Question:
The clinical specialist on my unit has been trying to get the staff to use "nurse sensitive outcomes" in our care plans. Some of us are finding this cumbersome and confusing. What is the point?
Answer:
Increasingly, nurses, along with other health care professionals, are understanding the importance of documenting the results of what they do in patient care. In a climate of concern about costs, it's important to be able to demonstrate that nursing interventions are effective in getting results. The concept of nurse sensitive outcomes grows out of the reality that most nurses work in multidisciplinary team situations. The challenge is to identify and measure those outcomes or results that are due specifically to nursing interventions. One of the methods that is recognized by the American Nurses Association (ANA) was developed by the University of Iowa College of Nursing. Referred to as the Nursing Outcomes Classification, or NOC, it provides a research based framework to evaluate the results of nursing interventions in multiple categories. While this may feel pretty academic to staff nurses, you can learn from the clinical nurse specialiston your team. The end result will be better nursing care and increased visibility for the value of what nurses do. Here are a few things to know to get you started:
1. Physiologic outcomes are most commonly used.
Physiologic outcomes are measured with the use of tools you already use every day in practice. These include measures of vital signs, laboratory values, body mass index (BMI) among others. Clinical signs such as dehydration, mental status, and skin integrity are also included.
2. Psychosocial outcomes measure attitudes, emotions, and moods.
Patterns of behavior and function affect personal well being. Rating scales are available that may be used to measure stress, depression, spiritual health and social support. Improvements in self confidence can empower individuals to take needed steps toward improving their health.
3. Outcomes may be patient focused, family focused, or community focused
Outcomes measures focused on individual patients include biologic and physiologic as well as holistic measures. Holistic measures include changes to healthier lifestyles, better quality of life, and improved functional and self care ability. Outcomes that look at the effectiveness of nursing interventions for families are harder to measure, but may focus on improved support systems and better availability and use of resources. Community outcomes might look at improved safety, better recreational and exercise opportunities, transportation availability, proximity of health clinics, and environmental hazards. Morbidity and mortality statistics that reflect the health of the community can be used as well as measures of participation in health promotion efforts.
As you become used to thinking about nurse sensitive outcomes, the benefit will be that you will be more aware of how the things you do on a day to day basis can become more efficient and more effective. Demonstrating that effectiveness to employers, consumers, and policy makers is what outcome measures are all about. If you find yourself intrigued by this component of evidenced based nursing practice, you may want to check out options in nursing careers in research, or informatics, both of which will require an MSN degree.