Process and outcome measures using nursing sensitive indicators

Measuring the impact of high quality nursing care has become an imperative driven by several issues during the past several years. Current challenges surrounding the nursing shortage and the decreasing nursing workforce projected for the next decade alone have raised serious questions about the effect fewer registered nurses (RNs) will have on the quality of health care. In addition, heightened public attention to patient safety and adverse outcomes has prompted national organizations, such as the Joint Commission for Accreditation of Healthcare Organizations, the American Nurses Credentialing Center, and the National Quality Forum, to consider and implement recommendations for establishing and monitoring nursing quality indicators that focus on nursing-sensitive patient outcomes. These issues, now more than ever, have provided us with a burning platform to examine exactly what nurses do and their impact on patient health outcomes.     

Advancing the clinical nurse leader model through academic-practice-policy partnership

The nursing profession is tasked with identifying and evaluating models of care with potential to add value to health care delivery. In consideration of this goal, we describe the Clinical Nurse Leader (CNL) initiative and the activities of a national-level CNL research collaborative. The CNL initiative, launched by the American Association of Colleges of Nursing in collaboration with education and healthcare leaders, has delineated CNL education curriculum and practice competencies, and fostered the creation of academic-practice-policy partnerships to pilot CNL integration into frontline nursing care delivery. The partnership has evolved into an Agency for Healthcare Research and Quality affiliate practice-based research network, the CNL Research Collaborative, which links research, policy, education, and practice stakeholders to advance the CNL evidence base. We summarize foundational CNLRC research to explain CNL practice, quantify CNL effectiveness, and bring clarity to how CNLs can be implemented to consistently influence care, quality, and safety.     

The national agenda for quality palliative care: the National Consensus Project and the National Quality Forum

The release in 2007 of the National Quality Forum (NQF) preferred practices is a significant advance in the field of palliative care. These NQF preferred practices build on the clinical practice guidelines for palliative care developed by the National Consensus Project (NCP). The NQF is dedicated to improving the quality of American health care, and their focus on palliative care recognizes its growing place within the broader scope of health care. This article reviews the work of both the NCP and NQF and presents the domains and preferred practices that should guide quality improvement efforts in hospice and palliative care.     

Education in practice: the United Kingdom experience

Health care leaders, government agencies, and professional nursing associations all understand that rethinking existing delivery strategies is part of the strategic approach to workforce planning. In the United Kingdom, the demand for nurses is great and the supply inadequate. The potential for a public health crisis is challenging the way the United Kingdom educates and positions nurses within the health care industry. This article reviews past efforts and current strategies in workforce characteristics, age, educational mix, competencies, career goals, and future plans to ensure adequate nurses to care for the health needs of the people residing in the United Kingdom. The activities of the National Association of Theatre Nurses in promoting dialogue around this issue and fostering collaborative initiatives are presented in a framework of efforts designed to benefit all.     

Claiming the future of nursing through nursing-sensitive quality indicators

Although many of the changes in today's health care arena have been beneficial, there continues to be persistent dissatisfaction with the nation's health care delivery system. The provision of outcome-oriented, cost-effective health care is no longer a goal. It is a mandate. To accomplish this mandate, the relationship between the costs, quality and desired outcomes of care, and the processes involved in providing care must be reexamined. This article describes factors stimulating the American Nurses Association to develop nursing-sensitive quality indicators, details development of the National Database for Nursing Quality Indicators (NDNQI), and discusses the implications of nursing-sensitive indicators and NDNQI for nurse administrators. Nursing's quality indicators can be of value in the development of evidence-based health care report cards and can be used to direct change. We must move forward together in claiming the future of nursing through nursing-sensitive quality indicators.     

Report cards: relevance for nursing and patient care safety

The emergence of health care report cards in the North American environment is outlined. While it is evident that substantial activity has emerged, the majority of these initiatives excluded nursing, or use a broad indicator for nursing that may not provide meaningful representations of the quality of nursing care provided in the system and the relevance of this care to patient care safety. Given that nurses are the primary care provider in health care settings, this represents a significant gap in health care report cards. The pioneering work of the American Nurses Association (ANA) Nursing Report Card in the development and validation of report card indicators for nursing is discussed. Challenges related to data availability and data quality are identified. Potential opportunities for linking nursing practice outcomes to patient care quality and patient safety through a report card process are outlined.     

The American Society of Pain Management Nurses practice analysis: role delineation study.

