Advancing the Primary Health Care Mandate for Nursing.

A call to increase home visits and human function documenting by nurses.

Describing precisely what nurses do.

Numerous important papers written by nurses and other scientists to improve nursing practice are not read by many nurses because two of the common ways authors use to describe what nurses do obscures the applicability of studies to nurses in general. Interventions (aka, procedures, skills, tasks) used and populations studied, including diseases, are less robust indicators of research results than are tests of nursing theory. Further, some of these important papers are not stored in or retrieved by accessing the Cumulative Index of Nursing and Allied Health Literature database. We believe many research papers by nurses and those who study nursing would benefit from an explicit rather than implicit test of nursing theory and we advise authors use Henderson's theoretical textbook because of its link to research and expert opinion professional literature. Significant papers should be reversely cited in her textbook to place them in the context of the knowledge of nursing she recorded for much of the 20th century.

Rationale for Quantification in Nursing Services Using the International Council of Nurses Nurse-Patient Summary.

This review provides evidence that new data from nurses meets criteria that explains variation in hospital charges, length of hospital stay and end results of hospital care compared with ICD data; that nurses' data can be used to evaluate assignments of nurses to patients; that new data properly distinguishes patients' human needs within ICD categories. These new data are derived from the professional literature indexed and synthesized by Henderson. It is proposed to adopt the ICN-NPSum to standardize quantification in nursing services.

Nurses' Own Recordkeeping: The Nursing Minimum Data Set Revisited.

There is no consistent, standardized, concise method for nurses to record information about their patients and clients that is conducive to store, retrieve, and use in patient and client care; to improve professional self-development; and to use in collaboration with patients and clients, their families, other nurses, doctors, hospitals, and health systems. Nurses gauge the health status of their patients and clients every day and are now in a position both to record their impressions for their own use and to share them with colleagues who care for the same patients and clients. What is now needed is a way to record these clinical impressions within an authoritative format that is related to the depth and breadth of the clinical literature related to nursing and the needs of the patients and clients nurses serve. The International Council of Nurses' Nurse-Patient Summary is proposed here to fill the gulf between narrative nurses' notes, proprietary and widely varying electronic health record systems, and information from nurses about their patiens and clients human needs. The International Council of Nurses' Nurse-Patient Summary could replace nursing diagnosis items in the Nursing Minimum Data Set and serve as a substitute for the World Health Organization's International Classification of Function, Disability and Health, a seldom used instrument derived from the International Council of Nurses' Basic Principles of Nursing Care.

The reliability and validity of the diabetes care profile for Chinese populations.

This study aimed to translate into Chinese the Diabetes Care Profile (DCP), a measure of psychosocial factors and diabetes treatment, and to test the reliability and validity of the instrument within a Chinese population. The English version of the DCP was translated into Chinese following the standard translation methodology with consideration to cultural adaptation. The questionnaire was administered to 313 people with type 2 diabetes in an urban community in Beijing, China. Cronbach's α coefficient was used to calculate reliabilities, which ranged from .55 to .86 on DCP subscales. Mean values on the DCP differed by diabetes treatment as expected and supports the construct validity of the DCP. The overall score on the DCP correlated well both with blood glucose levels and with a validated measure of a Chinese version of the Diabetes Specific Quality of Life scale, thus supporting the DCP's criterion validity. The DCP is an acceptable measure of the psychosocial factors related to diabetes and its treatment in a Chinese population with type 2 diabetes.

Men, medics, and nursing: The military might just provide a way to curtail the nursing shortage.

The military might just provide a way to curtail the nursing shortage.

Nursing intensity: In the footsteps of John Thompson.

The Nursing Minimum Data Set (NMDS) provides a way to incorporate nursing data into the hospital discharge abstract to potentially compare nursing care across institutions. An extension of this framework is to use these data for directly billing and reimbursing hospital nursing care. We provide a review of the existing literature and new empirical evidence to support hospital nurse billing. Two existing large data sets are compared, one using nursing diagnosis and the other a nursing intensity based tool to collect daily nursing times. These NMDS data sources are compared to diagnostic related groups (DRG) and hospital outcomes from the UB92 discharge abstract using multivariate regression and logistic regression. Either NMDS approach provides additional explanatory power (improvements in R2) over DRG alone. The findings strengthen the argument to use primary nursing data such as nursing intensity as a basis for direct costing, billing, and reimbursement of hospital nursing care.

