Updating and normalization of the Nursing Management Minimum Data Set element 6: patient/client accessibility

Patient/client accessibility is one of 18 Nursing Management Minimum Data Set data elements developed to evaluate contextual factors at the nursing unit or service level of care. The Nursing Management Minimum Data Set 06 patient/client accessibility was developed to capture variability in time and distance required to access patients. Variability in access to patients, needed supplies, equipment, and information for patient care has an impact on the amount of time available for direct patient care. Limitations in time available to provide safe and quality care may negatively affect patient outcomes, nurse retention, and, as a result, a healthcare organization's accreditation and finances. Since 2005, the first five Nursing Management Minimum Data Set data elements have been incorporated into the publicly accessible healthcare data set Logical Observation Identifier Names and Codes, thereby making results derived from these nursing management data elements available for empirical use. A critical review of the literature and other healthcare resources was conducted to update patient/client accessibility. A consensus approach was used by an interdisciplinary panel of experts to finalize recommendations for revisions. The name, conceptual and operational definitions, and measures were updated. The revised data element is titled "client accessibility." The conceptual and operational definitions were expanded and measures changed to increase validity and reliability of data collection. The updated conceptual definition is "the time, distance, and method to connect the nurse/provider and client for an encounter and includes the information, supplies, equipment, and personnel required for the encounter." The Nursing Management Minimum Data Set can provide individuals responsible for managing and financing nursing resources with quantifiable data regarding the context of nursing care. At present, healthcare costs are rising at an unsustainable rate, and many national healthcare outcomes are worsening. More information is needed to identify potential areas of improvement in the management and funding of nursing care. The update and use of Nursing Management Minimum Data Set 06 data element client accessibility may help to identify problem areas associated with nursing time, distance traveled, and methods used to provide patient care. Such empirical evidence may support better informed decisions on caseloads in diverse settings, hospital designs, methods used to provide care, and fiscal requirements.     

Nurse autonomy,nurse job satisfaction and client satisfaction with nursing care: their place in nursing data sets

Many changes have taken place in the healthcare system that have influenced nurse autonomy, job satisfaction and client satisfaction. Standardized language facilitates communication within the discipline of nursing. Examples of such language include the Nursing Intervention Classification (NIC) and the Nursing Outcomes Classification (NOC) systems as well as the Nursing Minimum Data Set (NMDS), which provides a formal structure for electronic data sets to support nursing care. The Nursing Management Minimum Data Set (NMMDS) was designed to identify variables to guide nurse managers in evaluating the impact of nursing interventions on client outcomes. Gaps within NMDS and NMMDS are discussed, and solutions are proposed.     

临床护理人力资源管理数据集的交叉比照研究

目的 发展符合国内外标准的临床护理人力资源管理基本数据集(clinical nursing human resource management basic data set,CNHRMBDS).方法 根据文献和相关国家标准发展CNHRMBDS,再与护理管理相关数据集进行交叉比照研究.结果 CNHRMBDS包含数据元179项,中国医院信息基本数据集标准1.0版、中国公共卫生信息分类与基本数据集(第1版)及社区卫生信息基本数据集的相关指标项均在其中,与世界卫生组织护理人力最小数据集中的24项指标(85.7%)对应,与美国护理管理最小数据集中的155项指标(76.4%)对应.结论 CNHRMBDS完整全面,可满足国内外护理人力资源管理的要求,可发展为行业标准.     

Use of the nursing minimum data set.

The purpose of this study was to obtain information about usage of the Nursing Minimum Data Set (NMDS). Forty-six individuals (44%) who requested the NMDS Data Collection Manual responded to a mailed questionnaire. Most respondents reported actually using the Manual to educate other nurses or to structure nursing documentation. More than one third of the respondents used all of the elements within the NMDS, but the majority used, or intended to use, the elements in the Nursing Care category. The majority of NMDS elements that were being used, or intended to be used, were available from handwritten patient records. The NMDS elements had been recorded on an ongoing basis by 86% of the respondents, but only 31% could retrieve readily all of the elements. Implications for access to comparable, minimum nursing care and resources data are discussed.     

Nursing Intervention Classification Systems

Purpose: To analyze the features, development, and research of the Omaha System, the Iowa Nursing Intervention Classification, and the Home Health Care Classification and provide a critical review of the unique components of each.
Organizing Framework: Five elements: achievement of original purpose, language used, ease of computerizing format, clinical utility, and linkage of the Nursing Minimum Data Set (NMDS) nursing care elements.
Conclusions: Further testing and development of nursing classification systems should be done to determine the general value of nursing classification, the extent to which the original goals and purposes of classification are met, and to identify the unique features and contributions of each system. Further testing is important to determine the strengths, weaknesses, and applicability of the various systems for capturing the elements of the NMDS for different care settings, care givers, and patient populations.
Implications: Nursing classification may eventually lead to naming and describing the work of nurses. Research findings will continue to provide information leading to a unified nursing language system that describes the practice of nursing in local, regional, national, and international health-care data sets used for research, clinical, education, policy, and administrative purposes.     

