Norma M. Lang

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.

Framing the problem of measuring and improving healthcare Quality: Has the Quality Health Outcomes Model been useful?

ObjectiveThe objective of this study was to determine the uses of the Quality Health Outcomes framework and indicator categories in the healthcare literature. Data SourcesWe studied personal communications and conducted a literature search using computerized databases since 1997, when the recommendations of the Invitational Conference on Measures and Outcomes of Care Delivery were available. Principal FindingsThe Quality Health Outcomes Model has been used explicitly to frame a small number of research summaries and programs. The outcome indicator categories can be found in several “report card” initiatives in the United States and Canada. Use of these outcome categories, thought to be sensitive to nursing care inputs, has grown since 1977, with a rising number of uses linked to system or organizational factors or interventions. ConclusionsThis model and others like it are increasingly forming the conceptual framework for studies that evaluate quality and system interventions to improve care. However, the available data continue to require the linking of negative outcomes (adverse events, complications) to structural and process inputs that reflect nursing care. An urgent need remains to incorporate this broader range of outcomes into available databases.

The nursing minimum data set conference: Executive summary

The nursing minimum data set (NMDS), developed recently at a national conference, is viewed as an initial effort to establish uniform standards for the collection of minimum, essential nursing data. In this article, generation of the NMDS is discussed; the identified data elements are presented; and plans for testing, refinement, and implementation are shared.

Using the Omaha System to Examine Outpatient Rehabilitation Problems, Interventions, and Outcomes Between Clients with and Without Cognitive Impairment

&NA; A retrospective cohort design was used to examine whether the Omaha System was useful in documenting differences in outpatient rehabilitation problems, interventions, and outcomes between clients with cognitive impairment and those with intact cognition. The sample included 201 clients who had been admitted to a comprehensive outpatient rehabilitation facility. The results showed no statistically significant differences in the prevalence of main Omaha problems, interventions, and outcomes between the two groups; however, clients with cognitive impairment experienced fewer changes in knowledge and behavior associated with neuro‐musculo‐skeletal function and pain than clients with intact cognition. These findings are consistent with an earlier report published by the authors that used standard instruments and indicate that the Omaha System can be valuable for rehabilitation clinical practice and research.

Reflections on quality health care.

The author, a JCAHO Codman Award recipient, reflects on her professional career in the area of health care quality and describes how nurses have been leaders in the study and improvement of health care quality. Nursings contributions to the development of quality of care measures, guidelines, and standardized languages are described and current and future opportunities for nursing are discussed.

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.

State of the Science Invitational Conference: Quality health care

Astate of the science invitational conference on quality health care, titled “Measuring and Improving Health Care Quality, Towards Meaningful Solutions To Pressing Problems, Nursing’s Contribution to the State of the Science,” will be held April 18-20, 2002, in Philadelphia at the Annenberg Center for Public Policy, University of Pennsylvania. This conference stems from the work of the American Academy of Nursing (AAN) Expert Panel on Quality Health Care and is responsive to the recent reports published by the Institute of Medicine and others regarding the quality of health care in America. This conference had its genesis in June 1996 during the AAN Expert Panel on Quality’s conference, titled “Outcome Measures and Care Delivery Systems.” Ideas were advanced further at subsequent AAN annual meetings and most recently in November 2001. This conference is led by the University of Pennsylvania School of Nursing and the Annenberg Center for Public Policy and is cosponsored by the AAN, the American Nurses Association, the Agency for Healthcare Research and Quality, and the National Institute for Nursing Research. The conference leaders are Norma Lang and Pam Mitchell. The Steering Committee also includes Ada Sue Hinshaw; Bonnie Jennings; Gerri Lamb; Barbara Mark; Patricia Moritz; Julie Sochalski; and 2 postdoctoral research fellows, Beth Ann Swan and Doris Vahey. The conference will begin with a 2-hour provocative panel discussion and audience participation chaired by Kathleen Hall Jamieson, dean of the Annenberg School of Communications and director of the Annenberg Public Policy Center. From the 3 perspectives of payers/insurers, health professionals/providers, and recipients/consumers, the distinguished panel members will be asked to answer the following questions: What are the 3 main reforms needed to improve quality? Is each reform based in research? What are the strengths and weaknesses of each reform? Do we need to rethink the agenda for quality health care? The Leonard Davis Institute cosponsors this session of the conference for Health Economics, University of Pennsylvania. Forty authors have agreed to prepare 22 papers. The conference will be devoted to the presentation of key points of the working papers and discussion among all expert interdisciplinary participants on what is known about nursing’s contribution to quality health care, strategies for measurement, available data sets, strengths and weaknesses of methodologies and technologies, and recommendations for further development and action. The papers and an annotated bibliography of the conference will be published. Executive summaries will be given to a variety of planners, providers, and users of health care services and, when applicable, recommendations will be made to appropriate agencies and groups. This event is just another exemplar of the Academy in action.