[Patient classification systems. Nursing workload from the perspective of applied research (part 2)]. / Patientenklassifikationssysteme. Leistungsdaten im Blickfeld angewandter Forschung (Teil 2).

Building on the first part of the article, which described aims, forms and a new developed typology of Patient Classification Systems (PCS), the second part discusses three wrong assumptions that are often behind the application of common PCS. These assumptions deal mainly with indices of nursing care intensity for measuring of staff requirements and with patient characteristics (deficiencies and problems) in regard to the expenditure of time. Additional examinations show whether or not it is scientifically possible to express staff requirements on the basis of added up individual nursing activities. Data collected in several intensive care units by diagnosis related analysis of work activities (DTA) show that the distribution of expenditure of time for singular nursing activities does not result in meaningful arithmetic means usable for assessment instruments scheduling of personnel. Given these methodical constraints it should be examined with minuteness before the application of a PCS exactly which question should be answered by an instrument or method, and it should be examined whether the method is suitable for the question asked.

A clinical care costing method.

The Clinical Care Costing Method (CCCM for the Home Health Care Classification (HHCC) System provides an innovative way to determine the cost of clinical nursing practice. This costing methodology consists of three major nursing indicators--Care Components, Actions and Outcomes. These three indicators require Clinical Care Pathways (CCP) to document, track, and code clinical care using the HHCC System. The clinical care costs and/or resources are derived from the time and frequencies of the Action Types for the specific nursing interventions performed by the different type of health care providers to achieve the Outcomes and resolve the Care Component that are used to classify nursing diagnoses/patient problems. This method can also be used to deter-mine the reimbursement for nursing care services retrospectively and once validated prospectively. The Clinical Pathway data provide the evidence that the nursing interventions achieve the desired outcomes.

Contexts for the study of the economic influence of nursing diagnoses on patient outcomes.

PURPOSE: To examine the historical, legal/ organizational, informatics, clinical, economic, and policy contexts underlying economic consequences of nursing diagnoses on patient outcomes. DATA SOURCES: Published literature, online material. DATA SYNTHESIS: Nursing diagnoses influence diagnostic-specific patient outcomes and other outcome variables such as length of hospital stay, morbidity, and mortality. CONCLUSIONS: Examination of the economic ramifications of nursing diagnosis on patient outcomes can be facilitated using standardized language and databases containing nursing-sensitive measures.

Diagnostic-specific outcomes and nursing effectiveness research.

PURPOSE: To review the use of diagnosis-specific outcomes in health care and nursing. DATA SOURCES: Published literature, information databases. DATA SYNTHESIS: The need to identify nursing diagnosis-specific outcomes is necessary in order to expand nursing's knowledge base and identify the cost-effectiveness of nursing interventions. CONCLUSIONS: Outcomes work needs to be done across settings where care is provided. PRACTICE IMPLICATIONS: Outcomes information is necessary to identify the cost and impact of nursing interventions.

[Nursing diagnosis of risks. Analysis of cost effectiveness]. / Diagnósticos de enfermería sobre riesgos. Análisis coste-efectividad.

BACKGROUND: Today, there is a discussion on the importance of the utilization of the nursing diagnosis: This makes convenient to evaluate the principal two existing methodological alternatives, that they are: 1) the problems identification, 2) the diagnoses statement of the NANDA within process nursing. The study is centered on the risk diagnoses. OBJECT: 1) To know which the two work methodologies is more effective. 2) To know if exist economic differences. METHODS: It is accomplished a cohorts study, in a population of user included in Program of Handicapped. These were studied during a year. RESULTS: In the group of patients without diagnoses the incidence rate was of 0.64 conversions/person-year), in the group with diagnoses was of 0.22 (p < 0.001). The mean of visits after that the is made real, in the group with diagnoses was of 0.35, in the group without diagnoses of 1.69 (p = 0.012). DISCUSSION: The analysis cost-efficiency of the two work methodologies is clearly more favorable for the methodology than states nursing diagnosis of the taxonomy of the NANDA.

Application of 'Clearview Chlamydia' for the rapid detection of cervical chlamydial antigen.

In a study to evaluate the Clearview chlamydia test in a genitourinary medicine clinic, the sensitivity and specificity were 76.4% and 99.4% respectively when compared with the DAKO IDEIA chlamydia test processed in a department of medical microbiology. The time taken to perform and read the Clearview chlamydia test 'on site' did not interfere with the normal routine functioning of the clinic and the nurses who performed it as part of their routine duties found it simple and easy to use.

Costing the nursing service of patient education.

Patient Classification Systems (PCS) are one method of determining nursing service cost of patient education. A teaching classification study compares the value that different PCSs place on this aspect of nursing care. Through this comparison, information obtained helps nurses objectively update existing patient classification systems and provides guidelines for developing a system to include patient education.

Two explanations of nurse practitioner interactions and participatory decision making with physicians.

The purpose of this study was to test a theoretical model that integrated two explanations of nurse practitioner interaction and participatory decision making with physicians. The two explanations were derived from technology theory and social exchange theory. Nurse practitioners (N = 38) responded to a four-scale magnitude estimation instrument measuring each of four concepts in the model: complexity, expected benefit-cost ratio of interaction, interaction, and participatory decision making. Predictions derived from both theories were supported. Nurse practitioner decisions about interaction with physicians were influenced by the dynamics of social exchange with physicians, as well as the technological requirements of primary care. The findings offer nurse practitioners new strategies for managing professional exchanges on behalf of their patients.