Development of a nursing data set for school nursing.

School nurses need to clearly identify how they promote the health and educational achievement of children. School nurses contribute to student health by providing health assessment and nursing interventions, advocating for healthy living, and contributing to prevention of illness and disease management. A Nursing Data Set for School Nursing can identify those data elements that are needed to prove that school nurses have a positive effect on children, families, and the community. The purpose of this project was to develop a Nursing Data Set for School Nursing that would describe and validate school nursing practice. Building on the Nursing Minimum Data Set developed by Werley, Devine, and Zorn, a Nursing Data Set for School Nursing was developed with guidance from experts in the field of school nursing. A Nursing Data Set for School Nursing has the potential to assist school nurses in documentation and validation of their nursing practice. It can validate the complexity of the role of the school nurse, the resources needed, and the effect school nurses have on improving the health and educational outcomes of students.     

Validity,reliability and utility of the Irish Nursing Minimum Data Set for General Nursing in investigating the effectiveness of nursing interventions in a general nursing setting: A repeated measures design

Background

Internationally, nursing professionals are coming under increasing pressure to highlight the contribution they make to health care and patient outcomes. Despite this, difficulties exist in the provision of quality information aimed at describing nursing work in sufficient detail. The Irish Minimum Data Set for General Nursing is a new nursing data collection system aimed at highlighting the contribution of nursing to patient care.

Objectives

The objectives of this study were to investigate the construct validity and internal reliability of the Irish Nursing Minimum Data Set for General Nursing and to assess its usefulness in measuring the mediating effects of nursing interventions on patient well-being for a group of short stay medical and surgical patients.

Design

This was a quantitative study using a repeated measures design.

Setting

Participants sampled came from both general surgery and general medicine wards in 6 hospitals throughout the Republic of Ireland.

Participants

Nurses took on the role of data collectors. Nurses participating in the study were qualified, registered nurses engaged in direct patient care. Because the unit of analysis for this study was the patient day, patient numbers were considered in estimations of sample size requirements. A total of 337 usable Nursing Minimum Data Set booklets were collected.

Methods

The construct validity of the tool was established using exploratory factor analysis with a Promax rotation and Maximum Likelihood extraction. Internal reliability was established using the Cronbach's Alpha coefficient. Path analysis was used to assess the mediating effects of nursing interventions on patient well-being.

Results

The results of the exploratory factor analysis and path analysis met the criteria for an appropriate model fit. All Cronbach Alpha scores were above .7.

Conclusion

The overall findings of the study inferred that the Irish Nursing Minimum Data for General Nursing possessed construct validity and internal reliability. The study results also inferred the potential of the tool in the investigation of the impact of nursing on patient well-being. As such, this new tool demonstrated potential to be used in the provision of quality information to inform policy in relation to the organisation of nursing care. More research is needed to further establish its use in the assessment of patient outcomes.     

Nursing Minimum Data Set development and implementation in Thailand

BACKGROUND: In 1997, the Thai Ministry of Public Health began planning to implement a national health information system. Development of the nursing component of this system is an ongoing process. The first step in developing a nursing information system is to identify an essential Nursing Minimum Data Set (NMDS). AIM: To describe the development of a NMDS in Thailand and explore the challenges of implementing it, including the issue of the comparability with data sets in other countries, primarily the United States of America. METHODS: The process of developing a NMDS specific to Thailand is reviewed. Strategies for implementing this data set and important issues related to it are then discussed. FINDINGS: Although a preliminary Thai NMDS has been identified, challenges associated with its development and implementation within the Thai National health information system remain. CONCLUSION: A Thai NMDS and its elements have been identified. The International Classification of Nursing Practice was translated and is to be used to implement the data set describing the nursing care of patients and their families. However, many issues, such as the need for conceptual translation and increasing nurses' involvement in the process, still need to be addressed in order to implement the data set successfully.     

Improving quality of care in nursing facilities. Gerontological clinical nurse specialist as research nurse consultant

It is becoming increasingly common for nursing facilities to use Quality Indicators (QI) derived from Minimum Data Set (MDS) data for quality improvement initiatives within their facilities. It is not known how much support facilities need to effectively review QI reports, investigate problems areas, and implement practice changes to improve care. In Missouri, the University of Missouri-Columbia MDS and Nursing Home Quality Research Team has undertaken a Quality Improvement Intervention Study using a gerontological clinical nurse specialist (GCNS) to support quality improvement activities in nursing homes. Nursing facilities have responded positively to the availability of a GCNS to assist them in improving nursing facility care quality.     

