Introduction

The changes in the delivery of health care services have shifted from a process oriented system to an outcomes and performance based system. These changes have been endorsed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee on Quality Assurance (NCQA) and the Center for Medicare and Medicaid Services(CMS) as ways to measure quality health care ¹. Increased consumer awareness, cost of health care and increased health care competition has resulted in the need for all health professionals to define, quantify, and objectively evaluate how their work influences a patient's health status. Moreover, the need to determine work practices, numbers of health care providers available and policies associated with quality patient care continue to be of concern ². Now more than ever before, nurses need to document how nursing care influences their patients'health status, quality of life, health knowledge and ability to continue activities that maintain their independence.