Does what nurses do affect clinical outcomes for hospitalized patients? A review of the literature.
OBJECTIVE: Through a review of the literature, to identify and describe (1) empirical studies of inpatient nursing care quality that evaluate links between nursing care processes and health-related patient outcomes, (2) nursing care processes for which process-outcome links have been established, and (3) important nursing care processes that have not yet been evaluated. DATA SOURCES/STUDY SETTING: Published empirical studies of inpatient nursing care quality that evaluated links between processes of nursing care and health-related patient outcomes. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS: This literature review used a five-step article search and review method. PRINCIPAL FINDINGS: Of 257 data-based studies of nursing care quality identified, 135 investigated a process-outcome link but only 17 met study inclusion criteria. The literature provides evidence that the quality of nursing care processes affects health-related patient outcomes during and after hospitalization. Gaps in the literature that evaluates nursing quality are identified. CONCLUSIONS: Although some nursing care processes affect health-related patient outcomes, the full extent of nursing process-outcome links is relatively understudied. Further evaluation of the interrelationships between nursing care processes and outcomes is critical. (+info)
Describing patient problems & nursing treatment patterns using nursing minimum data sets (NMDS & NMMDS) & UHDDS repositories.
Dramatic changes in health care have intensified practitioners' efforts to access and use information to determine more efficacious approaches to patient outcomes. The overall goal of the study is to measure the influence of nursing informatics clinical reasoning decision support interventions on patient outcomes. This paper describes Phases I of the study: the methodology for establishing and testing the usefulness of large data repositories comprised of three minimum data sets, including the Nursing Minimum Data Set (NMDS), the Nursing Management Minimum Data Set (NMMDS), and the Uniform Hospital Discharge Data Set (UHDDS), and the American Nurses Association Quality Indicators to support effectiveness research. The use of generic data modeling to construct a clinical nursing repository of more than 477,000 electronic records is discussed. Patient problem and treatment profiles, patterns, and variations based on standardized analyzing classifications are described for inpatient adult samples, and nursing and medical diagnosis groups. (+info)
Personal view: Randomized controlled trials in epilepsy specialist nursing: the seduction of content by form.
Research into the effectiveness of epilepsy specialist nursing needs to take into account a number of factors, which have not been adequately addressed in previous studies. Nursing outcome measures are different to medical ones and it is inappropriate to confuse these. Specialist nurses affect the whole culture of a service, and their impact on service quality may go beyond that of their individual patient contacts. Thus randomized studies within a service that already has specialist nurses may not give valid results. Some service users will benefit more from direct contact with a specialist nurse than others, and people who give informed consent to take part in randomized controlled trials might not be representative of those who would benefit most from specialist nurse access. The stampede for level one evidence risks failing to address the issues properly by overvaluing research process (form) against its appropriateness (content), yet there remain great opportunities for good quality research in this area. (+info)
How can a nurse intervention help people with newly diagnosed epilepsy? A qualitative study (of patients' views).
The aim was to describe the patients' views of the challenges posed by a new diagnosis of epilepsy and their assessment of a nurse intervention. Neurologists in South-East England referred patients into the study. Following a trial of a nurse intervention a subgroup of patients were purposefully identified for in-depth interviews. Transcriptions of tape-recorded interviews were analysed using qualitative methodology. We found that younger people with epilepsy seemed to experience more trouble with driving, jobs and managing their lives in the context of new epilepsy, while older people saw epilepsy as just another illness to cope with. Patients reported difficulty in remembering what their doctors told them which they attributed partly to lack of time available in the consultation. They valued the time, and the technique of probing with explanations used by the nurse. The nurse intervention was seen as useful in making sense of symptoms, tests, risk management, and driving regulations and in helping manage their medicine taking. We conclude that people with newly diagnosed epilepsy face different challenges, some of which are related to their age at diagnosis. Patients reported help from the nurse with understanding the diagnosis, tests, risk management and taking their medication. Follow-up is necessary to measure behavioural effects on self-management in the long run. (+info)
Polychlorinated biphenyls, cytochrome P450 1A1, and breast cancer risk in the Nurses' Health Study.
