Outcomes management: from concepts to application.

This article provides an introduction to the definition of and rationale for outcomes management and includes a brief review of the outcomes management literature. A model for outcomes management, which links processes that can be changed in care delivery to outcomes that can be measured in a patient population, is reviewed. Guidelines for application of the outcomes management model and practical examples of application to two surgical patient populations are presented. Finally, issues important to outcomes management as a tool for performance improvement are discussed.

Identifying nursing outcome indicators.

Patient outcomes...indicators..measurement. What do these concepts mean to you? More importantly, what do they mean to our customers, the patients? The department of nursing at the University of Maryland Medical System (UMMS) embarked on a 6-month initiative to begin to identify the major outcome indicators of nursing practice. This article will discuss the outcome indicator project from its inception to the identification of the actual outcome indicators. The rationale for undertaking this project and the process of selecting the indicators also will be addressed.

Caregiver learning needs and reactions to managing home mechanical ventilation.

OBJECTIVE: To identify caregivers' learning needs and reactions to providing care for adult patients receiving mechanical ventilation in the home. This report originated from a study that was undertaken to describe family function and reactions of family members. DESIGN: Prospective, descriptive. SETTING: Data collected at clients' homes in a midwestern city. SUBJECTS: Twenty caregivers and adult patients who are dependent on mechanical ventilation at home. INSTRUMENTS: Patients and their caregivers completed family coping and family function instruments. Caregivers also completed a Learning Needs Checklist and a caregiving inventory. RESULTS: The results indicate that caregivers, all relatives, provided an average of 7.3 hours per day direct care with little assistance from extended family or professionals. More disrupted schedules, financial strain, increased burden, and negative reaction to caregiving was associated with increasing ventilator hours per day. Family function was perceived as satisfactory by both patients and caregivers. Survival knowledge and skills were being taught, but additional information was needed by caregivers. There were no differences by gender in perceived learning needs, family function, or tasks of daily caregiving. CONCLUSIONS: Preferences for types of information suggest the use of a three-phase teaching program that should be sensitive to individual learning needs. A variety of coping strategies were used by families to manage home mechanical ventilation including problem-solving and mobilizing help from friends, extended family, community, or church.

Advanced rehabilitation nursing care of coronary angioplasty patients using self-efficacy theory.

The rapidly increasing numbers of patients who experience coronary angioplasty have not been widely studied concerning their rehabilitation, risk factor modification, health maintenance and role resumption. Bandura's self-efficacy theory serves as the framework of a study designed to explore the efficacy expectations for and behavioural performance of walking, following a diet, health maintenance, resumption of role and return to work in angioplasty patients. Based in this study, assessment and intervention strategies used by cardiovascular clinical nurse specialist authors are described with a clinical example.

Adaptation in families with a member requiring mechanical ventilation at home.

Current health care trends indicate that ventilator-dependent patients increasingly will be discharged to home after shorter hospitalizations. The purpose of this study was to determine how care givers adapt to having ventilator-dependent adults at home. Twenty families were interviewed in their homes by using an eight-question semistructured interview guide. The Roy model was used as a framework to analyze these data. Two instruments, the Family Coping Scale (F-COPES) and the Family APGAR, were administered to measure family coping and function. Patients, aged 18 to 74 years, required 24-hour (n = 9), 12- to 15-hour (n = 5), or 8- to 12-hour (n = 6) home ventilatory support and had neuromuscular or trauma-related diagnoses. Months receiving ventilation ranged from 2 to 312. Care givers, aged 20 to 74 years, were all relatives. Six care givers reported using support services outside their extended family. F-COPES scores fell within national norms whether the patient required 24-hour or less ventilation. Family APGAR results revealed satisfaction with overall family function although scores decreased over time. Interview data indicated that essential knowledge and skills are taught but additional information is desired. Both positive and negative responses to care giving were identified, with the majority of responses being concerned with role mastery, self-concept, and dependency issues. Positive themes in the interviews reflected confidence in ventilator care, satisfaction with the decision to care for their family member at home, and improved quality of life. Negative themes in the interviews reflected the burden of care giving, the dependence of the patient on the care giver, resentment, and hopelessness.(ABSTRACT TRUNCATED AT 250 WORDS)