CNC - Student Projects

Student Project and Theses

Dissertations

Validation of Nursing-sensitive Patient Outcomes for Rural and Urban Community Elderly
Barbara J. Head, MSN, RN with Meridean Maas, PhD, RN, Advisor

A survey research design was used to assess the importance, sensitivity to nursing intervention, and content validity of six client outcomes (Self-Care: Activities of Daily Living; Self-Care: Instrumental Activities of Daily Living; Treatment Behavior: Illness or Injury; Health Knowledge; Caregiver Performance: Direct Care; and Caregiver Physical Health) included in the Nursing Outcomes Classification (NOC)(Iowa Outcome Project, 1997) for community health nursing practice. Nurses certified by the American Nurses' Credentialing Center as community health nursing experts (N=368) returned 239 (66%) of the mailed questionnaires. Experts rated outcomes and indicators on a 5 point Likert-type scale. Outcomes were rated for: their importance for community health nursing and the influence of nursing intervention. Indicators of each outcome were rated for: their importance for determining the outcome and the nursing contribution to indicator achievement.

Quantitative estimates of content validity of outcomes and indicators were calculated using an adaptation of Fehring's (1987) technique and other methods. Regression analysis was used to evaluate the relationships between each outcome and its indicators. Rating differences were examined for demographic variables including expert service to older vs. younger and urban vs. rural clients. Content analysis of comments was performed.

Results supported the importance and nursing-sensitivity of the outcomes for community health nursing. Multiple regression analysis produced simultaneous and stepwise models that identified a concise list of potential key measures for importance and nursing-sensitivity of each outcome. Needs for further development of individual- and community-level NOC outcomes were identified. Implications were suggested for nursing practice, nursing education, and nursing research.

References :

Dillman, D. A. (1983). Mail and other self-administered questionnaires. In P. H. Rossi, J. D. Wright, & A. B. Anderson (Eds.), Handbook of survey research (pp. 359-376). San Diego: Academic Press.

Fehring, R. J. (1986). Validating diagnostic labels: Standardized methodology. In M. E. Hurley (Ed.), Classification of nursing diagnoses; Proceedings of the sixth conference . St. Louis: Mosby.

Fehring, R. J. (1987). Methods of validate nursing diagnoses. Heart & Lung, 16(6), 625-629.

Head, B. J. (1997). Validation of nursing-sensitive outcomes for rural and urban community elderly. Unpublished Doctoral dissertation, The University of Iowa, Iowa City, IA.

Maas, M., & Head, B. (1998). Moving to measurement. Outcomes Management for Nursing Practice, 2(4), 139-142.

Maas, M., Johnson, M., & Moorhead, S. (1997). Classifying nursing-sensitive patient outcomes. Image: Journal of Nursing Scholarship, 28(4), 295-301.

Iowa Outcomes Project. Johnson, M. & Maas, M., Eds.. (1997). Nursing Outcomes Classification (NOC). St. Louis: Mosby.

Sparks, S., & Lien, G., T. (1994). Modification of the diagnostic content validity model. Nursing Diagnosis, 5, 31-35.

Effect of Nurse Accountability on Patient Outcomes
Cindy Scherb, MSN, RN with Meridean Maas, PhD, RN, Advisor

The proposed research will assess the relationship of nurse accountability to patient outcomes as well as the role of other variables in the achievement of patient outcomes that are sensitive to nursing care. These data are needed to best structure and manage the delivery of quality nursing of patients in a cost constrained environment. Research in the relationship of perceived professional nurse accountability and patient outcomes is important to assessing how nursing care impacts patient outcomes, and is required to meet the profession's mandate, to influence health policy (Jennings, 1991), and to challenge nursing to measure and quantify its positive impact on quality of care (Fralic, 1985). Ethridge and Lamb (1989) state "...a professional accountability framework is seen as an important means of enhancing quality and cost outcomes of nursing care" (p.33), but the assumption must be systematically validated.

Only a few studies thus far have looked at the relationship between nurse accountability and patient outcomes. When patients are hospitalized, nurses are primary care givers who assist the patient in reaching expected outcomes. If nurses do not see their role as having professional accountability for patient outcomes, these outcomes may not be realized. Thus, it is important to determine the relationship of nurse accountability to patient outcomes as well the role of other variables in the achievement of patient outcomes that are sensitive to nursing care. These data are needed to best structure and manage the delivery of quality nursing of patients in a cost constrained environment.

Specific aims are to describe: 1) the perceived accountability of nurses working in primary nursing, team nursing, total patient care, and case management care systems on hospital orthopedic units, 2) the relationship of nurses' perceived accountability, job satisfaction, work environment, and achieved patient outcomes, and 3) the unique contribution of nurse accountability and type of delivery system to achieved patient outcomes in addition to the contribution of nurse and patient demographics, perceived job satisfaction and work environment.

The Nursing-Sensitive Outcomes Classification (NOC) (Iowa Outcomes Project, 1997)) will be used in evaluating patient outcomes. This research will add to knowledge regarding nursing-sensitive outcomes, provide testing of NOC standardized outcomes, and add data regarding patients' ratings of the sensitivity of some outcomes to nursing interventions. Questions contact cascherb@smig.net

References:

Ethridge, P., & Lamb, G.S. (1989). Professional nursing case management improves quality, access and costs. Nursing Management, 20 (3), 30-35

Fralic, M.F. (1985). Commentary of the competition approach to understanding occupational autonomy: Expansion and control of nursing service. Journal of Professional Nursing, 1 (5), 292.

Iowa Outcomes Project. M. Johnson & M. Maas (Eds.). (1997). Nursing Outcomes Classification (NOC). St. Louis: Mosby.

Jennings, B.M. (1991). Patient outcomes research: Seizing the opportunity. Advances in Nursing Science, 14 (2), 59-72.