Research and EBP Outcomes

Question 1

Outcome

Answer 1

a consequence or visible result that is measureable

Question 2

nursing outcome

Answer 2

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

Question 3

outcomes research

Answer 3

examines the effects of care and treatments on individuals and populations

Question 4

Why do we need to measure outcomes?

Answer 4

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

Question 5

Focuses of outcomes are related to…

Answer 5

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

Question 6

Outcomes example

Individual:

Answer 6

 Patient delivers a healthy baby

Question 7

Outcomes example

Family:

Answer 7

 Family incorporates baby with healthy bonding

Question 8

Outcomes example

Community:

Answer 8

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

Question 9

Outcomes example

Organization:

Answer 9

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

Question 10

Outcomes

Care-related:

Answer 10

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

Question 11

Outcomes

Patient-related

Answer 11

examines patient performance such as ability to self-inject insulin

Question 12

Outcomes

Performance-related

Answer 12

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

Question 13

Short-term

Answer 13

 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)

Question 14

Intermediate-term

Answer 14

 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)

Question 15

Long-term

Answer 15

 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)

Question 16

Physician sensitive

Answer 16

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

Question 17

organization sensitive

Answer 17

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

Question 18

Nurse sensitive

Answer 18

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

Question 19

Nurse sensitive indicators

Answer 19

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

Question 20

Nurse sensitive indicators

Structure:

Answer 20

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

Question 21

Nurse sensitive indicators

Process:

Answer 21

nursing process and job process

satisfaction, burn-out, turnover, certification rates

Question 22

Nurse sensitive indicators

outcomes:

Answer 22

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

Question 23

What does all this mean for EBP?

Answer 23

 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

Question 24

Choosing outcomes

Considerations:

Answer 24

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

Question 25

For each outcome, must always consider:

Answer 25

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

Question 26

Patient population | must reflect the patient population of the agency

Answer 26

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

Question 27

NOC list

Answer 27

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

Question 28

Team membership:

Answer 28

who is on the patient care team

Question 29

team membership | interdisciplinary outcomes

Answer 29

 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

Question 30

Organizational priorities

Answer 30

```  Mission statement and philosophy  Financial status and constraints  Accreditation issues  Benchmark issues  Public face ```

Question 31

Mandated reports

Answer 31

publicly accessible data

Question 32

required by organizations...

Answer 32

 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

Question 33

Evaluating the outcomes | Implement

Answer 33

 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.

Question 34

Ethics of measuring outcomes

Answer 34

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

Question 35

An innovator is someone who:

Answer 35

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

Question 36

Characteristics of an innovator

Answer 36

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

Question 37

Sense of inquiry

Answer 37

 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)

Question 38

critical thinking

Answer 38

 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

Question 39

flexibility

Answer 39

 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

Question 40

awareness

Answer 40

know yourself

Question 41

awareness | know your strengths

Answer 41

use them to your advantage

Question 42

awareness | know your weaknesses

Answer 42

seek to modify/remediate

Question 43

awareness | know your staff

Answer 43

 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.

Question 44

awareness | know your management

Answer 44

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

Question 45

communication skills

Answer 45

 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

Question 46

self-development as an innovator | as a new grad:

Answer 46

```  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 ```

Question 47

Self-development as an innovator | as a team leader

Answer 47

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

Question 48

Self development as an innovator | as a life-long learner (professionalism)

Answer 48

```  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 ```