Objective: The aim of this study was to identify nursing-sensitive patient outcomes and their attendant nursing inputs and processes that could be entered on and abstracted from patients’ charts or provided in other formats for the development of a database. The goal of this analysis was to provide sound information and recommendations for building a clinical database to document the quality and the effectiveness of nursing care in acute, community or home, and long-term care settings in Ontario.
Purposes: The purposes of this analysis were to identify the essential characteristics defining each outcome concept; to identify the instruments used to measure each outcome concept, and to review their content to determine their validity in capturing the domains and dimensions of the outcome concept; to review the psychometric properties and clinical utility of the outcome measures; and to determine the extent to which each outcome has demonstrated sensitivity to nursing.
Method: The literature review was conducted through a series of consecutive steps. Two general categories of references were included: theoretical or conceptual, and empirical, in order to address all the objectives set for this review. Theoretical/conceptual references discussed a perspective of how the clinical, functional, or perceptual outcomes are viewed - presenting theoretical and/or operational definitions of the outcomes. The definitions identified the essential characteristics of the outcome concept, and point to its domains and indicators. Empirical articles reported the results of descriptive-correlation or experimental studies that examined the relationships among structure, process, and outcome variables, assessed the psychometric properties of outcome measures, or evaluated the effectiveness of nursing interventions in achieving the desired outcomes.
Concepts/Variables Studied: The critical review and analysis of the literature on the outcomes considered as indicators of nursing care effectiveness, specifically functional status, self-care, symptom management, and patient satisfaction. As well, because of the known linkages between nurses work perceptions and patient satisfaction, a critical review and analysis of the literature on nurse job satisfaction was also conducted.
Results: There is evidence that nurses influence the following patient outcomes: morbidity, mortality, health status, self-care ability, symptom control and patient satisfaction with care, and adverse events such as infection rates, falls, skin breakdown and nosocomial infections. As well, nurses' job satisfaction is reported in several studies to be indirectly linked to patient satisfaction, i.e., when nurses have greater job satisfaction, patients report higher levels of satisfaction with care.
Conclusions: After reviewing the evidence from the literature on nurse-sensitive outcomes and examining the issues and complexities in capturing nurse-sensitive outcomes on databases a decision was made to proceed with pilot studies in the acute care, long-term care and community care sectors to assess the actual feasibility of capturing the data and to cost the process of conducting additional assessments, and recording and abstracting these new data elements. These pilots will assist in the testing of a template of key nursing-sensitive elements comparable among, or common to, all sectors.
Implications: Research supports the influence of nurses on patient outcomes; however, it is not always clear what the relationship is between nursing inputs and nursing practice processes and patient outcomes (Pierce, 1997). It is not always easy to measure outcomes or the associated inputs and processes or know when they should be measured in the course of a patient’s health care episode.
Back to Nursing and Patient Outcomes Research: Canadian Perspectives
Back to The Advancing Nursing Practice Excellence: State of the Science