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NUR3300 > Research and EBP Outcomes > Flashcards

Research and EBP Outcomes Flashcards

1
Q

Outcome

A

a consequence or visible result that is measureable

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2
Q

nursing outcome

A

measures states, behaviors, or perceptions of individuals, families, or communities…stemming from nursing actions.

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3
Q

outcomes research

A

examines the effects of care and treatments on individuals and populations

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4
Q

Why do we need to measure outcomes?

A 
	Patient and family suffering
	Quality of care
	Impact on transition to home
	General staff performance
	Cost
	Ratings on publicly accessible venues
	Accreditation standards
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5
Q

Focuses of outcomes are related to…

A

 Individual, group, community, organization
 Care received, patient outcome, nurse outcome
 Short term, intermediate term, long term
 Physician, organization or nurse sensitive

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6
Q

Outcomes example

Individual:

A

 Patient delivers a healthy baby

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7
Q

Outcomes example

Family:

A

 Family incorporates baby with healthy bonding

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8
Q

Outcomes example

Community:

A

 Community resources are available for positive resolution of formula/infant clothing need

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9
Q

Outcomes example

Organization:

A

 Home follow-up to new mothers visit by hospital staff decreases use of emergency room visits for infant feeding concerns.

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10
Q

Outcomes

Care-related:

A

examines the outcomes of care-giving such as wound healing.

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11
Q

Outcomes

Patient-related

A

examines patient performance such as ability to self-inject insulin

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12
Q

Outcomes

Performance-related

A

examines nurse performance such as records keeping (ex…incomplete charting)

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13
Q

Short-term

A

 Nurses use the new electronic medical record (EMR) and during the first week it is launched there are 350 calls to the IT department (benchmark=400 calls or less), comfort level stated as a 5 (benchmark=5 or more)

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14
Q

Intermediate-term

A

 Six months into the new EMR, nurses make 125 calls per week to IT, on average, (benchmark=100 calls or less), comfort level stated as 8 (benchmark=8 or more)

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15
Q

Long-term

A

 One year into the new EMR, nurses make 50 calls per week to IT, on average, (benchmark=50 calls or less), comfort level stated as 9.5 (benchmark=9 or more)

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16
Q

Physician sensitive

A

rate of labor inductions prior to first day of 39th week of pregnancy=17% (benchmark=2% or less)

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17
Q

organization sensitive

A

hospital readmission of heart failure patients within 30 days of discharge=18% (benchmark=5% or less)

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18
Q

Nurse sensitive

A

decubitus ulcer rate on unit caring for post-CVA patients is 5% (benchmark is 1% or less)

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19
Q

Nurse sensitive indicators

A

 Demonstrates effectiveness of structure, process and outcomes of nursing care

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20
Q

Nurse sensitive indicators

Structure:

A

sufficient staff at the appropriate level assigned to the appropriate patients
RN hrs per day, mix of RN to other staff

21
Q

Nurse sensitive indicators

Process:

A

nursing process and job process

satisfaction, burn-out, turnover, certification rates

22
Q

Nurse sensitive indicators

outcomes:

A

dependent on the care provided by the nurse
 pressure ulcers, falls, injury related to falls, IV infiltrations, pain management, use of restraints, nosocomial infection rate, assault assessment

23
Q

What does all this mean for EBP?

A

 Impact is all important
 EBP should, theoretically, have a positive impact on outcomes
 Pre- and post-intervention comparisons are made to determine impact
 Outcomes are measured quantitatively and qualitatively

24
Q

Choosing outcomes

Considerations:

A

 Patient population
 Team membership
 Organizational priorities
 Mandated reports

25
Q

For each outcome, must always consider:

A

 Fit the intervention
 Consider morbidity, cost, QOL, resources, etc
 Measurable with quantitative tool
 Tools must be reliable and valid

26
Q

Patient population

must reflect the patient population of the agency

A

specific: pediatric respiratory unit
general: adult general med-surg unit

27
Q

NOC list

A

nursing outcome classification
 31 classes grouped into 7 domains
 Functional, physiological, psychological, perceived, family and community health plus health knowledge and behavior
 385 current outcomes listed containing:
 Outcome definition,
 List of numeric indicators to select from,
 Target rating,
 5-point Likert measure of patient status

