Measuring nursing outcomes: a challenge for improving patient care

Dr William T F Goossen 
Senior Researcher and Consultant at Acquest Consultancy, Koudekerk aan den Rijn, The Netherlands

This paper is based on a presentation for the conference Health Services at the service of the Citizens for the regional ministry of health, Ars Norte in Porto, Portugal 19 October 1999

Introduction 

Changes in the population of European countries, such as ageing and increases in chronic diseases, require healthcare to adapt in order to continue delivering quality care. Citizens become knowledgeable and are demanding the best and ‘value for money’ care. In earlier times, the patient was heavily dependent on the skills and knowledge of doctors, and their professional power. Today, the patient is a consumer who shops to find what he believes is best for him or her. Of course, not every patient will be able to do so, but the picture for healthcare is clear: equal access means that those who cannot ‘shop’ will need and probably get some kind of support to do so

Increasingly, information about the performance of hospitals and clinicians becomes available to the public, partly via traditional publications such as consumer journals, additionally via new media as the Internet (e.g., WHO, 1999, Health-mart.net, 1999)

Traditionally, general outcome indicators for health gain include the death rate (mortality), prevalence and incidence rates of diseases (morbidity), costs, and length of stay (LOS), usually adjusted for the socio-economic situation in a country (WHO, 1999). Important is that these outcome variables are usually describing large populations. Additionally, we see an interest in so called patient or consumer satisfaction scales and general health surveys. These measure outcomes at group level

With a greater diversity in clients, and especially the diversity of their wishes for individually tailored care, there is a need for more detailed measures, preferably at the individual patient level. Here, the individual medical treatment result plays an important role. Additionally, nursing care increasingly plays a role in determining outcomes at the level of the individual patient and provider

There are however very few reports available on the use of specific nursing quality or nursing outcome indicators. Nursing plays an important role in determining outcomes at the level of the individual patient. To date, measures of ‘nursing sensitive patient outcomes’ are rare, and usually include small-scale studies. There is a growing need for the documentation of individual nursing outcome measures and the analysis of this in large populations

The purpose of this contribution is to explore if nursing is, or will be, able to measure ‘nurse sensitive’ patient outcomes, and thus can account for their contribution to health care. This exploration is mainly based on a literature study, although some empirical data from the Dutch nursing minimum data set project will be presented to illustrate the feasibility of collecting data on nursing outcomes in the European setting. The concept of nursing sensitive nursing outcomes will be explored, when a fundamental restriction is explained first. Secondly, examples of outcome measures in nursing from the literature are presented. Thirdly, the issue of measurement is addressed conceptually. Finally, the measurement of some nursing outcomes that serve as quality indicators will be illustrated with material from the pilot of the Nursing Minimum Data Set for the Netherlands (further: NMDSN)

Dr William T F Goossen