title: Refining and validating a conceptual model of Clinical Nurse Leader integrated care delivery.
abstract: OBJECTIVE
  To empirically validate a conceptual model of Clinical Nurse Leader integrated care delivery.
  
  
  BACKGROUND
  There is limited evidence of frontline care delivery models that consistently achieve quality patient outcomes. Clinical Nurse Leader integrated care delivery is a promising nursing model with a growing record of success. However, theoretical clarity is necessary to generate causal evidence of effectiveness.
  
  
  METHODS
  Sequential mixed methods.
  
  
  METHODS
  A preliminary Clinical Nurse Leader practice model was refined and survey items developed to correspond with model domains, using focus groups and a Delphi process with a multi-professional expert panel. The survey was administered in 2015 to clinicians and administrators involved in Clinical Nurse Leader initiatives. Confirmatory factor analysis and structural equation modelling were used to validate the measurement and model structure.
  
  
  RESULTS
  Final sample n = 518. The model incorporates 13 components organized into five conceptual domains: 'Readiness for Clinical Nurse Leader integrated care delivery'; 'Structuring Clinical Nurse Leader integrated care delivery'; 'Clinical Nurse Leader Practice: Continuous Clinical Leadership'; 'Outcomes of Clinical Nurse Leader integrated care delivery'; and 'Value'. Sample data had good fit with specified model and two-level measurement structure. All hypothesized pathways were significant, with strong coefficients suggesting good fit between theorized and observed path relationships.
  
  
  CONCLUSIONS
  The validated model articulates an explanatory pathway of Clinical Nurse Leader integrated care delivery, including Clinical Nurse Leader practices that result in improved care dynamics and patient outcomes. The validated model provides a basis for testing in practice to generate evidence that can be deployed across the healthcare spectrum.
authors.affiliation: Program in Nursing Science, University of California, Irvine, California, USA.
authors.forename: Miriam
authors.identifier: http://orcid.org/0000-0003-2457-1652
authors.initials: M
authors.lastname: Bender
authors.affiliation: Central Texas Veterans Health Care System, Temple, Texas, USA.
authors.forename: Marjory
authors.initials: M
authors.lastname: Williams
authors.affiliation: Evaluation and Assessment Unit, School of Public Health, University of Alabama at Birmingham, Alabama, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Su
authors.affiliation: Evaluation and Assessment Unit, Department of Health Care Organization and Policy, The University of Alabama at Birmingham, Alabama, USA.
authors.forename: Lisle
authors.initials: L
authors.lastname: Hites
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004522:Educational Status; D006801:Humans; D007857:Leadership; D008875:Middle Aged; D016294:Models, Nursing; D009720:Nurse Clinicians / Q000592:standards / Q000706:statistics & numerical data*; D024802:Nurse's Role; D009726:Nurses / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult
keywords: care delivery model; clinical leadership; clinical nurse leader; nursing; structure equation modelling