Though highly relevant to quality assessment and self-regulation in nursing, development and routine monitoring of nurse process measures has fallen into the “too hard to do” domain. Background: Nursing is an integral part of all healthcare services, and has the potential of having a wide and enduring impact on health outcomes for a global ageing population. Nursing Inquiry, 13(1), 44-51. It is called the Unit Level Summary of Outcomes which are the Quality indicators for Nursing. The nurse structures were selected based on data availability and the outcomes were selected based on the strength of their theoretical link to nursing care quality. Annals of Internal Medicine, 163, 554-556. doi:10.7326/M15-1933, Patrician, P. A., Loan, L., McCarthy, M., Brosch, L.R., & Davey, K. S. (2010). Conceptualizing performance of nursing care as a prerequisite for better measurement: A systematic and interpretative review. Value-Based Purchasing Measures Used by CMS in 2016.a. The term ‘patient outcomes’ is used frequently in healthcare research [3], [4], [5], [6]. The National Database of Nursing Quality Indicators (NDNQI), Online Journal of Issues in Nursing, 12(3). Journal of Continuing Education in Nursing, 41(6), 246-256. doi:10.3928/00220124-07. Fessele, K., Yendro, S., & Mallory, G. (2014). Nursing performance measurement and reporting. Although the nursing quality agenda should accommodate measures related to efficiency, accreditation requirements, and VBP, it should be driven by the social contract. b=California Nursing Outcomes Coalition (Aydin et al., 2004) However, empirical evidence to support the unique contribution of nurses to quality outcomes is currently lacking (Needleman, Kurtzman, & Kizer, 2007). Western Journal of Emergency Medicine, 15(4), 541-547. doi:10.5811/westjem.2014.3.19658. Health Affairs, 30(2), 211-218. However, technological advances and healthcare reform legislation provide new opportunities to address some of these challenges. The evaluation process included a review of empirical evidence to support presumed linkages and an assessment of data quality and availability. Nursing History Review, 19, 127-155. doi:10.1891/1062-8061.19.127. Meaningful use includes the reuse of clinical and administrative data to improve the safety, quality, and access to care for patients (Westra et al., 2010). Once developed, researchers must be given access to these systems for the kind of robust research needed to develop nurse-sensitive measures that satisfy NQF consensus standards. Patient outcomes reflected in the endorsed measures are important and the act of measurement has without question generated selective attention and resource allocation toward reducing complications. Researchers cannot establish specific causal chains without capturing the effects of nurse structures on nurse processes and/or the effects of nurse processes on patient outcomes (Needleman et al., 2007). Thus, the social contract between health professionals and the public dictates that nurses engage in self-regulation to assure quality performance. Therefore, nurses have a social obligation to develop and document the evidence base for the entirety of nursing practice and shift from a task-based practice, which emphasizes what nurses do for patients, to an outcome-based practice that emphasizes what nurses achieve with patients. The efficiency gained in information retrieval is potentially offset by a loss of efficiency related to data entry. Similarly, the World Health Organization defines quality care as "the extent to which health care services provided to individuals and patient populations improve desired health outcomes." There are no intrinsic benefits in measuring nursing outcomes; rather, the benefits are contingent upon whether or not the act of measurement results in changes that lead to improved quality of care (Farquhar, Kurtzman, & Thomas, 2010). Instead, a sub-set of nurse structures and patient outcomes, primarily related to injury prevention, were selected for further development and inclusion in the first report card. Dr. Jones completed her PhD in 2004 at The University of Texas at Austin and was selected to participate in the NIH-Sponsored Clinical Scholars Program at The University of Texas Southwestern Medical Center at Dallas from 2007-2010. Institute of Medicine. Silver Spring, MD: Nursebooks.org. Nurses are obligated to serve the public good through stewardship of health resources. This improves patient’s outcomes which has been evident in patient’s surveys as in HCAHPS survey. However, the adoption of EHRs has not yet achieved the expected benefits. Sustained innovative and collaborative actions from multiple stakeholders are needed. ...health outcomes are rarely, if ever, the result of a singular process or provider. The combined dependent, independent, and interdependent components of nursing practice add to this challenge (Doran, 2011). Outcomes that are not empirically linked to specific malleable processes are not useful because they do not help decision makers determine how to improve care. Measurement is essential to quality assessment. She has been recognized as one of the Great 100 Nurses in Dallas-Ft. Worth and an Outstanding Graduate in her doctoral and undergraduate programs. Performance-based payment incentives increase burden and blame for hospital nurses. Lankshear, A. J., Skeldon, T. A., & Maynard, A. Brennan, C. W., Daly, B. J., & Jones, K. R. (2013). Journal of Health and Human Services Administration, 23(4), 416-442. For example, the nursing intervention of surveillance does not occur in a singular space or time. Biomedical Instrumentation & Technology, 47(1), 30-34. Limited Range of Patient Outcome Measures. Are measurable . Therefore, assumptions about the nursing contribution to care must be replaced with empirical evidence of the nursing profession’s actual contributions to care. Nurse staffing and healthcare outcomes. Fasolino, T., & Verdin, T. (2015). Such factors as demographics of the nursing force, education and certification, engagement, and organizational staffing models are associated with patient-experience outcomes, as are cultural and structural practices and processes. Nursing surveillance and physiological signs of deterioration. Consequently, adoption of EHRs has increased over time (Abbass, Helton, Mhatre, & Sansgiry, 2012). Email: Tjones0222@aol.com. Lapses in nursing documentation hinder the ability to establish empirical links between nursing care and patient outcomes (Alexander, 2007; Anthony, 2008; Needleman et al., 2007). Online Journal of Issues in Nursing, 16(2), 12. doi:10.3912/OJIN.Vol16No02InfoCol01. Moreover, due to limitations of study designs, the body of evidence produced thus far is still insufficient to support direct causal paths linking nurse structures to patient outcomes. Washington, DC: American Nurses Publishing. CCC of Nursing Outcomes (V2.5) consists of 528 Nursing Outcomes (176 Nursing Diagnoses with 3 outcome qualifiers: Improved, Stabilized, or Deteriorated– these 3 qualifiers are used to modify the 176 diagnoses totaling 528 Nursing Outcomes).They are used to depict both 1) Expected Outcomes/ Goals and 2) Actual Outcomes. 