28
Q

Team membership:

A

who is on the patient care team

29
Q

team membership

interdisciplinary outcomes

A

 Include nurse sensitive outcomes if a nurse is on the team
 Strong team outcomes needed for Magnet status
 Importance of the APN (APRN)
 Knows population
 Knows organization
 Knows the evidence
 Knows the national guidelines and benchmarks
 Knows how to perform QI initiatives

30
Q

Organizational priorities

A 
	Mission statement and philosophy
	Financial status and constraints
	Accreditation issues
	Benchmark issues
	Public face
31
Q

Mandated reports

A

publicly accessible data

32
Q

required by organizations…

A

 Centers for Medicare and Medicaid (CMC)
 Ohio Board of Health
 Specialty Standards of Care
 Joint Commission (TJC)
 Institute for Healthcare Improvement (IHI)
 Magnet Recognition Program

33
Q

Evaluating the outcomes

Implement

A

 Measure
 Be sure to get “current practice” data as well as practice change data
 Be sure to measure all significant data (extraneous variables)
 Compile data into meaningful groupings
 Use a data collection sheet
 Analyze and compare current practice to innovation
 May need a statistician
 Report to appropriate body
 Focus on both statistical and clinical significance
 Disseminate to interested stakeholders
 Paper, poster, presentation, etc.

34
Q

Ethics of measuring outcomes

A

 Protocol must be followed exactly
 Data must be collected per protocol
 Documentation must be complete
 Confidentiality must be maintained

35
Q

An innovator is someone who:

A

 Is an early adopter of change
 Is eager to try new things
 Sees the possibilities
 Strives for excellence

36
Q

Characteristics of an innovator

A

 Sense of inquiry
 Flexibility to change
 Awareness of self and unit
 Good communication skills

37
Q

Sense of inquiry

A

 Curiosity (leads to currency in practice)
 Continue to read (when no one has set a deadline)
 Consider problems you see and how the problems might be solved
 Use your research and EBP knowledge
 Use your critical thinking (see next slide)

38
Q

critical thinking

A

 Identify the problem
 Decipher the “why” of the problem
 Examine assumptions made about the problem
 Consider the problem from several different view points
 Determine the rationale for change
 Look a the data surrounding the problem
 Determine several alternative approaches to solving the problem
 Evaluate the thinking process for flaws

39
Q

flexibility

A

 Change is constant
 Constant flexibility requires a positive attitude
 Flexibility is facilitated by a good change agent who takes into consideration feelings of achievement, loss, pride and stress

40
Q

awareness

A

know yourself

41
Q

awareness

know your strengths

A

use them to your advantage

42
Q

awareness

know your weaknesses

A

seek to modify/remediate

43
Q

awareness

know your staff

A

 Who is reliable and who is unreliable.
 Who is a positive influence and who is a negative influence.
 Who is gives good care and who doesn’t give good care.
 Who is a leader, follower, fence-sitter, agitator, etc.

44
Q

awareness

know your management

A

 Strengths and weaknesses
 Pet peeves and sore points
 What he/she is looking for in a staff nurse

45
Q

communication skills

A

 Consider all communications skills information learned in the program
 Communication with staff
 Communication with patients/family
 Communication with others in agency outside your unit
 Communication with peers in other agencies

46
Q

self-development as an innovator

as a new grad:

A 
	Seek mentors and role models
	Observe process
	Interact with staff
	Learn the role of the various staff
	Know where the resources are and use them
	Gain credibility before being critical
	Seek new opportunities
47
Q

Self-development as an innovator

as a team leader

A 
	Use “grass roots” methods for change
	Use change champions
     	Expert clinician
     	Informal leader
     	Passionate about topic
     	Commitment to improving quality of care
48
Q

Self development as an innovator

as a life-long learner (professionalism)

A 
	Read, read, read
	Join a professional organization
	Establish professional ties in the community
	Go to workshops and conferences
	Take a course or two or three
	Enroll in a MS program
	Enroll in a doctoral program

NUR3300 (20 decks)

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