Mary Ann Lavin

Development of an instrument to measure the quality of documented nursing diagnoses, interventions and outcomes: the Q-DIO.

AIMS AND OBJECTIVES This paper aims to report the development stages of an audit instrument to assess standardised nursing language. Because research-based instruments were not available, the instrument Quality of documentation of nursing Diagnoses, Interventions and Outcomes (Q-DIO) was developed. BACKGROUND Standardised nursing language such as nursing diagnoses, interventions and outcomes are being implemented worldwide and will be crucial for the electronic health record. The literature showed a lack of audit instruments to assess the quality of standardised nursing language in nursing documentation. DESIGN A qualitative design was used for instrument development. METHODS Criteria were first derived from a theoretical framework and literature reviews. Second, the criteria were operationalized into items and eight experts assessed face and content validity of the Q-DIO. RESULTS Criteria were developed and operationalized into 29 items. For each item, a three or five point scale was applied. The experts supported content validity and showed 88.25% agreement for the scores assigned to the 29 items of the Q-DIO. CONCLUSIONS The Q-DIO provides a literature-based audit instrument for nursing documentation. The strength of Q-DIO is its ability to measure the quality of nursing diagnoses and related interventions and nursing-sensitive patient outcomes. Further testing of Q-DIO is recommended. RELEVANCE TO CLINICAL PRACTICE Based on the results of this study, the Q-DIO provides an audit instrument to be used in clinical practice. Its criteria can set the stage for the electronic nursing documentation in electronic health records.

Testing the Q‐DIO as an Instrument to Measure the Documented Quality of Nursing Diagnoses, Interventions, and Outcomes

PURPOSE To describe pilot testing of Quality of Diagnoses, Interventions and Outcomes (Q-DIO), an instrument to measure quality of nursing documentation. DESIGN Instrument testing was performed using a random, stratified sample of 60 nursing documentations representing hospital nursing with and without implementation of standardized nursing language (30 for both strata) in a Swiss General Acute Hospital. METHODS Internal consistency and intrarater and interrater reliabilities were tested. Through item analyses, the grades of difficulty and the discrimination validity of items were evaluated. FINDINGS Internal consistency of nursing diagnoses as process produced Cronbachs alpha .83; nursing diagnoses as product .98; nursing interventions .90; and nursing-sensitive patient outcomes .99. With Kappas of .95, the intrarater and interrater reliabilities were good. Criteria for the grades of difficulty of items and discrimination validity were well met. The results of this study suggest that Q-DIO is a reliable instrument to measure the documentation quality of nursing diagnoses, interventions, and outcomes. Further testing of Q-DIO in other settings is recommended.

Pflegediagnosen, -interventionen und -ergebnisse: Anwendung und Auswirkungen auf die Pflegepraxis: Eine systematische Literaturübersicht.

Dieser Artikel beschreibt eine systematische Literaturubersicht zu den Auswirkungen der Pflegediagnostik. Es werden Auswirkungen auf die Qualitat des Pflegeassessments sowie auf die Haufigkeit, Genauigkeit und Vollstandigkeit von Pflegediagnosen und auf die Koharenz zwischen Pflegediagnosen, -interventionen und -ergebnissen aufgezeigt, wie sie in Patientenakten2 dokumentiert werden. Steigende Kosten machen es erforderlich, den Beitrag der Pflege zur Gesundheitsversorgung zu bestimmen. Dies wird durch den Einsatz standardisierter Terminologien erleichtert. Zwar liegen Studien vor, in denen eine standardisierte Dokumentation von Pflegediagnosen und ihre Beziehung zu Pflegeinterventionen und Pflegergebnissen evaluiert wurden, eine systematische Ubersicht fehlte jedoch bislang. Es wurde eine Suche in MEDLINE, CINAHL und der Cochrane Database (1982–2004) durchgefuhrt und durch Grundlagenartikel und Tagungsberichte erweitert. Einschlusskriterien wurden bestimmt und umgesetzt. Anschliesend sind sechsunddreisig A...