Nurse staffing, nursing intensity, staff mix, and direct nursing care costs across Massachusetts hospitals.

OBJECTIVE: This study describes the distribution of patient-to-registered nurse (RN) ratios, RN intensity of care, total staff intensity of care, RN to total staff skill mix percent, and RN costs per patient day in 65 acute community hospitals and 9 academic medical centers in Massachusetts. METHODS: We conducted a retrospective secondary analysis of the Patients First database published by the Massachusetts Hospital Association for planned nurse staffing in 601 inpatient nursing units in the state for 2005 using a multivariate linear statistical model controlling for hospital type and unit type. Nursing unit types were identified as adult and pediatric medical/surgical, step down, critical care, neonatal level II, and neonatal level III/IV nurseries. RESULTS: Medical centers had significantly higher case-mix index (1.72 vs 1.20, P < .001), longer lengths of stay (5.18 vs 4.19, P < .001), more beds (574 vs 147, P < .001), discharges (31,597 vs 7,248, P < .001), and patient days (161,440 vs 31,020, P < .001) compared with to community hospitals. Medical centers had significantly lower patient-to-RN ratios (3.22 vs 4.64, P < .001), higher nursing intensity and total nursing staff intensity (9.62 vs 7.43/11.75 vs 9.87, both P < .001), higher percent of RN to all staff mix (79% vs 71%, P < .001), and higher RN costs per patient day ($385 vs $297, P < .001) compared with to community hospitals. There were significant differences in adult med/surg units between community hospitals and medical centers for patient-to-RN staffing ratios (5.25 vs 4.08), nursing intensity (5.1 vs 6.2 hours daily), skill mix (67% vs 73% RN), and RN costs per patient day ($203 vs $248, all P < .001). There were no significant differences between the adult step-down units. CONCLUSION: The significant differences between community hospitals and medical centers, unit type, as well as the high degree of variability in patient-to-RN ratios, nursing intensity, skill mix, and RN costs per patient day suggest that nursing resource expenditure at Massachusetts hospitals is complex and affected by case mix, unit size, and complexity of care.

Nursing diagnoses, diagnosis-related group, and hospital outcomes.

BACKGROUND AND OBJECTIVE: There are no nursing centric data in the hospital discharge abstract. This study investigates whether adding nursing data in the form of nursing diagnoses to medical diagnostic data in the discharge abstract can improve overall explanation of variance in commonly studied hospital outcomes. METHOD: A retrospective analyses of 123,241 sequential patient admissions to a university hospital in a Midwestern city was performed. Two data sets were combined: (1) a daily collection of patient assessments by nurses using nursing diagnosis terminology (NDX); and (2) the summary discharge information from the hospital discharge abstract including diagnosis-related group (DRG) and all payer refined DRG (APR-DRG). Each of 61 daily NDX observations were collapsed as frequency of occurrence for the hospital stay and inserted into the discharge abstract. NDX was then compared to both DRG and APR-DRG across 5 hospital outcome variables using multivariate regression or logistic regression. RESULTS AND CONCLUSIONS: In all statistical models, DRG, APR-DRG, and NDX were significantly associated with the 5 hospital outcome variables (P <.0001). When NDX was added to models containing either the DRG or the APR-DRG, explanatory power (R2) and model discrimination (c statistic) improved by 30% to 146% across the outcome variables of hospital length of stay, ICU length of stay, total charges, probably of death, and discharge to a nursing home (P <.0001). The findings support the contention that nursing care is an independent predictor of patient hospital outcomes. These nursing data are not redundant with the medical diagnosis, in particular, the DRG. The findings support the argument for including nursing care data in the hospital discharge abstract. Further study is needed to clarify which nursing data are the best fit for the current hospital discharge abstract data collection scheme.