Edward J. Halloran

Development and Validation of the Nursing Severity Index: A New Method for Measuring Severity of Illness Using Nursing Diagnoses

The purpose of this study was to develop and validate the Nursing Severity Index, a new method used to measure the admission severity of illness of hospital patients using nursing diagnoses, which categorize biologic, functional, cognitive, and psychosocial abnormalities. This retrospective cohort study with independent development and testing phases was conducted at a U.S. academic medical center. In the development phase, data regarding 14,183 adult medicalsurgical patients admitted to the medical center in 1985 and 1986 was used. In the testing phase, data regarding 7,302 patients admitted in 1987 and 1988 was used. Primary nurses prospectively recorded the presence or absence of 61 nursing diagnoses on admission. Demographic and clinical data were obtained from hospital data bases. In the development phase, the number of admission nursing diagnoses was highly related (P < 0.001) to in-hospital mortality. Using multiple logistic regression, 34 nursing diagnoses were identified as independent predictors of mortality; the Nursing Severity Index equals the number of these 34 diagnoses. In the testing phase of 7,302 patients, the Nursing Severity Index was related (P < 0.001) to mortality rates, which were 0.5%, 1%, 2%, 6%, 13%, 22%, and 31% in seven hierarchical strata defined by the Index. The Index was as accurate in predicting mortality as MedisGroups (receiver-operatingcharacteristic curve areas, 0.814 ± 0.016 vs. 0.845 ± 0.015, respectively, P = 0.12). Furthermore, the Nursing Severity Index and MedisGroups together (receiver operating caracteristic curve area 0.880 ± 0.014), were more accurate (P < 0.01) than either measure alone. The Nursing Severity Index assesses multiple dimensions of illness, can be easily measured during routine patient care, accurately predicts the risk of in-hospital death, and has similar prognostic accuracy as MedisGroups. Its usefulness in outcomes assessment, quality assurance, and case management merits further study.

Nursing diagnosis, DRGs, and length of stay

It is becoming clear that a patient classification system based only on medical diagnosis does not always accurately predict cost of care and length of stay. This article describes a computerized patient classification system based on nursing diagnosis and shows how it can be used to more reliably predict length of stay.

Men, medics, and nursing: The military might just provide a way to curtail the nursing shortage.

The military might just provide a way to curtail the nursing shortage.

Gender Diversity in Nursing

Edited byJacquelyn H. Flaskerud, RN, PhD, FAANSchool of Nursing, University of California, Los Angeles, CAJanna Lesser, RN, PhDUniversity of Texas Health Science Center, San Antonio, TXDuring my ye...

The Reliability and Validity of the Diabetes Care Profile for Chinese Populations

This study aimed to translate into Chinese the Diabetes Care Profile (DCP), a measure of psychosocial factors and diabetes treatment, and to test the reliability and validity of the instrument within a Chinese population. The English version of the DCP was translated into Chinese following the standard translation methodology with consideration to cultural adaptation. The questionnaire was administered to 313 people with type 2 diabetes in an urban community in Beijing, China. Cronbach’s α coefficient was used to calculate reliabilities, which ranged from .55 to .86 on DCP subscales. Mean values on the DCP differed by diabetes treatment as expected and supports the construct validity of the DCP. The overall score on the DCP correlated well both with blood glucose levels and with a validated measure of a Chinese version of the Diabetes Specific Quality of Life scale, thus supporting the DCP’s criterion validity. The DCP is an acceptable measure of the psychosocial factors related to diabetes and its treatment in a Chinese population with type 2 diabetes.

Nurses' Own Recordkeeping: The Nursing Minimum Data Set Revisited.

There is no consistent, standardized, concise method for nurses to record information about their patients and clients that is conducive to store, retrieve, and use in patient and client care; to improve professional self-development; and to use in collaboration with patients and clients, their families, other nurses, doctors, hospitals, and health systems. Nurses gauge the health status of their patients and clients every day and are now in a position both to record their impressions for their own use and to share them with colleagues who care for the same patients and clients. What is now needed is a way to record these clinical impressions within an authoritative format that is related to the depth and breadth of the clinical literature related to nursing and the needs of the patients and clients nurses serve. The International Council of Nurses’ Nurse-Patient Summary is proposed here to fill the gulf between narrative nurses’ notes, proprietary and widely varying electronic health record systems, and information from nurses about their patiens and clients human needs. The International Council of Nurses’ Nurse-Patient Summary could replace nursing diagnosis items in the Nursing Minimum Data Set and serve as a substitute for the World Health Organization’s International Classification of Function, Disability and Health, a seldom used instrument derived from the International Council of Nurses’ Basic Principles of Nursing Care.

Nursing patients to independence.

Author Edie Ann Brous responds: Chances are you’ll never have a problem with malpractice claims or licensure discipline, but you are taking a prudent step early in your career. Find out what kind of policy your school offers and be sure to fully explore the terms, coverage, limits, and exclusions—you never want to rely on what someone else calls protection without reviewing it yourself. In addition, it’s not unheard of for students to obtain their own policies. The Nurses Service Organization (www.nso.com), for example, offers students malpractice protection and is the National Student Nurses’ Association’s official provider of professional liability insurance.

Case Mix Management: Matching Patient Need with Nursing Resource

The degree of patients’ dependence on nursing care is as important to the management of nursing department resources as it is in their clinical management. The nursing dependence must be ascertained to ensure effective patient management, and to more efficiently utilize nurses—the costs for whom make up 20–30 percent of total hospital expense. The contributions nurses make in patient care management are not well understood because nursing is often blurred together with medicine and the outcome of nurses’ activity sometimes is attributed to physicians.