Ethics Education in MSN Programs: A Study of National Trends

The aim of this study was to determine the manner in which masters of science in nursing programs, accredited by either the National League for Nursing Accrediting Commission or the Commission on Collegiate Nursing Education, conduct ethics education. A survey method was employed to obtain requisite data. Among the main variables investigated were: the percentage of programs that require a course with formal ethics content; the average number of class hours a program or track dedicates to ethics education; required and actual credentials of instructors who teach ethics; and objectives, topics, teaching methods, and grading methods of required courses with formal ethics content. Results indicated that most programs do not require instructors to have completed formal ethics training. In terms of content, few common trends exist and there are important gaps in clinical ethics topics. Comparisons between school of medicine ethics content reported in the literature and MSN ethics content reported in this study indicate that medical schools are more exacting of their students. The study concludes with a call for the establishment of guidelines or standards relevant to ethics content in MSN curricula in the United States.

[Psychometric properties of Q-DIO, an instrument to measure the quality of documented nursing diagnoses, interventions and outcomes].

The instrument Q-DIO was developed in the years 2005 till 2006 to measure the quality of documented nursing diagnoses, interventions, and nursing sensitive patient outcomes. Testing psychometric properties of the Q-DIO (Quality of nursing Diagnoses, Interventions and Outcomes.) was the study aim. Instrument testing included internal consistency, test-retest reliability, interrater reliability, item analyses, and an assessment of the objectivity. To render variation in scores, a random strata sample of 60 nursing documentations was drawn. The strata represented 30 nursing documentations with and 30 without application of theory based, standardised nursing language. Internal consistency of the subscale nursing diagnoses as process showed Cronbachs Alpha 0.83 [0.78, 0.88]; nursing diagnoses as product 0.98 [0.94, 0.99]; nursing interventions 0.90 [0.85, 0.94]; and nursing-sensitive patient outcomes 0.99 [0.95, 0.99]. With Cohens Kappa of 0.95, the intrarater reliability was good. The interrater reliability showed a Kappa of 0.94 [0.90, 0.96]. Item analyses confirmed the fulfilment of criteria for degree of difficulty and discriminative validity of the items. In this study, Q-DIO has shown to be a reliable instrument. It allows measuring the documented quality of nursing diagnoses, interventions and outcomes with and without implementation of theory based, standardised nursing languages. Studies for further testing of Q-DIO in other settings are recommended. The results implicitly support the use of nursing classifications such as NANDA, NIC and NOC.

Brief: Nursing Diagnostic Applications Derived From National Academy of Clinical Biochemistry (NACB) Draft Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

This brief indicates how methods used by the National Academy of Clinical Biochemistry (NACB) in the development of its guidelines and recommendation for the laboratory analysis in the diagnosis and management of diabetes mellitus may be applied to advance nomenclature, clinical practice, and research development within nursing. Specifically, human response diagnoses require the identification of accurate tests to confirm or reject the diagnoses. Each test needs to be described in terms of its use, rationale, analytical, and emerging considerations. Accurate test development will move nursing nomenclature, clinical practice, and research forward.

NLINKS: Online, Peer‐Reviewed Bibliographic References on Sleep

PURPOSE To develop a methodology for establishing an online (http://www.nlinks.org), peer-reviewed, annotated bibliography. Disturbed sleep patterns and sleep deprivation were the arbitrarily selected foci. METHODS Tasks included developing an annotated bibliographic form and collecting reviews, first from investigators and next from an online solicitation, and improving the annotated form as needed with the implementation of each of the following steps: (a) selecting MEDLINE and CINAHL search strategies for the years 1966–1982 and 1982–2001, respectively, (b) classifying an articles evidence base and its contribution to language development; (c) evaluating construct and content validity of the evidence base and the contribution to language development classifications, (d) determining interrater reliability in evaluating reviews, (e) publishing the results online, and (f) preparing for the deductive phase of the research and future research efforts. FINDINGS There was high interrater reliability within the contribution to language development scale but not within the evidence-based scale. This finding led to a discussion on the evidence base of nursing. Comparisons between evidence base of medicine and nursing were made. A three-tiered matrix was developed to allow for the cross-categorization of level of nursing evidence with diagnoses, defining characteristics, related factors, interventions or treatments, and outcomes. Access to literature within any one cell of the matrix required knowledge of filters used by MEDLINE and CINAHL and adapting these filters to capture subject headings consistent with language development subjects and terms. CONCLUSIONS Future searches are planned and the implications for nursing informatics, education, practice, and research have been articulated. The move toward evidence-based nursing is international in nature.