Test of the nursing minimum data set: availability of data and reliability

An initial study of the availability of the elements in the Nursing Minimum Data Set (NMDS) and intercoder reliability across four types of clinical settings is reported. These clinical settings included an acute care hospital, a nursing home, a home health care agency, and two ambulatory care clinics. The health records of 116 randomly selected subjects were reviewed to determine the availability of the NMDS elements. A randomly selected subset of 23 of these records provided data on intercoder agreement. All but four of the NMDS elements were available for 85% or more of the subjects. The average intercoder agreement across all NMDS elements was a satisfactory 91%. However, the intercoder agreement on some NMDS elements was much lower, suggesting a need to refine the definitions and procedures for collecting some of the NMDS elements. Where appropriate, coefficient Kappa and Pearson product moment correlation statistics for reliability are reported on individual NMDS elements.     

Development of the Society of Gastroenterology Nurses and Associates Minimum Data Set: an evidence-based resource.

The Society for Gastroenterology Nurses and Associates (SGNA) has developed a Minimum Data Set identifying the essential elements necessary to document delivery of patient care in the gastrointestinal endoscopic setting. Standardized information, such as a minimum data set, for facilitating communication among practitioners is believed to enhance patient outcomes. The SGNA Minimum Data Set was developed for "public" use to facilitate quality patient outcomes and to enhance the education, research, and clinical practice of GI nurses. Data were collected from a cross-sectional representation of geographic locations and settings (major medical centers, community hospitals, and free-standing clinics) in order to establish a broad evidence-based perspective for the data set. Data for the four primary endoscopic procedures: esophagogastroduodenoscopy (EGD), colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and flexible sigmoidoscopy; as well as the most common therapeutic procedures (biopsy, polypectomy, dilation, endoscopic ultrasound [EUS], and manometry/motility) were analyzed to establish the key elements of the Minimum Data Set. Focus groups with members from around the U.S. verified the validity of the Minimum Data Set. The SGNA Minimum Data Set can be used by healthcare institutions, industry, and individuals to facilitate the capture and analysis of standardized data for the purpose of improving GI patient outcomes and enhancing delivery of nursing care.     

Initial field testing of an instrument to measure: observable indicators of nursing home care quality

The "Observable Indicators of Nursing Home Care Quality" instrument was developed as a new measure of nursing home care quality. The instrument is based on a theoretical model of quality nursing home care grounded in data from provider and consumer focus groups. The instrument was piloted in 10 Missouri nursing homes. Subsequent versions were tested in 109 Missouri and 11 Icelandic nursing homes. Content validity was established using experts. Concurrent and known groups validity was evaluated using Minimum Data Set quality indicators, survey citations, and a process of care measure. Interrater and test-retest reliabilities were calculated as well as coefficient alpha. The "Observable Indicators of Nursing Home Care Quality" instrument is a new measure that can be used by researchers, and potentially by regulators, consumers, or providers, to observe and score specific indicators of quality care following a 20- to 30-minute inspection of a nursing home.     

Use of the Nursing Minimum Data Set to Describe Nursing Interventions for Select Nursing Diagnoses and Related Factors in an Acute Care Setting

This study describes the prevalence of nursing interventions across six nursing diagnoses and their related factors using the framework of the Nursing Minimum Data Set (NMDS). Six nursing diagnoses (pain, potential for injury, anxiety, decreased cardiac output, potential for infection, and knowledge deficit) were among the most prevalent in an acute care setting studied in 1992. The NMDS and a nursing information system using standardized classification systems for nursing diagnoses and interventions provided an opportunity to describe nursing practice. Multiple related factors were identified across all six nursing diagnoses; three or four were selected frequently within each diagnostic category. The related factors also influenced the selection of interventions. Implications for the development of nursing classification systems and recommendations for further research are described .     

Classifying Nursing-Sensitive Patient Outcomes

This report describes research at the University of Iowa College of Nursing to develop a comprehensive classification of nursing-sensitive patient outcomes. The Nursing-Sensitive Outcomes Classification (NOC) completes the nursing process elements of the Nursing Minimum Data Set (NMDS). We describe resolution of conceptual and methodological problems that define the inductive approach taken to develop the NOC. Strategies used to develop NOC included review of the literature, clinical databases and instruments; concept analysis; and surveys of nurse experts. Examples of outcomes, definitions, and indicators are presented. The NOC provides standardized patient outcomes for determining the effectiveness of nursing interventions and enables inclusion of these data in data sets for healthcare effectiveness research.     