12 No. (2015). Nutrients (e.g., vitamins, food types) 5. A. Please see below each of the 3 Outcome Qualifiers by: Code, Outcome & Definition. Despite decades of intentional efforts to this end, nursing's contributions to patient outcomes have not been sufficiently quantified. ...nurses are accountable for and obligated to measure interventions and outcomes... Nurses have a social and an economic imperative to measure outcomes. Nurse leaders were particularly concerned about the absence of information about nursing care in the UHDDS, fearing that this would result in the inability to cost out nursing services and establish the profession of nursing on equal footing with medicine in terms of contributions to inpatient care. Journal of Nursing Administration, 40(7/8), 336-343. doi: 10.1097/NNA.0b013e3181e93994. State of the science. Kurtzman, E. T., Dawson, E. M., & Johnson, J. E. (2008). Safety: (utilizes clinical reasoning and critical thinking that drives a culture of safety to prevent risk … Development of evidence-based, nurse-sensitive quality measures that meet the NQF consensus standards must become a research priority. An introduction to quality assessment in health care. Staffing levels that result in documentation lapses are unsatisfactory and it is unlikely that technology alone will solve the problem. Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. Doran (Ed), Nursing Outcomes State of the Science (2nd ed, 487-508). DIAGNOSIS ----- Statement of Problem (Nursing diagnosis [NANDA List] plus etiology) NOT. Researchers must be willing to pursue methods beyond secondary analysis of these databases. In contrast to frameworks based on the medical model of care (Donabedian, 2003), patient outcome categories proposed in nursing quality frameworks are typically more closely aligned with nursing’s social mandate. Electronic documentation systems have not reduced the documentation burden for nurses. In other words, measurement of an outcome draws attention to that outcome and ultimately to its contributing factors. Nursing sensitive databases. Regardless of intention, measure selection communicates importance and generates selective attention that ultimately drives selective improvement (Kurtzman & Jennings, 2008). It is time to garner the will and the resources to support direct care nurses as they struggle to document all aspects of their care, to include patient responses. Can electronic medical records really improve quality? They are used to depict both 1) Expected Outcomes/ Goals and 2) Actual Outcomes. For example, the measures of patient outcomes used by Aiken et al. Laissez-faire Leadership. Compared to abstraction of data from paper based documentation systems, retrieval of data from an EHR for quality analysis and reporting is more efficient (Alexander, 2007). Continued support is unlikely for care providers and processes that lack evidence of a meaningful contribution to these aims. (2013). Montalvo, I. Failure to invest in data collection methodologies that yield reliable and valid measures of important nursing care processes and patient outcomes has resulted in an inadequate evidence base to support the nurse contribution to patient care. Informatics: The standardized nursing terminologies: A national survey of nurses’ experiences and attitudes. Nursing’s social policy statement: The essence of the profession. Instead, specific quality measures must be derived from domain and/or problem specific frameworks. Quality assessment and outcomes research initiatives have historically been hindered by lack of available data related to nursing processes and patient outcomes across these domains of practice. Nursing exists for the sole purpose of serving the public good; therefore, the public owns the discipline. Execution of a NMDS requires a standardized language to effectively capture nursing services and outcomes of interest (Mac Neela, Scott, Treacy, & Hyde, 2006). doi:10.1186/1472-6955-12-7. Lewin-VHI. The American Recovery and Reinvestment Act of 2009 provided incentives for healthcare organizations to invest in electronic health records (McCulloch & Tegethoff, 2013). Nurse administrators should initiate partnerships with vendors to guide these refinements and provide opportunities for beta testing. Teaching and Learning in Nursing, 8, 120-127. doi:10.1016/j.teln.2013.05.001. Moving healthcare quality forward with nursing-sensitive value-based purchasing. Not surprisingly, some nurses are unwilling to accept responsibility for outcomes over which they lack complete control. Although nurses may contribute to a broad array of patient outcomes, the expected contribution is variable, and teasing out the unique nursing contribution to patient outcomes is difficult (Needleman et al., 2007). Nurse leaders and scholars have long recognized the need to measure the outcomes of nursing care and have attempted to address the associated challenges at various times throughout history. Pay for performance in hospitals: Implications for nurses and nursing care. All of these databases were designed for the evaluation of nursing care in acute care hospitals, primarily on medical-surgical units. Meaningful use and its impact on healthcare technology management. (2014). The changing reimbursement landscape: Nurses’ roles in quality and operational excellence. Nursing care is often more difficult to conceptualize and measure than care from other disciplines. Quality assessment initiatives are hindered by the paucity of available data related to nursing processes and patient outcomes across these three domains of practice.