There is concern that exposures to the environmental chemicals polychlorinated biphenyls (PCBs) may contribute to breast cancer risk. An individual's susceptibility to the effects of PCBs may be partially determined by polymorphisms in the gene encoding the biotransformation enzyme cytochrome P450 1A1 (CYP1A1). PCB exposure induces CYP1A1 activity, and PCBs themselves or other xenobiotics can be metabolized to carcinogenic intermediates in the presence of the variant genotype. A previous case-control study provided evidence of an interaction between high exposures to PCBs and the CYP1A1-exon 7 polymorphism (the A to G transition at nucleotide 4889), leading to a significant increase in postmenopausal breast cancer risk. We examined the interaction of PCBs with the CYP1A1-MspI (the T to C transition at nucleotide 6235) and exon 7 polymorphisms among 367 breast cancer case-control pairs (293 postmenopausal pairs) in the Nurses' Health Study. Although there was no independent association of either the CYP1A1 variants or PCBs with breast cancer risk, the relative risk among the postmenopausal women with plasma PCB levels in the highest third of the distribution in the control group and at least one exon 7 variant allele compared with women who were homozygous for the wild-type allele and who had PCB levels in the lowest third was 2.78 (95% confidence interval, 0.99-7.82). The majority of studies have concluded that exposure to PCBs is unlikely to be a major cause of breast cancer, but these findings indicate that further studies of genetically susceptible populations are warranted. (+info)
The role of oncology nursing to ensure quality care for cancer survivors: a report commissioned by the National Cancer Policy Board and Institute of Medicine.
PURPOSE: To examine the roles of oncology nurses in improving quality care for cancer survivors. DATA SOURCES: A content analysis of textbooks, journals, and key documents; surveys of graduate oncology nursing programs and the Oncology Nursing Society's Survivorship Special Interest Group; review of the nursing licensure examination and oncology nursing certification; review of undergraduate and graduate nursing standards; and review of currently funded nursing research. DATA SYNTHESIS: Ten critical content areas of cancer survivorship were used for the analysis: description of population of cancer survivors, primary care, short- and long-term complications, prevention of secondary cancer, detecting recurrent and secondary cancers, treatment of recurrent cancer, quality-of-life issues, rehabilitative services, palliative and end-of-life care, and quality of care. Although findings within each source indicated significant information related to the roles of nurses in caring for cancer survivors, deficits also were identified. CONCLUSIONS: Review of key literature and resources suggests significant contributions by oncology nursing over the past two decades to the area of cancer survivorship. IMPLICATIONS FOR NURSING: Support is needed to expand education and research to ensure quality care for future cancer survivors. (+info)
Contributions of qualitative research to evidence-based practice in nursing.
AIM: This article aims to identify the contributions of qualitative research to evidence-based practice in nursing. BACKGROUND: Qualitative research dates back to the 1920s and 1930s, when anthropologists and sociologists used qualitative research methods to study human phenomena in naturalistic settings and from a holistic viewpoint. Afterwards, other subject matters, including nursing, adopted qualitative methods to answer their research questions. The restructuring of health care over the past decade has brought about increased accountability in nursing research. One method for increasing this accountability is evidence-based practice. METHOD: The method used was a search in the Cumulative Index to Nursing and Allied Health Literature database from 1999-present. The search resulted in 61 citations for evidence-based practice in nursing research; however, only 5 citations focused on evidence-based practice and qualitative research. FINDINGS: The authors' findings revealed six contributions of qualitative research to evidence-based practice: generation of hypotheses; development and validation of instruments; provision of context for evaluation; development of nursing interventions; development of new research questions; and application of Qualitative Outcome Analysis. CONCLUSION: Qualitative research makes important contributions to the quality of evidence-based practice. (+info)
Evaluation of the draft international standard for a reference terminology model for nursing actions.
PURPOSE: The purpose of this study was to evaluate the draft ISO reference terminology model (RTM) for nursing actions. Nursing RTM models attempt to include concepts that are universally represented in nursing documentation to improve the depiction of nursing practice in computerized systems. METHOD: Content analysis was used to decompose interventions into words and phrases, which were then mapped to the six model categories used to represent nursing actions in the draft ISO RTM. The decomposition of interventions was applied to nurses' documentation of pain interventions entered into a clinical information system. FINDINGS: Consistent with the ISO standard requirements, all (100.00%) of the interventions contained an word or phrase and a <>. Additional findings are discussed in relation to earlier studies of terminology models. CONCLUSIONS: It is recommended that terminology and information system developers consider this model in their ongoing system development, evaluation, maintenance, and revisions. Further evaluation of the ISO RTM for nursing will contribute to the goals of this specific model and the harmonization and integration with other health care models. (+info)