A comparison of nursing and medical diagnoses in predicting hospital outcomes. (1/74)

The main premise of the Nursing Minimum Data Set (NMDS) is that nursing data should be included in the hospital discharge abstract. Yet to date, little empirical evidence has been published to measure the efficacy or usefulness of these nursing data elements. We report the results of a comparison between a daily collection of nursing assessments using nursing diagnoses (NDX) to the Diagnostic Related Group (DRG) and the All Payer Refined DRG (APR-DRG) in their ability to predict three common outcome variables: hospital days, ICU day, and total charges. A secondary data analysis was performed from a large existing data set of four years patient data from a Midwest University hospital. FINDINGS: NDX is significantly associated with hospital length of stay, ICU length of stay, and total charges. NDX also improves explanatory power when added to models with DRG or APR-DRG. This suggests that nursing data compliments existing data and is not redundant with the DRG or APR-DRG. The findings also suggest that NDX explains a different portion of the variance of the three outcome variables in this series. The results of this study support the argument that nursing data should be included in the hospital discharge abstract.  (+info)

Training nurse practitioners for general practice. The EROS Project Team. (2/74)

BACKGROUND: For nurse practitioners (NPs) in general practice to substitute for general practitioners (GPs) in consultations, their educational needs require specification, and their effectiveness and acceptability to patients must be determined. There is limited evidence in the United Kingdom about training requirements or how NPs compare with GPs. AIM: To describe the education provided to trainee NPs (TNPs), describe their work, compare their practise with GPs, and determine their acceptability to patients. METHOD: Four TNPs were provided with a mainly practice-based education. After one year, TNP diagnoses and management decisions were compared with those of GPs for 586 patients. After being judged competent, TNPs conducted independent consultations. After two years, 400 independent consultations were analysed to describe TNPs' work and reasons for patients contacting the practice again. Opinions of a further 400 patients about their consultation with a TNP or GP, and willingness to consult a TNP in the future, were obtained. RESULTS: General practitioners and TNPs agreed on 94% of diagnoses and 96% of management decisions made. Early in training, TNPs transferred 38% of patients to the GP, of whom 34% were without a diagnosis and 40% without a management decision. In independent practice, 69% of patients consulting TNPs were female and fewer than 10% were aged over 65 years. TNPs were dealing with a wide range of diagnoses. Immediate referrals to GPs had decreased to 13%. In one-third of consultations, over-the-counter (OTC) medications were suggested and, in 63%, formulary medications were recommended, with prescriptions signed by GPs. Health education featured in 84% of consultations. After two weeks, 29% of patients had returned to the surgery, of whom 72% had been asked to return and 60% consulted about the original condition or its treatment. Eighty per cent of patients completed an opinion questionnaire. While 38% of TNP consulters would have preferred a GP consultation, they rated TNP consultations as good as or better than GPs' consultations. Patients with experience of previous TNP consultations gave the most positive ratings, were more likely to consult a TNP again, and about a wider range of conditions. TNPs' listening skills and explanations were particularly valued. CONCLUSIONS: Early in their training, TNPs made good diagnostic and treatment decisions, while their high level of patient transfers to GPs indicated residual uncertainty. In independent practice, their GP mentors judged them to be offering an effective service, with acceptable transfer and patient return rates. They were liked by patients and more so by patients with previous TNP experience. TNPs are a valuable substitute for GPs for patients wishing for a same-day consultation, and for younger and female patients who prefer a female TNP over a male GP. Limited authority to prescribe and refer to secondary care reduces NP efficiency.  (+info)

Describing patient problems & nursing treatment patterns using nursing minimum data sets (NMDS & NMMDS) & UHDDS repositories. (3/74)

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)

Prognostic value of performance status assessed by patients themselves, nurses, and oncologists in advanced non-small cell lung cancer. (4/74)

Accuracy in the assessment of performance status by oncologists has not been well evaluated. We investigated possible discrepancies in the assessment of performance status among patients, nurses, and oncologists, and evaluated the prognostic importance of each assessment. Two hundred and six inpatients with inoperable, advanced non-small cell lung cancer were investigated prospectively. Weighted Kappa statistics for inter-observer agreement were 0.53 between oncologists and patients and 0.63 between oncologists and nurses. There was a significant difference among the assessments by the three groups (P < 0.001). Oncologists gave the healthiest performance status assessment, nurses an intermediate assessment, and patients the poorest. When included separately in the Cox model, the assessment by each group was significantly correlated with survival. However, the assessment by the patients themselves failed to distinguish survival of patients with performance status 1 and 2. Among the three models including patient-, nurse-, and oncologist-assessed PS, that including oncologist-assessed PS best fitted to the observed survival data. These results showed that the assessment by the patients themselves is different from those by the nurses and the oncologists and provided additional support for the use of the assessment by oncologists in clinical oncology.  (+info)

