Friday, October 26, 2007

Nursing Sensitive Outcome Indicators

Nursing Sensitive Outcome Indicators

Introduction
Along with health care reform, the quest for cost-effectiveness and quality of care and the growing sophistication of health care systems, has come an increased emphasis on evidence and outcomes. These elements, together with a growing concern about changes in skill mix, prompted nursing to focus on identifying outcome indicators sensitive to nursing inputs and staffing levels.

Nursing Sensitive Patient Outcomes
Outcomes define the end results of nursing interventions and are indicators of problem resolution or progress toward problem or symptom resolution. i The ICNP® defines a nursing outcome as the measure or status of a nursing diagnosis at points in time after a nursing intervention, while ii nursing-sensitive outcomes are defined as changes in health status upon which nursing care has had a direct influence. iii Variables affecting patient outcomes include diagnosis, socio-economic factors, family support, age and gender, and the quality of care provided by other professionals and support workers.

Commonly Used Nursing Sensitive Outcome Indicators
The following patient outcomes are commonly used nursing sensitive indicators: iv
1) Patient complications, such as urinary tract infections, skin pressure ulcers, hospital acquired pneumonia and deep vein thrombosis/pulmonary embolism.
2) A group of exploratory measures, comprising upper gastrointestional bleeding, central nervous system complications, sepsis and shock/cardiac arrest.
3) Complications among surgical patients such as wound infection, pulmonary failure and metabolic derangement.
4) Patient length of stay, and failure to rescue (failure to respond to patients' urgent conditions such as shock, cardiac arrest and deep vein thrombosis, potentially resulting in increased morbidity and/or mortality).In addition, an inventory of patient outcomes has been identified related to the scope of practice and staff mix in a health facility. These include:
- Symptom control and change in symptom severity.
- Functional status.
- Knowledge of condition and treatment.
- Patient satisfaction with care.
- Unplanned emergency department visits.
- Unplanned hospital readmissions.
- Strength of treatment alliance.
What is the Importance of Nurse Sensitive Indicators?
Use of nursing sensitive outcome indicators helps focus attention on the safety and quality of patient care and the measurement of care outcomes. vi It is important that nurses and health facilities collect data to monitor the ongoing cost and quality of patient care. Using nursing sensitive outcome indicators is crucial to effectively demonstrate that nurses make the critical, cost-effective difference in providing safe, high-quality patient care.

The importance of articulating nursing sensitive quality indicators cannot be overstated. Such articulation and the correlation of nursing activities with health outcomes provide strong support for appropriate allocation of health care resources. For example, studies comparing staffing levels and patient outcomes show that when there are more registered nurses, patients’ experience fewer complications, shorter lengths of stay, decreased mortality rates and even lower overall costs. vii Similarly, a strong and consistent relationship has been found between nurse staffing and five patient outcomes in medical patients: urinary tract infections, pneumonia, length of stay, upper gastrointestinal bleeding and shock. viii This means higher levels of nurse staffing are associated with less adverse effects.
Conclusion
Nursing sensitive outcome indicators are intended to draw correlations between nursing intervention patients have received and their resulting health status. They are an attempt to measure the effectiveness of nursing care by measuring patient outcomes. Linkages are more easily seen when diagnosis, intervention and outcomes are identified. Since nurses are an integral part of the health care delivery system, nursing sensitive indicators capture what nurses do, what outcomes they achieve and at what cost. This is an important step in appropriate allocation of health care resources and in making nursing contribution to health care visible.
The International Council of Nurses (ICN) is a federation of 129 national nurses' associations representing the millions of nurses worldwide. Operated by nurses for nurses since 1899, ICN is the international voice of nursing and works to ensure quality care for all and sound health policies globally.
References:
i ANA Web site http://www.nursingworld.org/mods/archive/mod30/cec213.htm
ii International Council of Nurses (2001) International Classification for Nursing Practice – Beta 2 version. Geneva, ICN.
iii Ke-Ping A. Yang; Lillian M. Simms; Jeo-Chen T. Yin (1999) Factors Influencing Nursing-Sensitive Outcomes in Taiwanese Nursing Homes, Online Journal of Issues in Nursing , Article published August 3, 1999
iv http://nursingworld.org/books
v Calgary Health Region. http://www.clpna.com/HPA.pdf#search=%22%22Nursing%20sensitive%20outcome%20indicators%20%22%22
vi American Nurses Association. http://www.nursingworld.org/mods/archive/mod30/cec213.htm
vii American Nurses Association (1997), Implementing Nursing's Report Card: A Study of RN Staffing Length of Stay and Patient Outcomes. ANA Web site http://www.nursingworld.org/mods/archive/mod30/cec213.htm
viii American Nurses Association. http://www.nursingworld.org/mods/archive/mod30/cec213.htm

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