Paper
Thursday, July 14, 2005
What Is the Relationship Between Nursing Interventions and Patient Outcomes in Acute Care and Long-Term Care Settings?
Diane M. Doran, RN, PhD1, Margaret B. Harrison, RN, PhD2, Heather K. S. Laschinger, RN, PhD3, John P. Hirdes, PhD4, Ellen Rukholm, RN, PhD5, Linda McGillis Hall, RN, PhD1, and Ann Tourangeau, RN, PhD1. (1) Faculty of Nursing, University of Toronto, Toronto, ON, Canada, (2) School of Nursing, Queen's University, Kingston, ON, Canada, (3) School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada, (4) Dept. of Health Studies and Gerontology, University of Waterloo, Waterloo, ON, Canada, (5) Laurentian University, Sudbury, ON, Canada
| Learning Objective #1: Understand the relationship between nursing interventions and nursing-sensitive patient/resident outcomes in acute care and long-term care settings |
| Learning Objective #2: Understand how nurses can use outcomes data to review the effectiveness of nursing interventions, improve practice, and explore practice in relation to best available evidence |
The purpose of this paper is to explore the relationship between nursing interventions documented in the patient health record and outcomes for medical surgical patients and long-term care residents. Methods: The Nursing Role Effectiveness Model provided the framework for evaluating the relationship between patient characteristics, nursing interventions, and outcomes. A repeated measures design was used. The setting consisted of 4 acute care hospitals and 8 long-term care facilities. The sample consisted of nurses and patients from selected units. Nurses were trained to collect data on patients' functional status, self-care, symptoms, and pressure ulcers using standard measurement tools. Research assistants collected data on nursing interventions through chart audit. Results: A voluntary sample of 191 staff nurses (RR=80%) and 966 patients (RR=80%) was obtained. The average nurse participant was 42 years old with 16.2 years of experience. The mean age of patients was 69 years. Inter-rater reliability for outcome measures was °Ý 0.79. Percent agreement for chart audit was 85%. There was a significant improvement (p<0.05) in outcomes in acute care, a decline in functional status in LTC, and an improvement in symptoms in LTC. Functional status was associated with nursing interventions for exercise promotion, urinary incontinence care, bed rest care, positioning, and self-care assistance (R2 =0.22 acute care, 0.71 LTC). Pressure ulcer outcomes was associated with nursing interventions aimed at pressure ulcer care, wound care, skin care, and dementia management (R2 =0.50 acute care, 0.42 LTC). Symptoms were related to nursing interventions for medication administration, chest physio (dypnea), and heat/cold application (pain). Conclusions and Implications: The study results demonstrate that nurses can use data on patient outcomes to gain insight into the effectiveness of their interventions. Nurses can use this information to identify areas for practice improvement, and explore their practice more critically in relation to the best available evidence.