Some impacts of nursing on acute care hospital outcomes.

Measuring nursing-sensitive patient outcomes using publicly available data provides exciting opportunities for the nursing profession to quantify the patient care impact of staffing changes at individual hospitals and to make comparisons among hospitals with differing staffing patterns. Using data from California and New York, this study tested the feasibility of measuring such outcomes in acute care hospitals and examining relationships between these outcomes and nurse staffing. Nursing intensity weights were used to acuity-adjust the patient data. Both higher nurse staffing and higher proportion of RNs were significantly related to shorter lengths of stay. Lower adverse outcome rates were more consistently related to a higher proportion of RNs.

ANA standards for nursing data sets in information systems.

The American Nurses Association has established the Nursing Information and Data Set Evaluation Center. The purpose of this Center is to develop and disseminate standards pertaining to information systems that support the documentation of nursing practice, and to evaluate voluntarily submitted information systems against these standards. The need for an evaluation center arises out of a long history of calls for standards pertaining to nursing data and information systems. These calls have come from the Secretary of Health and Human Services Commission on Nursing, the National Commission on Nursing Implementation Project, and a joint Task Force appointed by the Congress of Nursing Practice Steering Committee on Databases to Support Clinical Nursing Practice and the Congress of Nursing Practice Committee on Nursing Practice Standards and Guidelines. Standards have been developed to evaluate the completeness, accuracy and appropriateness of four dimensions of nursing data sets and the systems that contain them: (1) nomenclature, (2) clinical content, (3) clinical data repository, and (4) general system characteristics.

Nursing and threats to patient and nurse safety and quality of patient care.

A major effect of today's emphasis on cost-cutting in health care has been reductions in the numbers and mix of registered nurses (RNs). RNs have increased concerns over patient and practitioner safety and patient care quality. The American Nurses Association (ANA) has a major, multi-phase project addressing these concerns, called Nursing's Safety and Quality Initiative. This initiative encompasses: nursing-sensitive quality indicators, educating staff nurses, researching the impact of skill mix on patient outcomes, political activities, a national database of nursing quality indicators, and liaisons and coalitions. These activities reflects ANA's commitment to patient and nurse safety and the quality of patient care.

Information systems in critical care: a measure of their effectiveness.

Information systems in critical care settings are intended to assist critical care nurses in handling large volumes of multi-source, multi-variant patient data. These systems are known by many names, including patient data management systems (PDMS). The focus of this research was the development and testing of a generic, non-vendor-specific effectiveness measure for PDMS. Eight PDMS goals were identified and developed into the 79 item PDMS Effectiveness Measure. Testing included internal consistency reliability (.9098), test-retest reliability (r = .8941) and content validity (CVI = 0.66). Construct validity was estimated via contrasted groups analysis with significantly higher scores for nursing units with PDMS. The PDMS Effectiveness Measure is reliable, valid and useful for measuring the effectiveness of PDMS in critical care settings. Furthermore, PDMS do assist nurses in information handling.

Toward a uniform language for nursing in the US: work of the American Nurses Association Steering Committee on databases to support clinical practice.

This paper reports on the work of the American Nurses Association Steering Committee on Databases to Support Clinical Practice, in existence since 1989. Responding to its broad charges, the Steering Committee has laid down the foundations for its work in declaring the nursing process as the framework for nursing data in database systems, and in endorsing the Nursing Minimum Data Set as the set of minimum elements for any system designed to carry health-related data that reflects nursing care. In addition, the Steering Committee has begun initiatives to: 1) promote the inclusion of nursing-related data in large health-related databases, and 2) develop a Uniform Language for nursing through a phased approach. The Steering Committee also works directly with the International Council of Nurses to promote the inclusion of nursing data in internationally used classification systems and to develop an international language that describes nursing care.

Toward standard classification schemes for nursing language: recommendations of the American Nurses Association Steering Committee on Databases to Support Clinical Nursing Practice.

The American Nurses Association (ANA) Cabinet on Nursing Practice mandated the formation of the Steering Committee on Databases to Support Clinical Nursing Practice. The Committee has established the process and the criteria by which to review and recommend nursing classification schemes based on the ANA Nursing Process Standards and elements contained in the Nursing Minimum Data Set (NMDS) for inclusion of nursing data elements in national databases. Four classification schemes have been recognized by the Committee for use in national databases. These classification schemes have been forwarded to the National Library of Medicine (NLM) for inclusion in the Unified Medical Language System (UMLS) and to the International Council of Nurses for the development of a proposed International Classification of Nursing Practice.

Privacy and confidentiality of patient information. Challenges for nursing.

The growing interest in automating healthcare information and the emergence of the computer-based patient record-keeping have brought the issues of privacy and confidentiality to the fore-front. Nurse executives and nurse managers need to be sensitive to these issues, as never before, to guide their staffs and to prevent harm. Technology makes sensitive information more accessible to more people, with resulting benefits and dangers. The author presents a nursing ethical framework for discussing patient privacy and confidentiality issues, and highlights specific issues that reflect nursing's unique viewpoints.