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Public Policy and Administration


Steven A. Matarelli


Registered Nurses use clinical documentation to describe care planning processes, measure quality outcomes, support reimbursement, and defend litigation. The Connecticut Department of Health, guided by federal Conditions of Participation, defines state-level healthcare policy to include required care planning processes. Nurses are educated in care planning process standards, however no policy-required competency verification processes in academia or employers exists. Guided by the advocacy coalition framework, the purpose of this quasi-experimental study was to determine if the quality of nurse coalition actors’ clinical documentation, a relatively stable parameter, would increase after attending policy-centered structured education. Data were extracted from 272 electronic medical records (136 pre - 136 post attendance) and mean quality scores were computed using the Müller-Staub Q-DIO scale from 17 nurse coalition actors. A two group dependent t test was used to examine quality score differences and linear regression was used to isolate process education subsections that significantly predicted post mean score improvements. Findings indicate a statistically significant difference between pre and post education quality scores (p < .001) and improvement drivers of the post-education quality scores were identified in the subscales of ‘diagnosis as a process’ (p < .001) and ‘interventions’ (p < .001). Implications for positive social change include recommendations to state-level policy makers to mandate confirmation of graduating nurses’ documentation quality and to install continuing education requirements as a condition of bi-annual license renewal; each area acting to reduce non-compliant clinical documentation in light of federal Conditions of Participation rules.