Ambulatory nursing outcomes

Ambulatory nursing outcomes

Mastal, Peg

AAACN Participates in Classification Study on Patient Outcomes

During 2000, AAACN participated in a research study conducted by the Nursing Outcomes Classification (NOC) research team at the Center for Nursing Classification, College of Nursing, The University of Iowa.

The classification center has a 4-year grant from the National Institute of Nursing Research (NINR) at the National Institutes of Health (NIH) to evaluate 260 nursing-sensitive patient outcome measures as defined in the NOC schema (Johnson & Moss, 2000).

What is NOC?

NOC provides a standardized language and method for measuring outcomes that are specific patient responses to nursing interventions throughout the duration of an illness or episode.

The outcomes are stated as concepts that represent an individual, family, or community condition and can be measured on a 5-point Likert scale. Each outcome is defined and has a set of specific indicators. For example, one outcome listed is Knowledge: Treatment Regimen which is defined as the “extent of understanding conveyed about a specific treatment regimen.” It has a list of 13 specific indicators such as “description of the rationale for the treatment regimen,” “description of expected effects of the treatment,” or “performance of self-monitoring techniques” (Johnson & Moss, 2000). The development of this schema represents over 6 years of research to develop and classify comprehensive nursing-sensitive patient outcomes.

Purpose and Methodology

One major purpose of the classification center’s study is to describe the NOC outcomes that are most relevant for patients in specialty nursing practice areas and in selected field sites representing the continuum of health care. The center sent questionnaires to 13 specialty organizations asking an expert nurses) representing the organization to complete the questionnaire (NIC/NOC Letter, 2001).

The questionnaire listed and defined each of the 260 NOC outcomes, asking the respondents to rate the percentage of their patients on a scale of 0-100% for whom that outcome category was “most relevant.” The center received a 100% return rate from the specialty organizations. The outcomes ranked most relevant to the aggregate 13 specialty associations are:

* Neurologic Status

* Knowledge: Personal Safety

* Knowledge: Treatment Regimen

* Knowledge: Treatment Procedures

* Participation: Health Care Decisions

* Vital Signs Status

* Coagulation Status (NIC/NOC Letter, 2001)

AAACN Participation

AAACN distributed the questionnaire to 13 of our members employed in institutions in different sections of the country (northwest, southeast, etc.), different types of ambulatory settings (university hospital clinics, HMOs, etc.), and different practice settings (care management, primary care clinics, infusion centers, etc.). Seven members responded, a 54% return rate. All of the questionnaires were forwarded to the center for analysis and evaluation. The center forwarded the results to each participating specialty organization.

AAACN Findings

The top seven client outcome categories identified by AAACN members as relevant to ambulatory practice are (refer to Table 1 for definitions):

* Vital signs status – relevant to 82% of ambulatory patients

* Knowledge: Health Promotion – relevant to 80% of ambulatory patients

* Medication Response – relevant to 78% of ambulatory patients

* Physical Aging Status – relevant to 76% of ambulatory patients

* Health Seeking Behavior – relevant to 76% of ambulatory patients

* Acceptance: Health Status – relevant to 75% of ambulatory patients

* Compliance Behavior – relevant to 75% of ambulatory patients

In this study, AAACN ambulatory nurses identified that health screening (Vital Signs Status) and health promotion information (Knowledge: Health Promotion) are categories of patient outcomes most critical to their practice. Clients’ need for information was made more specific in the subsequent categories of outcomes, i. e. information about the therapeutic and adverse effects of medications, changes in the body due to aging, and actions that will promote recovery from illness as well as those actions needed for optimal health. Acceptance of Health Status was also an important outcome, inferring that nurses see gaining acceptance of one’s health status as an important outcome for clients in the ambulatory environment. In essence, the nurses who participated identified that the most important outcomes for clients in their settings were to receive specific information about their health status; information about how to comply with treatment and achieve even better health; and realize abilities for adapting to their health situations.

References

Johnson, M., & Moss, M. (Eds.). (2000). Nursing Outcomes

Classification (NOC), 2nd edition. St. Louis: Mosby-Year Book, Inc.

Center for Nursing Classification. (2001). The NIC/NOC Letter, 9(1).

Peg Mastal, PhD, MSN, RN

Practice Evaluation and Research Committee (202) 466-7460 pmastal@hscsn.org

Copyright American Academy of Ambulatory Care Nursing Jul/Aug 2001

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