Information model and terminology model issues related to goals. (5/74)

Goal statements are a significant component of structures that support the process of health care delivery such as practice guidelines, standards of care, critical pathways, disease management plans, patient education plans, and nursing care plans. Although these structures are increasingly computer-based, there has been little attention to the formal representation of goal statements. This is a necessary prerequisite for enabling semantic interoperability. Existing and evolving information model and terminology model standards offer some approaches that may be applicable to goal statements, however, a number of issues require resolution  (+info)

Integrating nursing diagnostic concepts into the medical entities dictionary using the ISO Reference Terminology Model for Nursing Diagnosis. (6/74)

OBJECTIVE: The purposes of the study were (1) to evaluate the usefulness of the International Standards Organization (ISO) Reference Terminology Model for Nursing Diagnoses as a terminology model for defining nursing diagnostic concepts in the Medical Entities Dictionary (MED) and (2) to create the additional hierarchical structures required for integration of nursing diagnostic concepts into the MED. DESIGN AND MEASUREMENTS: The authors dissected nursing diagnostic terms from two source terminologies (Home Health Care Classification and the Omaha System) into the semantic categories of the ISO model. Consistent with the ISO model, they selected Focus and Judgment as required semantic categories for creating intensional definitions of nursing diagnostic concepts in the MED. Because the MED does not include Focus and Judgment hierarchies, the authors developed them to define the nursing diagnostic concepts. RESULTS: The ISO model was sufficient for dissecting the source terminologies into atomic terms. The authors identified 162 unique focus concepts from the 266 nursing diagnosis terms for inclusion in the Focus hierarchy. For the Judgment hierarchy, the authors precoordinated Judgment and Potentiality instead of using Potentiality as a qualifier of Judgment as in the ISO model. Impairment and Alteration were the most frequently occurring judgments. CONCLUSIONS: Nursing care represents a large proportion of health care activities; thus, it is vital that terms used by nurses are integrated into concept-oriented terminologies that provide broad coverage for the domain of health care. This study supports the utility of the ISO Reference Terminology Model for Nursing Diagnoses as a facilitator for the integration process.  (+info)

Testing the generalizability of the ISO model for nursing diagnoses. (7/74)

The purpose of this study was to explore whether the ISO reference terminology model for nursing diagnoses could be generalized to the MDS data set that, like nursing terminologies standardizes expressions of the concepts within and relevant to the domain of nursing practice. We first constructed paraphrased expressions of the rubrics from the data set. Next we dissected those expressions into the reference model domains of focus and judgment, recorded any qualifiers required for either domain, and semantic links required to represent associative relations. Our findings demonstrate that the ISO model for nursing diagnoses is generalizable to the MDS data set, however expansions to the model are required if the model is to be used to represent objects rather than terms.  (+info)

Detection of severe protein-energy malnutrition by nurses in The Gambia. (8/74)

AIM: To test whether nurses can use the WHO integrated management of childhood illness (IMCI) nutrition algorithm to identify reliably severe protein-energy malnutrition in children. METHODS: Nurses were trained to identify severe protein-energy malnutrition using IMCI training materials. They identified visible severe wasting and bipedal oedema, and categorised weight-for-age using a growth chart, in consecutive children attending outpatient clinics. Their findings were compared with weight for height Z (WHZ) score, bipedal oedema assessed by a trained observer, and weight-for-age Z score. RESULTS: A total of 352 children were recruited, of whom 34 (9.7%) were severely wasted (WHZ score <-3) and 18 (5.1%) had bipedal oedema. In the detection of severe wasting, the nurses' assessments showed 56% sensitivity, 95% specificity, and 56% positive predictive value (PPV), and for bipedal oedema 22%, 99%, and 57% respectively. Overall, the nurses identified only half of 50 children with severe wasting and/or bipedal oedema and wrongly identified a further 13 children as severely malnourished. Plotting weight for age by the nurses showed 62% sensitivity, 99% specificity, and 89% PPV for the detection of children with very low weight. CONCLUSIONS: Severe malnutrition was both under-diagnosed and wrongly diagnosed by nurses trained in the use of the IMCI nutrition algorithm in a clinic setting in The Gambia. These guidelines for health workers and the training materials, particularly with respect to calculation of age, need further development to improve the detection of malnourished children.  (+info)