The purpose of outcomes research is to evaluate: the quality of care for health conditions and diagnoses of enrolled populations and the performance of health plans in meeting patient needs while determining accountability. McCormick ²⁹ has defined health outcomes within three domains: 1) effective clinical interventions used to prevent, diagnose, treat and manage clinical conditions; 2) methods and data to advance the clinical application of outcomes; and 3) evaluation of the impact of clinical outcomes on patient populations. The use of clinical practice guidelines grounded in research, in addition to the use of appropriate diagnostic treatment regimens can improve the quality of patient care without increasing the cost of care³⁰.

Measuring nursing outcomes to determine if nursing care makes a difference (what the nurse does for the patient, with predicted health outcomes that result from specified nursing interventions) requires a new set of clinical skills. Nurses need to demonstrate the value of nursing care in terms of improved outcomes linked to nursing activities and interventions by evaluating the rate of improvement in a patient's health status (functional status/self-care, psychological adjustment and involvement with managing their health) within the health care system. Examples of nursing sensitive outcome measures as defined by the ANA³¹ for acute care settings include: nosocomial infection rates; patient injury rates from falls; patient satisfaction with nursing care; pain management; educational information; nursing job satisfaction; maintenance of skin integrity; and staff mix (RNs, LPNs, technicians). These nursing quality indicators are defined in operational terms to specifically measure nursing actions (Table 1).

Table 1. ANA Nursing Quality Indicators and Their Operational Definitions*

Nosocomial Infection Rate: The rate per 1000 patient acute care days at which patients develop clinically active bacteremia (as defined by CDC) in whom there is no evidence to suggest that infection was present or incubating at admission (using CDC differential criteria).

Patient Injury Rate: The rate at which patients fall and incur physical injury (unrelated to a surgical or diagnostic procedure) during the course of their hospital stay per 1000 patient days.

Patient Satisfaction with Nursing Care: Patient opinion of care received from nursing staff during the hospital stay as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding key elements of nursing care services.

Patient Satisfaction with Pain Management: Patient opinion of how well nursing staff managed their pain as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding specific aspects of pain management.

Patient Satisfaction with Educational Information: Patient opinion of nursing staff efforts to educate them regarding their condition and care requirements as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding specific aspects of patient education activities.

Patient Satisfaction with Care: Patient opinion of the care received during the hospital stay as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding global aspects of care.

Nursing Job Satisfaction: Job satisfaction expressed by nurses working in hospital settings as determined by scaled responses to a uniform series of questions designed to elicit nursing staff attitudes toward specific aspects of their employment situation.

Maintenance of Skin Integrity: Rate per 1000 patient days at which patients develop pressure ulcers (Grade II or greater) during the course of their hospital stay, but, 72 hours or more following their admission.

Mix of RNs, LPNs, Unlicensed Staff Caring for Patients in Acute Care Settings: The ratios (expressed in FTEs) of registered nurses with direct patient care responsibilities to LPNs and unlicensed workers.

Total Nursing Care Hours Provided per Patient Day: Total number of hours worked by nursing staff with direct patient care responsibilities on acute care units per patient day.

*American Nurses Association. (1996). Nursing quality indicators: Definitions and implications. Washington,DC: American Nurses Publishing.

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