Nursing Outcomes Classification: implications for nursing information systems and the computer-based patient record.

Quality improvement, measurement, and accountability pervade all health care, including the agendas of nursing, other care providers, and consumer groups. One new face of quality is unequivocal: data will be more equitably shared among all groups for data-based quality judgments. This will emphasize quality more than cost with greater involvement of the citizens compared to health care providers, payers, and health care product suppliers. Emphasis on quality will allow patients to have a voice heard and amplified through the implementation of patient-centered outcomes in the computerized patient care record. This article describes the implications of the Nursing Outcomes Classification (NOC) for nursing information systems and the computer-based patient record.

South Dakota statewide Nursing Minimum Data Set Project.

The elements of the Nursing Minimum Data Set (NMDS) were collected manually from 188 medical records in eight acute care facilities. These eight facilities represent 54 per cent of the beds in South Dakota. The purpose of the study was to describe discharge destination, nursing diagnoses, nursing interventions, and nursing resource utilization for patients with fractured femur with pinning. The sample was primarily female (69.1 per cent), with a mean age of 78.5 years. Most (84.0 per cent) patients were transferred to another facility, with 46.2 per cent going to extended care facilities. The most frequent nursing diagnoses were comfort (89.9 per cent) and physical mobility (59.6 per cent). Interventions were classified using the 16-category classification scheme developed by Werley and Lang. The most frequently recorded types of interventions were in the category of monitoring and/or surveillance (16.7 per cent of 7,555 interventions), whereas emotional support and/or counseling was much less frequent (3.0 per cent of 7,555). Discharge planning was the most frequent nursing intervention in the category of coordination and collaboration of care (54.8 per cent of 188 patients). Documentation systems have been structured to accommodate technical tasks on flow sheets, for example. Nursing resource utilization was the most difficult, and also presently the least meaningful, NMDS element to collect because each facility has different staffing, different patient classification systems, and no prescribed method for collecting these data. Manual data collection is time-consuming and expensive and therefore not recommended.

The affective outcomes of course work on computer technology in nursing.

At the University of Iowa, nursing students are introduced to computer technology as one unit in a course designed to explore nursing as a profession. A single group, pretest/posttest design was used to evaluate changes in attitudes associated with the course work. Relationships of attitudes scores and eight background variables were studied. Posttest attitudes scores were significantly higher than pretest scores. The attitudes scores were positively related to skills scores at a statistically significant level of .05, with no significant relationship between attitudes scores and knowledge base scores. Four of the eight background factors were related to the attitudes scores at a statistically significant level of .05.

Validating impaired physical mobility.

The clinical presence of impaired physical mobility documented for acute-care patients was studied. The frequency, individual, and group sensitivity levels of the defining characteristics documented as empirical referents for the diagnosis were examined. The frequency of the related factors associated with the diagnosis, patient demographics, length of stay (LOS), discharge destination, and diagnostic-related groups (DRGs) were also examined. Data were obtained from electronic tapes of patient information. Support was found for impaired mobility, as a high-frequency diagnosis, in heterogeneous acute-care patients. No support was found for any major defining characteristics across the heterogeneous sample. A cluster of three defining characteristics: (a) inability to purposefully move within the environment; (b) decreased muscle strength, control, or mass; and (c) imposed restrictions of movement was supported by group sensitivity measures. Major defining characteristics were supported in two DRG subsets. Clusters of defining characteristics varied among four DRGs. The NANDA-preidentified related factors were associated with the diagnosis. Electronic storage and retrieval of computerized nursing data, including the elements of the Nursing Minimum Data Set (NMDS), was an effective, efficient method for data collection and analysis.

Nurse educators' acceptance of the computer in baccalaureate nursing programs.

Although several studies have investigated nurse educators' perceived knowledge of and acceptance of computer technology, none have incorporated objective indicators of knowledge or acceptance. This descriptive research study used standardized and investigator-developed tests to examine acceptance of the computer by randomly selected administrators and faculty in private baccalaureate nursing programs. Levels of computer literacy and attitudes were sufficiently positive to promote the awareness, interest, and evaluation stages of Roger's diffusion and adoption model. Responses were not sufficiently positive to promote the trial and adoption of computer technology for instructional and administrative activities. Recommended approaches to meeting this challenge included instruction related to computer software and educational applications and the use of consortial arrangements to share knowledge, computer hardware and software, and application experiences.