Since August 1991, a research team consisting of 43 nurses representing service agencies and nursing education has been conducting a study of nursing-sensitive patient outcomes. The purposes of the research are to: 1) identify, label, validate, and classify nursing-sensitive patient outcomes and indicators, 2) evaluate the validity and usefulness of the classification in clinical field testing, and 3) define and test measurement procedures for the outcomes and indicators. The classification contains patient outcome categories and indicators at four levels of abstraction and empirical measurement scales. The taxonomy of domains and labels can be obtained from the NOC project office at the University of Iowa.

An inductive approach was used to extract outcomes, indicators, and measures from current literature, instruments, and information systems. Combined inductive and deductive approaches were used to label and define outcomes, specify indicators for the outcomes, and develop the classification

For purposes of this study, a nursing-sensitive patient outcome is defined as a variable patient or family state, behavior or perception, responsive to nursing interventions and conceptualized at middle levels of abstraction. Thus outcomes are stated as concepts which are measured along a continuum rather than as goals. Each outcome has an associated group of indicators which are used to determine the outcome.

The following illustrates an outcome label, it's definition and 2 example indicators with the measurement scale.

Surveys of random samples of masters prepared nurses, representing diverse areas of practice, were used to validate each outcome and its associated indicators as well as their sensitivity to nursing interventions. Nurses were asked to rate the importance of each indicator for assessing the outcome and the contribution of nursing to the outcome. Fehring's methodology for assessing content validity of nursing diagnoses was used with minor revisions to estimate content validity and sensitivity to nursing interventions. The NOC is being tested in a tertiary care setting, a community hospital, a nursing home, and a home care setting. NOC provides one of the elements necessary to complete the Nursing Minimum Data Set. NOC has major implications for nursing administrative practice and care delivery. It provides the first standardized language and measurement for nursing-sensitive patient outcomes. The use of standardized language allows nurses to compare outcomes for large numbers of patients across settings, diagnoses, age groups, or other aggregates of interest. Development of outcomes as neutral statements that are measured on a continuum rather than as "expected outcomes," facilitates the identification and analysis of patient states actually being achieved for specific populations and/or settings. It also enables the evaluation of nursing care over a care continuum as well as at one point in time. However, if goals are needed they can be defined as a desired point on the outcome continuum. A book describing the research and containing the outcomes is available from Mosby Publication.

For additional information contact Lori Penaluna, Program Associate, at the College of Nursing, The University of Iowa (319)-353-5414, e-mail: lori-penaluna@uiowa.edu or fax (319)-335-9990 or http://www.nursing.uiowa.edu/noc/

References

Blegen, M. & Tripp-Reimer, T. (1997). Implications of Nursing Taxonomies for Middle-Range Theory Development. Advances in Nursing Science, 19(3), 37-49.

Head, B., Maas, M. & Johnson, M. (1997). Outcomes for Home and Community Nursing in Integrated Delivery Systems. Caring Magazine, 16(1), 50-56.

Iowa Intervention Project. J.C. McCloskey & G.M. Bulechek (Eds.). (1996). Nursing Interventions Classification (NIC) (2nd ed.). St. Louis: Mosby.

Iowa Outcomes Project. M. Johnson & M. Maas (Eds.). (1997). Nursing Outcomes Classification (NOC). St. Louis: Mosby.

Johnson, S.L., Brady-Schluttner, K., Ellenbecker, S., Johnson, M., Lassengard, E., Maas, M., Stone, J. Westra, B.L. (1996). Evaluating physical functional outcomes: One category of the nursing outcomes classification system. MEDSURG Journal of Nursing 5, 157-162.

Maas, M., Johnson, M., & Moorhead, S. (1996). Classifying nursing-sensitive patient outcomes. Image-Journal of Nursing Scholarship 28,(4), 295-301.

Maas, M., Johnson, M., & Kraus, V. (1996). Nursing sensitive patient outcomes classification. In K. Kelly (Ed.), Series on nursing administration: Outcomes of effective management practices: Vol. 8. (pp. 20-35). Thousand Oaks, CA: Sage Publications.