Chapter 14 outcome research

Nursing-sensitive patient outcomes
these outcomes are influenced by nursing care decision and action

Patient health outcomes
these outcomes are clearly interwoven into the entire care context

outcomes research
an established field of health research that focuses on the end results of patient care

administrative data bases
databases that are created by insurance companies, government agencies, and other not directly involved in providing patient care.

Nurses’ role in outcome
have three subcomponent that includes nurses’ independent roles, nurses’ dependent roles, and nurses’ interdependent roles.

proximal outcomes
an outcome that is close to the delivery of care

nursing care report card
this includes a group of indicators that could facilitate the benchmarking, or setting of a desired standard, that would allow comparison of hospitals in terms of their nursing care quality.

structure of care
the elements of organization and administration, as well as provider and patient characteristic, that guide the process of care.

Standard of care
A norm on which quality of care is judged such as clinical guidelines, critical paths, and care maps.

Distal outcomes
an outcome that is removed from the care or a service received and might be more influenced by external (non-treatment) factors.

quality of care
the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Clinical database
Databases that are created by providers such as hospitals, clinics, and healthcare professionals.

A major theory dominating outcomes research was developed by
Donabedian

Donabedian’s cube included which three aspects of health?
physical-psychological functions, psychological functions, and social functions.

Donabedian identifies three foci of evaluation in appraising quality. Identify these three foci.
structure:
process:
outcomes:

provide an example of Donabedian foci of structure
nursing units, hospital, clinics, or home health agencies

provide an example of Donabedian foci of process
what care is provided or practice patterns of intervention provided patients, how care is provided or practice styles and standards of care delivered (clinical guidelines, critical paths, or care maps)

provide an example of Donabedian foci of outcomes
morbidity rates, mortality rates, length of stay in hospitals, complications from procedure, side effects of medication, medication errors, fall rates, infection rates, costs, or patients satisfaction.

Loegering, Reiter, and Gambones (1994) modified Donabedian’s model to include three types of care
care by practitioner and other providers, care imleented by patient, and care revieved by community

Nursing role effectiveness model provided a frame work for conceptualizing
nursing-senittive outcomes,

Nurse’s independent roles functions include _____,______ ______, ______-________ ___________ and follow up care.
assessment, nursing diganosise, nurse-initiated interventions.

Nurses’ interdependent role functions include such action as __________, ______________, ___________, _________ of ________ __________ ___________, and reporting
communication, case management, coordination of care, continuity, monitoring.

to evaluate an outcome as defined Donabedian, the identified outcomes must be clearly linked to the process of care that caused the ____________.
outcome

List three examples of standard of care
clinical guidelines, critical paths, care maps

The agency for healthcare research and quality (AHRQ) website is a valuable source of information about outcomes research including __________, ____________ and _______ __________ _______ ___________.
funding opportunities, recently completed outcomes research

are (heterogeneous or homogenous) samples preferred in outcomes studies?
heterogeneous

What are two types of databases that are important sources of data for outcomes studies?
administrative, clinical

statistical methods for outcomes studies focus on analysis of ________ and ___________.
change, improvement

What are the three major questions used for critically appraising outcomes studies?
are the results valid, what are the results, and how can I apply the results to patient care?

ANA
American Nursing Association

provided funding to develop a national database to house data collected using nursing-sensitive quality indicator.

national quality forum
was created in 1999 as a national standard-setting organization for health care performance measures.

performance measures, serious reportable events, and preferred practices.

NDNQI
National Database of Nursing Quality Indicator.

(previous ANA), requirement for the magnet recognition program, and 20% of database member participated for that reason.

more specifically outcomes research is concerned with
effectiveness of healthcare interventions and health services

Avedis Donabedian
proposed a theory of quality health care and provided a process for evaluating it

World health organization
WHO

Donabedian represented his key concepts with
a cube

the three dimensions of the cube are
health
subjects of care
providers of care

the cube also incorporates
three of the many aspects of health

physical/psychological function
psychological function
social function

Donabedian identified three foci of evaluation of appraising quality
structure
process
outcomes

nursing interventions reflect
the care delivered by nurses

fall risk assessment or pressure ulcer risk assessment are examples of
nursing interventions

nursing services are a general concept referring to
the organization and administration of nursing activities

structures in outcomes
have 3 subcomponents being:
nurse
organization
patient

independent role functions for nurses
assessment
diagnosis
nurse initiated interventions
follow up care

example of proximal outcome
signs and symptoms of a disease

example of distal outcome
quality of life

clinical guideline panels are established to
incorporate available evidence on health outcomes

a nursing sensitive outcome is “sensitive” because
it is influenced by nursing

1. Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by 2020? a. Positions that historically required registered nurses will be filled by unlicensed personnel. b. The job growth rate for RNs will surpass job growth in …

The nurse cares for a client with a cuffed tracheostomy tube. Before performing oral care, the nurse notes that the client’s tracheostomy cuff is inflated. Which of the following is the MOST appropriate action for the nurse to take? 1. …

The nurse cares for a client with a cuffed tracheostomy tube. Before performing oral care, the nurse notes that the client’s tracheostomy cuff is inflated. Which of the following is the MOST appropriate action for the nurse to take? 1. …

What is the primary focus of nursing care in the “family as context” approach? 1 The relationship among family members 2 The health and development of an individual 3 The ability of the family to meet their basic needs 4 …

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