Research and EBP Outcomes Flashcards
Outcome
a consequence or visible result that is measureable
nursing outcome
measures states, behaviors, or perceptions of individuals, families, or communities…stemming from nursing actions.
outcomes research
examines the effects of care and treatments on individuals and populations
Why do we need to measure outcomes?
Patient and family suffering Quality of care Impact on transition to home General staff performance Cost Ratings on publicly accessible venues Accreditation standards
Focuses of outcomes are related to…
Individual, group, community, organization
Care received, patient outcome, nurse outcome
Short term, intermediate term, long term
Physician, organization or nurse sensitive
Outcomes example
Individual:
Patient delivers a healthy baby
Outcomes example
Family:
Family incorporates baby with healthy bonding
Outcomes example
Community:
Community resources are available for positive resolution of formula/infant clothing need
Outcomes example
Organization:
Home follow-up to new mothers visit by hospital staff decreases use of emergency room visits for infant feeding concerns.
Outcomes
Care-related:
examines the outcomes of care-giving such as wound healing.
Outcomes
Patient-related
examines patient performance such as ability to self-inject insulin
Outcomes
Performance-related
examines nurse performance such as records keeping (ex…incomplete charting)
Short-term
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)
Intermediate-term
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)
Long-term
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)
Physician sensitive
rate of labor inductions prior to first day of 39th week of pregnancy=17% (benchmark=2% or less)
organization sensitive
hospital readmission of heart failure patients within 30 days of discharge=18% (benchmark=5% or less)
Nurse sensitive
decubitus ulcer rate on unit caring for post-CVA patients is 5% (benchmark is 1% or less)
Nurse sensitive indicators
Demonstrates effectiveness of structure, process and outcomes of nursing care
Nurse sensitive indicators
Structure:
sufficient staff at the appropriate level assigned to the appropriate patients
RN hrs per day, mix of RN to other staff
Nurse sensitive indicators
Process:
nursing process and job process
satisfaction, burn-out, turnover, certification rates
Nurse sensitive indicators
outcomes:
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
What does all this mean for EBP?
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
Choosing outcomes
Considerations:
Patient population
Team membership
Organizational priorities
Mandated reports
For each outcome, must always consider:
Fit the intervention
Consider morbidity, cost, QOL, resources, etc
Measurable with quantitative tool
Tools must be reliable and valid
Patient population
must reflect the patient population of the agency
specific: pediatric respiratory unit
general: adult general med-surg unit
NOC list
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
Team membership:
who is on the patient care team
team membership
interdisciplinary outcomes
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
Organizational priorities
Mission statement and philosophy Financial status and constraints Accreditation issues Benchmark issues Public face
Mandated reports
publicly accessible data
required by organizations…
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
Evaluating the outcomes
Implement
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.
Ethics of measuring outcomes
Protocol must be followed exactly
Data must be collected per protocol
Documentation must be complete
Confidentiality must be maintained
An innovator is someone who:
Is an early adopter of change
Is eager to try new things
Sees the possibilities
Strives for excellence
Characteristics of an innovator
Sense of inquiry
Flexibility to change
Awareness of self and unit
Good communication skills
Sense of inquiry
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)
critical thinking
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
flexibility
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
awareness
know yourself
awareness
know your strengths
use them to your advantage
awareness
know your weaknesses
seek to modify/remediate
awareness
know your staff
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.
awareness
know your management
Strengths and weaknesses
Pet peeves and sore points
What he/she is looking for in a staff nurse
communication skills
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
self-development as an innovator
as a new grad:
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
Self-development as an innovator
as a team leader
Use “grass roots” methods for change
Use change champions
Expert clinician
Informal leader
Passionate about topic
Commitment to improving quality of careSelf development as an innovator
as a life-long learner (professionalism)
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
