Nursing process outcome linkage research: issues, current status, and health policy implications.

BACKGROUND

The use of large clinical datasets to assess the effectiveness of health care is of growing interest in continuing efforts to understand the impact of healthcare costs on quality. Correspondingly, there is a greater need to define and measure outcomes that are sensitive to nursing interventions. However, concerns exist about the ability to amass and use large clinical nursing datasets to assess the effectiveness of nursing interventions. Some nursing studies have used large clinical datasets to examine patterns of nursing diagnoses, interventions, and outcomes. Among patient populations, however, systematic effectiveness studies of nursing process and outcome linkages at the individual nurse and patient level of analysis are essentially nonexistent. This is largely the result of slow development of nursing classifications, reference terminologies, and reference information standards. Nursing information systems have an unprecedented potential for documentation of nursing practice, as well as the accumulation and analysis of large clinical datasets, to improve nursing performance, increase nursing knowledge, and provide data and information necessary for nursing to participate in the formulation of healthcare policy.

OBJECTIVES

A literature search shows that a common framework is beginning to evolve that represents nursing's essential information, eg, the Nursing Minimum Data Set, Management Minimum Data Set, and several standardized nursing languages. Extensive research and other initiatives have produced 1) nursing languages and reference terminologies that span healthcare settings; 2) information models; and 3) standards for datasets supporting information systems. A number of issues remain, however, that concern the development of uniform nursing datasets, definitions of outcomes, quality of nursing data, information system design, and methods of data analysis. We review nursing process outcome research, clarify issues inherent in nursing effectiveness research, and discuss implications for nursing and health policy.