Nursing Outcomes Across a Surgical Care Episode

Abstract

PURPOSETo test the validity and reliability of the NOC labels.METHODS94 NOC labels were assigned to neurologic, orthopedic, and surgical patients. Because of a nursing shortage and nurses' objections to the time‐consuming nature of the study procedures, changes were made in the data‐gathering process. Realizing that busy floor nurses would complete ratings on labels that had already been started but were reluctant to search through 94 different labels to find the ones most critical to their particular patient, the pool of selectable NOCs was shortened by nurse experts from 94 to a handful deemed most critical to the patient population. Outpatient nurses selected NOCs during patients' presurgical work‐up and completed a first rating. Clinic nurses were asked to complete a third rating at the patients' postoperative visit. This left only a second rating and some interrater reliability ratings to be done by inpatient nurses.FINDINGSResults from the surgical patient population involved 122 subjects with preoperative clinic visit ratings and postoperative inpatient setting ratings. Postoperative clinic visit ratings were obtained on 94 of the 122 subjects as well. Twelve different NOCs were used for this population. Most frequently chosen were Comfort Level (n= 78), Pain Level (n= 26), and Ambulation: Walking (n= 24).For Comfort Level the average change from first to second rating (mean difference) was 1.12. Change from first to third rating was 1.53. Change from second to third rating was 0.48. These mean differences are all significant at the p<.001 level. Subjects who were rated on Comfort Level in the inpatient setting only (n= 14) demonstrated a change from first to second rating of 0.77, from first to third rating 1.43, and from second to third rating of 0.67. The n on other individual labels of the study subset was too small for meaningful tests of statistical significance. However, grouping all labels together, all mean difference ratings for this population are significant at the p<.001 level.DISCUSSIONNOC is conceptualized as a neutral patient state that will vary across the life span of the individual as that person's health status changes. It seems axiomatic that ratings spaced widely across the span of a surgical episode of care would demonstrate greater change than those clustered during the inpatient portion of the episode of care. Although very small, this study lends credence to the validity of the language to capture patient state changes.CONCLUSIONSThe question of when to rate NOCs is of more than passing theoretical interest. It is critical to the appropriate use of outcomes. Although this work needs to be replicated with a larger sample size, different diagnosis‐related groups, and at different institutions, this preliminary work seems to support the ability of NOC to demonstrate significant changes in outcome ratings across an acute surgical episode of care.