A role delineation study was carried out by the American Society of Pain Management Nurses (ASPMN) to determine the activities performed by nurses involved in pain management. Demographic characteristics of pain management nurses and differences in practice based on educational preparation and specialty affiliation were identified. The role delineation survey was developed based on Nursing Intervention Classifications. The survey consisted of 91 activity statements. Respondents rated the frequency of performing each activity and the importance of the activity. A Mean Activity Index score was calculated for each item. All members of the ASPMN, the nursing special interest group (SIG) of the American Pain Society, and the pain SIG of the Oncology Nursing Society, as well as random samples of members of the National Association of Orthopaedic Nurses, Hospice and Palliative Nurses Association, American Association of Nurse Anesthetists, American Association of Critical Care Nurses, and American Academy of Nurse Practitioners were surveyed. Seven hundred and sixty-one questionnaires were analyzed (24.8% response rate). Demographic characteristics of the sample mirrored those of nursing as a whole in the United States. The activities with the highest Mean Activity Index were primarily those involving assessment of pain. Nurses with diploma and Associate Degree preparation rated assessment and nonpharmacologic management higher and communication and collaboration lower than nurses with higher educational preparation. Activities varied somewhat as a reflection of respondents' nursing specialty. The results of the study will be used to refine standards of care, develop nursing education curricula, develop research priorities, and develop a blueprint for a certification examination in pain management nursing.     

Measuring intensive care unit performance after sustainable growth rate reform: An example with the National Quality Forum metrics

BackgroundPerformance measurement is essential for quality improvement and is inevitable in the shift to value-based payment. The National Quality Forum is an important clearinghouse for national performance measures in health care in the United States.AimWe reviewed the National Quality Forum library of performance measures to highlight measures that are relevant to critical care medicine, and we describe gaps and opportunities for the future of performance measurement in critical care medicine.ConclusionCrafting performance measures that address core aspects of critical care will be challenging, as current outcome and performance measures have problems with validity. Future quality measures will likely focus on interdisciplinary measures across the continuum of patient care.     

State of the art: interdisciplinary collaboration for health professional education in genetics

Nursing has a long and productive history of interdisciplinary cooperation in providing education to nurses as well as other professionals. Interdisciplinary education is effective in socializing students and practicing clinicians for practice incorporating new discoveries, in areas such as genetics, for continuing relevance in health care delivery. The National Coalition for Health Professional Education in Genetics (NCHPEG), established in 1996 with the cooperation of the American Nurses Association, the American Medical Association, and the National Human Genome Research Institute at the National Institutes of Health, has provided leadership in bringing advances in genetics to the nation's care providers in nearly all health-related disciplines. Nursing plays a key role in this model initiative aimed at new genetic discoveries to improve the health care of all Americans.     

Using clinical models to frame outcomes evaluation: the Arizona Nurses' Association Nursing Report Card Project

The American Nurses Association (ANA) inaugurated Nursing's Safety and Quality Initiative in 1994. This multiphased initiative provides a framework for the application of the Nursing Care Report Card for Acute Care that aims to evaluate the nature and strength of the linkages between nursing care and nursing-sensitive quality indicators in the acute care setting. Arizona is one of six states participating in this investigation. This article describes the development of the Arizona Nurses' Association (AzNA) Nursing Report Card Project and associated model.     

Best practices in creating a culture of certification

Certification is the criterion standard of professional practice, distinguishing excellence in nursing care, mastery of knowledge, skills, and abilities beyond the scope of professional licensure. It is the validation of an individual nurse's qualifications for practice in a defined area. Becoming certified is a personal and professional commitment that demonstrates the value that the individual nurse places on higher standards of practice and lifelong learning. The American Association of Critical-Care Nurses (AACN) Beacon Award for Excellence, Magnet Recognition Program, and Malcolm Baldrige National Quality Award all recognize certification as a key component of nursing excellence in specialty practice. Both the general public and nurse professionals increasingly recognize the need for practice on the basis of evidence to provide safe, quality patient care. In today's rapidly changing and complex health care delivery system, certification is becoming the standard by which bedside practice and the impact of nursing care on patient outcomes are measured. This article will provide a review of current best practices in creating a culture of certification, including the journey of 3 hospitals selected as the 2010 Best Practice Roundtable presentations at the AACN National Teaching Institute.     

Said another way. My definition of nursing

The definition of nursing has evolved since the introduction of the definition by the American Nurses Association in 1980. The society we nurses serve has changed significantly and members of the society demand quality health care and respect for their individual decisions regarding their health care. As a profession, we must keep our fingers on the pulse of society and be ready to respond to the changes of society's needs. Being diligent in defining our position in society is imperative for the preservation of the nursing profession. This paper supports the current definition of the ANA (2003) within the domains of the art, science, and practice of nursing.     

