Marion Johnson

THE NURSING OUTCOMES CLASSIFICATION

The Nursing Outcomes Classification (NOC) is a comprehensive taxonomy of patient outcomes influenced by nursing care. Each outcome is stated as a variable concept measured on a five-point Likert scale and includes a definition, indicators, and references. The classification provides outcomes that can be used across the care continuum to assess patient status following nursing interventions. The classification has a number of advantages, including being research-based, standardized, comprehensive, and flexible for clinical use. It was developed by a large research team that included clinical experts and has been subjected to testing.

The Medical Outcomes Study: a nursing perspective

The authors analyze the Medical Outcomes Study framework as a means of measuring the effectiveness of a multidimensional, interdisciplinary health care delivery system. The potential for this model to measure outcomes resulting from the interventions of nurses is demonstrated. The similarities between variables in the Medical Outcomes Study (MOS) framework and in research in nursing are presented. Modifications in the framework are suggested that would represent the collaboration among physicians, nurses, and allied health practitioners and the influence of their interaction on patient outcomes. The authors also suggest adding the domain of societal outcomes to include such outcome variables as cost. These modifications will enhance future health outcomes research based on the MOS conceptual framework and will encourage investigations of the interactive effects of health care providers on patient outcomes.

Evaluation of the reliability and validity of nursing outcomes classification patient outcomes and measures

One hundred sixty-nine of the Nursing Outcomes Classification (NOC) patient outcomes were tested for interrater reliability, criterion validity, and sensitivity. In 10 field sites, ranging from hospitals to home care, pairs of nurses rated the outcome measures for 5 to 130 patients. Inter-class correlations were greater than or equal to 0.70 for 63 outcomes. Pearson’s correlations with criterion measures were greater than or equal to 0.60 for 40 outcomes and from 0.39 to 0.60 for 43 additional ones. Change scores for 99 outcomes ranged from 0 to 2.0 from first to second and second to third rating. Most NOC measures demonstrated good inter-rater reliability, substantial criterion validity, and sensitivity to change. More testing and thorough training of nurses using NOC outcomes are needed.

Adjunct executive appointment for faculty. An innovation in nursing collaboration

The need for collaboration has never been greater. The healthcare delivery system faces unprecedented challenges arising from prospective payment, competition in the marketplace, higher patient acuity levels, and a shortage of professional nursing staff. The authors discuss a service-education collaboration model based on adjunct executive appointments of faculty members to healthcare organizations. The authors describe the model, a conceptual framework to guide its development, case studies of its implementation, and a summary of the benefits and risks associated with the initial implementation of the model.

Testing the nursing outcomes classification in three clinical units in a community hospital

The testing of the Nursing Outcomes Classification (NOC) was the focus of a 4-year study to evaluate the use of the outcomes and measurement scales developed by the Iowa Outcomes Project, a research team at the University of Iowa. Three units in a Midwest community hospital collected data as part of the larger (ten) clinical site study to test the reliability, validity, and sensitivity of the NOC. This article focuses on the results of sensitivity testing obtained in a birth center, behavioral health center, and an oncology unit in a midwestern community hospital. Methods used in this study focused on change scores from initial assessment to post-treatment status for the outcomes studied in each unit. Average baseline ratings, average follow-up ratings, average change scores, and range of change are reported. Thirty-five outcomes are reported for the behavioral health unit, 21 outcomes are reported for the Birth Center, and 8 outcomes for the Oncology Unit. The overall average baseline for the behavioral health unit was 1.89 with an average follow-up rating of 3.22. For the Birth Center, the average baseline rating was 3.23 with an average follow-up score of 3.88. For the Oncology Unit, the average baseline score was 3.01 with an average follow-up rating of 3.12. The results of this study suggest that the NOC outcomes are able to identify change in some outcome ratings through time and in a direction expected for the populations studied in these three specialty units.

The nursing outcomes taxonomy: development and coding.

Interest in the theoretical knowledgebase of nursing has increased over the last 25 years and has led to the current interest in middle-range theory development to describe the essence of nursing. This article describes the creation of a three-level taxonomy and coding structure for the Nursing Outcomes Classification (NOC) based on methods developed by the Nursing Interventions Classification (NIC) work. A model is presented depicting the importance of standardized nursing diagnoses, interventions, and outcomes in the development of the substantive component of nursing practice and to enable nurses to be accountable for care of their clients.

What is the study of nursing service administration

In the past decade, forces such as prospective payment systems, cost containment, increased competition, corporate mergers, and alternative care delivery systems have converged upon health care organizations. In a climate of uncertainty and rapid change, it is imperative that nurse administrators be well prepared. In the past few years nursing service administration as a field in itself has regained popularity. Many people still have questions, however, about the nature and need for this specialty area within nursing. This article outlines the study of nursing service administration and differentiates it from business administration and health administration. Curricular issues that nursing service administration faculty need to address are raised.