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Nursing-Sensitive Outcomes Data Collection in Acute Care and Long-Term-Care Settings

Doran, Diane M.; Harrison, Margaret B.; Laschinger, Heather S.; Hirdes, John P.; Rukholm, Ellen; Sidani, Souraya; Hall, Linda McGillis; Tourangeau, Ann E.

FEATURES

Background: Most administrative databases do not contain good information about nursing-sensitive outcomes.

Objectives: To determine (a) the reliability of the instruments measuring nursing-sensitive outcomes, (b) whether the outcome measures are sensitive to changes in patients' health, and (c) whether the outcome measures are associated with nursing interventions.

Methods: The sample consisted of 890 patients from acute care hospitals and long-term-care facilities. A repeated measures design was used. Functional status was assessed on admission and discharge using Minimum Data Set 2.0 items. Symptom (pain, nausea, dyspnea, fatigue) frequency and severity were assessed with 4-point and 11-point numeric scales, respectively. Therapeutic self-care was assessed on discharge from acute care. Nursing interventions were assessed by documentation review.

Results: The outcome measures demonstrated very good interrater reliability with weighted Kappa ranging from .64 to .93. The internal consistency reliability was high for functional status and therapeutic self-care. The outcome tools were sensitive to change in patient condition. Select nursing interventions were related to functional status, therapeutic self-care, and symptom outcomes.

Discussion: The findings suggest that nurses are able to collect data on nursing-sensitive patient outcomes in a reliable and valid way.

Diane M. Doran, PhD, RN, FCAHS, is Professor, Associate Dean of Research and International Relations, Faculty of Nursing, University of Toronto; Nursing Health Services Research Unit, Toronto, Ontario, Canada.

Margaret B. Harrison, PhD, RN, is Associate Professor, School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.

Heather S. Laschinger, PhD, RN, is Professor, Associate Director of Research, School of Nursing, University of Western Ontario, London, Ontario; Nursing Health Services Research Unit, University of Toronto, Toronto, Ontario, Canada.

John P. Hirdes, PhD, is Professor, Department of Health Studies and Gerontology, University of Waterloo; and Scientific Director, Homewood Research Institute, Waterloo, Ontario, Canada.

Ellen Rukholm, PhD, RN, FCAHS, is Professor and Director, School of Nursing, Laurentian University; and Faculty member, Centre for Rural and Northern Health, Sudbury, Ontario, Canada.

Souraya Sidani, PhD, is Professor, Faculty of Nursing, University of Toronto; Nursing Health Services Research Unit, Toronto, Ontario, Canada.

Linda McGillis Hall, PhD, RN, is Associate Professor, Faculty of Nursing, University of Toronto; Nursing Health Services Research Unit, New Investigator, Canadian Institutes of Health Research, Toronto, Ontario, Canada.

Ann E. Tourangeau, PhD, RN, is Assistant Professor, Faculty of Nursing, University of Toronto; Adjunct Scientist, Institute for Clinical Evaluative Sciences in Ontario; Co-investigator, Nursing Health Services Research Unit; Career Scientist, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada.

Accepted for publication November 21, 2005.

We gratefully acknowledge the Ontario Ministry of Health and Long-Term Care for their funding of this research. The opinions, results, and conclusions are those of the authors. No endorsement by the Ministry of Health and Long-Term Care is intended or should be inferred.

Corresponding author: Diane M. Doran, PhD, RN, FCAHS, Faculty of Nursing, Nursing Health Services Research Unit, University of Toronto, #215-155 College Street, Toronto, ON, Canada M5T 1P8 (e-mail: diane.doran@utoronto.ca).

© 2006 Lippincott Williams & Wilkins, Inc.