吞咽障碍患者服药管理的最佳证据总结

目的检索、评价和总结吞咽障碍患者服药管理的最佳证据。方法运用循证护理的方法,针对吞咽障碍患者服药管理提出问题,系统检索UpToDate、BMJ、乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)图书馆、Cochrane Library、加拿大安大略注册护士协会网站、英国国家临床医学研究所指南库、苏格兰学院间指南网、美国国立指南网、国际网络指南网、加拿大医学会临床实践指南、美国心脏/脑卒中协会网站、PubMed、CINAHL、英国NEWT网站、中国生物医学文献数据库、医脉通、中国知网等数据库或网站,检索时限为建库至2021年1月,文献类型涵盖临床决策、临床实践指南、证据总结、系统评价、专家共识。由3名研究者对检索到的文献进行评价和证据提取。结果共纳入12篇文献,其中临床决策2篇、指南2篇、证据总结6篇、专家共识2篇。总结了8个方面的最佳证据,包括医护人员教育和培训、用药前筛查和评估、多学科合作、代偿性方法、口服固体剂型的选择、碾碎药物的管理、胃肠营养管用药、用药效果监测和记录。结论该研究针对吞咽障碍患者服药管理进行证据总结,为建立吞咽障碍患者服药规范流程、实践...     

Policy perspectives of major nursing organizations, part II. Interview by David M Keepnews

Understanding the roles of interest groups is an important element of examining policy change. There are a number of interest groups that affect the policy environment for nursing and that shape the profession's impact on health policy. This article, the second of a two-part series, presents interviews with executive directors and chief executive officers of major nursing organizations about their organizations' policy priorities and policy-related activities. Included in this article are the American Organization of Nurse Executives, the National League for Nursing, Sigma Theta Tau International, and the National Black Nurses Association.     

The importance of research to school nurses and school nursing practice.

Historically, school nursing has not documented sufficiently the health issues in schools, nor has it prioritized these issues for school nursing interventions or evaluated the effectiveness of nursing interventions. The National Association of School Nurses (NASN) is strongly committed to the advancement of children's health. Thus, NASN is developing an infrastructure to support research that articulates the health conditions affecting children's school success and the contributions of school nursing to children's health and academic success. In 1999, NASN participated with the National Center for School Health and the National Nursing Coalition for School Health at a Research Summit to set a school nursing research agenda. Needs and issues were identified for future research activities. The primary outcome was the identification that school nurses must practice the standards of care pertaining to research. These standards specify that clinicians be informed about, supportive of, and participate in the conduct and use of research.     

Quality measurement in nursing: an update of where we are now

This article summarizes the findings of the third review of nursing quality measurement literature commissioned by the American Nurses' Association, discusses implications of the current state of the art of nursing measurement, and suggests directions based upon lessons learned from all 3 reviews. Using both computer and hand searching methods, 326 articles describing measurement of nursing care quality were abstracted. Recommendations based on the analysis of Literature include incorporating the Nursing Minimum Data Set into databases; documenting nursing hours and nursing educational preparation; determining appropriate patient outcomes within different settings; continued research identifying nurse-sensitive outcomes; and continued nursing leadership in quality improvement efforts for health care.     

Lessons learned while collecting ANA indicator data. The American Nurses Association responds

In 1994, the American Nurses Association (ANA) began a multiphase initiative known as Nursing's Safety and Quality Initiative (the Initiative) to address concerns about patient safety and quality of care. The Initiative has three basic components: research, education, and policy.     

Assisted living nursing practice: admission assessment

Admission assessment, generally conducted by a registered nurse, is autonomous, without opportunity for dialogue with colleagues and other health care professionals and bounded by the nurse's knowledge and skills, state regulations, facility practices, and marketing. The fact that some states permit admission and retention of nursing home level-of-care residents and provision of end-of-life care means that the assessment has to be able to predict the resident's likely trajectory of well-being as well as chronic illness exacerbation. The nurse must have a clear perspective on staff competencies and judge whether additional education or training will be necessary. This article reviews assessment standards of practice as put forth by the American Assisted Living Nurses Association as part of its application for recognition of assisted living nursing as specialty nursing practice by the American Nurses Association. The role of the Licensed Practical Nurse/Licensed Vocational Nurse in resident assessment is also discussed.     

Capturing the imagination of nurse executives in tracking the quality of nursing care

Nurses represent the single largest healthcare profession in the United States. A growing evidence base demonstrates nursing's direct influence on inpatient safety and healthcare outcomes. Support for nursing's essential role in quality and patient safety and mounting interest in publicly reporting performance results have led to efforts to standardized nursing-sensitive performance measures. To this end, in 2004, the National Quality Forum endorsed a set of 15 nursing-sensitive consensus standards intended for use by the public in assessing inpatient nursing care. However, until recently, only anecdotal knowledge existed regarding the implementation of these consensus standards. As a step toward better understanding the interest in and adoption of nursing performance measures, The Robert Wood Johnson Foundation funded a study that concluded in March 2007. In this article, findings from the study are summarized as they apply to nursing leadership and implications for the future role of the nurse executive.