Preparing a large data set for analysis: using the minimum data set to study perineal dermatitis

AIM: The aim of this paper is to present a practical example of preparing a large set of Minimum Data Set records for analysis, operationalizing Minimum Data Set items that defined risk factors for perineal dermatitis, our outcome variable. BACKGROUND: Research with nursing home elders remains a vital need as 'baby boomers' age. Conducting research in nursing homes is a daunting task. The Minimum Data Set is a standardized instrument used to assess many aspects of a nursing home resident's functional capability. United States Federal Regulations require a Minimum Data Set assessment of all nursing home residents. These large data would be a useful resource for research studies, but need to be extensively refined for use in most statistical analyses. Although fairly comprehensive, the Minimum Data Set does not provide direct measures of all clinical outcomes and variables of interest. METHOD: Perineal dermatitis is not directly measured in the Minimum Data Set. Additional information from prescribers' (physician and nurse) orders was used to identify cases of perineal dermatitis. The following steps were followed to produce Minimum Data Set records appropriate for analysis: (1) identification of a subset of Minimum Data Set records specific to the research, (2) identification of perineal dermatitis cases from the prescribers' orders, (3) merging of the perineal dermatitis cases with the Minimum Data Set data set, (4) identification of Minimum Data Set items used to operationalize the variables in our model of perineal dermatitis, (5) determination of the appropriate way to aggregate individual Minimum Data Set items into composite measures of the variables, (6) refinement of these composites using item analysis and (7) assessment of the distribution of the composite variables and need for transformations to use in statistical analysis. RESULTS: Cases of perineal dermatitis were successfully identified and composites were created that operationalized a model of perineal dermatitis. CONCLUSION: Following these steps resulted in a data set where data analysis could be pursued with confidence. Incorporating other sources of data, such as prescribers' orders, extends the usefulness of the Minimum Data Set for research use.     

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items Rationale Currently, there is no systematic collection of nursing care data in the Netherlands, while pressure is growing from the profession, policy-makers and society to justify the contribution of nursing and its costs. A nursing minimum data set can provide data to demonstrate nursing's contribution to health care as it can be used to describe the diversity of different patient populations and the variability of nursing activities, and to calculate the associated nursing workload. Objective To identify categories and items for inclusion in the Nursing Minimum Data Set for the Netherlands. Design A multimethod, exploratory approach was used. This included interviews, document analysis, consensus rounds, seeking validation in the literature, and drawing up lists of most frequently occurring patient problems, interventions and outcomes of care. Eight hospitals, with a total of 16 wards, participated in the study. Results Relevant categories and items emerged after analysis and grouping of the material and included: five hospital-related items, six patient demographics items, seven medical condition items, 10 nursing process items, 24 patient problems, 32 nursing interventions, four outcomes of nursing care, and three complexity of care items. Almost every item could be located in the existing documentation systems, the lists of patient problems, outcomes and interventions, or in the literature. Conclusion A set of categories and items of nursing data has been identified. The content validity of this set is partly supported by its consistency with the literature, findings from practice and the judgement of potential users. Nursing outcomes need further development. The data set will be tested in practice to find out whether the categories and items are useful, and whether they can be minimized.     

The cross‐cultural adaptation of the Belgium Nursing Minimum Data Set to Finnish nursing

Background Nursing has been invisible in most of the international and national healthcare information systems and databases; also in Finland. The use of nursing minimum data set could be one solution to this problem. It is an information system that collects, stores, processes, retrieves, displays and communicates timely information about nursing practice needed for a variety of users and purposes. Objectives To test the cultural applicability of the Belgian Nursing Minimum Data Set (BeNMDS) to Finnish nursing. Methods The study design was methodological. It included testing of the validity, reliability and sensitivity of the BeNMDS. Content validity was tested using content analysis of the Finnish nursing doctorate dissertations, Katie Eriksson's publications of her Nursing Process Model and focus‐group interviews of the healthcare administrators. Reliability, construct validity and sensitivity were tested using the data collected with the BeNMDS‐tool from patients' nursing notes in Finnish Hospitals. Findings The validity, reliability and sensitivity of the BeNMDS in Finland were mainly good. The study showed, however, that the interventions to describe the patient's spiritual well‐being, were missing and the psycho‐social care interventions were insufficient in the data set. Conclusion The Finnish version of the BeNMDS has been shown to be valid, reliable and sensitive and applicable to describe nursing practice in Finland. Should the interventions to describe patient's spiritual and psycho‐social well‐being be included in the data set, Finnish nursing will have a valuable tool available to make nursing visible for the healthcare information systems and databases.     

Antidepressant Treatment of Depression in Rural Nursing Home Residents

Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.     

Antidepressant treatment of depression in rural nursing home residents

Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.