An implementation account can show a model is feasible and liked; it cannot show patients fared better. Each source's placement carries a sentence of reasoning, so borderline cases, such as a hospital's before-and-after report with no comparison group, are visible rather than quietly promoted. Outcome studies are then appraised on one scale, with certainty stated for each outcome. The synthesis is organized by outcome rather than by model: mortality and skill mix, continuity and harm, readmission, patient experience. That order shows where the evidence speaks to the population's needs and where it is silent, particularly on readmission, which few nursing model studies measure. Closing the review is a statement of what the bounded proposal can claim and what it must test locally.
Get an NU507 Unit 5 example written to your instructions
Share the models under comparison, any studies already collected and the appraisal method your course names, with this unit's rubric. Real, citable studies only: advocacy is sorted from outcome research, certainty is rated and the gaps are stated. Returned in 24-48h to your own instructions, the first custom sample is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU507 Unit 5 questions, answered
Is a model's implementation literature useless as evidence?
No, it answers different questions. Accounts from adopting hospitals show whether a model can be implemented, what it costs in effort and how staff respond. They rarely compare outcomes against a control. The sample keeps them in a separate column and uses them for feasibility, while outcome claims rest only on comparative studies.
Which appraisal system should I use?
Whichever the course names. GRADE rates certainty across a body of evidence for each outcome; the Johns Hopkins and Melnyk hierarchies rate individual sources. The sample uses GRADE because the question is what the combined evidence supports for each outcome, but it would restructure the table around a source-level hierarchy if the rubric required one.
What if the evidence does not support my preferred model?
Report what it supports, and revise or bound the recommendation. A review that finds low certainty and says so is stronger than one that selects favorable studies. The sample finds only indirect support for primary nursing on readmission and turns that gap into a local measure rather than overstating the case.