Mapping nursing concepts to ontologies for evidence-based nursing.

In this paper we describe a project to map natural language expressions of nursing-related concepts to standard ontologies in support of an evidence-based nursing initiative. Natural language concept expressions are identified from syntheses of nursing knowledge and mapped to ICNP and SNOMED-CT.

The promise of simultaneous transformation of practice and research with the use of clinical information systems.

The author builds a case that the design and use of intelligent information systems in real-time practice holds the promise of simultaneously transforming practice and research. Requirements include the identification of actionable knowledge that can be embedded in clinical decision support and electronic documentation systems, the creation of clinical data repositories, and a data warehouse from which analyses can be conducted across multiple settings. An innovative project, the Knowledge-Based Nursing Initiative, is briefly described as illustrative of these requirements.

Using the Omaha System to examine outpatient rehabilitation problems, interventions, and outcomes between clients with and without cognitive impairment.

A retrospective cohort design was used to examine whether the Omaha System was useful in documenting differences in outpatient rehabilitation problems, interventions, and outcomes between clients with cognitive impairment and those with intact cognition. The sample included 201 clients who had been admitted to a comprehensive outpatient rehabilitation facility. The results showed no statistically significant differences in the prevalence of main Omaha problems, interventions, and outcomes between the two groups; however, clients with cognitive impairment experienced fewer changes in knowledge and behavior associated with neuromusculoskeletal function and pain than clients with intact cognition. These findings are consistent with an earlier report published by the authors that used standard instruments and indicate that the Omaha System can be valuable for rehabilitation clinical practice and research.

Clinician adoption patterns and patient outcome results in use of evidence-based nursing plans of care.

Delivery of safe, effective and appropriate health care is an imperative facing health care organizations globally. While many initiatives have been launched in a number of countries to address this need from a medical perspective, a similar focus for generating evidence-based nursing knowledge has been missing. This paper reports on a collaborative evidence-based practice (EBP) research initiative that adds nursing knowledge into computerized care protocols. Here, a brief overview of the study's aims, purpose and methodology is presented as well as results of data analysis and lessons learned. The research team examined nurses' adoption patterns of EBP recommendations with respect to activity tolerance using four-month patient data collected from a pilot hospital. Study findings indicate a need for more focus on the system design and implementation process with the next rollout phase to promote evidence-based nursing practice.

Framing the problem of measuring and improving healthcare quality: has the Quality Health Outcomes Model been useful?

OBJECTIVE: The objective of this study was to determine the uses of the Quality Health Outcomes framework and indicator categories in the healthcare literature. DATA SOURCES: We studied personal communications and conducted a literature search using computerized databases since 1997, when the recommendations of the Invitational Conference on Measures and Outcomes of Care Delivery were available. PRINCIPAL FINDINGS: The Quality Health Outcomes Model has been used explicitly to frame a small number of research summaries and programs. The outcome indicator categories can be found in several "report card" initiatives in the United States and Canada. Use of these outcome categories, thought to be sensitive to nursing care inputs, has grown since 1977, with a rising number of uses linked to system or organizational factors or interventions. CONCLUSIONS: This model and others like it are increasingly forming the conceptual framework for studies that evaluate quality and system interventions to improve care. However, the available data continue to require the linking of negative outcomes (adverse events, complications) to structural and process inputs that reflect nursing care. An urgent need remains to incorporate this broader range of outcomes into available databases.

Reflections on quality health care.

The author, a JCAHO Codman Award recipient, reflects on her professional career in the area of health care quality and describes how nurses have been leaders in the study and improvement of health care quality. Nursing's contributions to the development of quality of care measures, guidelines, and standardized languages are described and current and future opportunities for nursing are discussed.

Penn Macy initiative to advance academic nursing practice.

Academic nursing practice holds great promise for the future of the nursing discipline. The successful and intentional integration of the tripartite mission of research, education, and clinical practice can facilitate both the evolution of the science and implementation of evidence-based practice, while imbuing practitioners in the making with the world of the possible. Although many schools of nursing have been involved in some aspects of academic practice, the lack of common focus and direction has hampered concerted movement. The Penn Macy Initiative was conceived as a vehicle to help build and coalesce the critical mass needed to bridge this gap. The Penn Macy Initiative, its implementation and experience in the first 3 years, and how its alumni fellows, an annual conference, and Web-based consultation will continue to provide impetus, leadership, and resources for academic nursing practice in the years to come are described.