NOC Implementation and Testing in a Cardiac Surgery ICU

BACKGROUND

Nursing has increasingly found itself in the position of having to demonstrate it makes a difference in the outcome of a patient's recovery. How care is documented plays an important role in validating the effect nursing interventions have on patient outcomes. Standardized nursing languages have been and are being developed to provide a common basis of documentation, communication, and comparison of nursesensitive patient outcomes.

MAIN CONTENT POINTS

Two cardiac surgery ICUs participated as clinical test sites for The University of Iowa continuation grant to refine and validate measures for NOC outcomes. In the cardiac transplant ICU, data were collected on 42 outcomes: 30 had an average interrater reliability of ≥85%; 16 had an absolute agreement interrater reliability of ≥85%. The top 4 outcomes using 80% of the indicators were Communication Ability, Neurological Status, Tissue Integrity: Skin and Mucous Membranes, and Vital Sign Status. The bottom 4 outcomes using ≤51% of the indicators were Nutritional Status: Food and Fluid, Respiratory status: Ventilation, Tissue Perfusion: Cardiac, and Safety Behavior: Fall Prevention.

In the cardiac surgery ICU, data were collected on 30 outcomes: 25 had an average interrater reliability of ≥85%; 6 had an absolute interrater reliability of >85%. The top 5 outcomes using ≥87% of the indicators were Blood Transfusion Reaction Control, Knowledge: Medication, Pain level, Vital Sign Status, and Nutritional Status: Nutrient Intake. The bottom 4 outcomes using ≤54% of indicators were Comfort Level, Infection Status, Tissue Perfusion: Cardiac, and Safety Behavior: Fall Prevention.

The study implementation process included meetings and inservice classes (many one on one) with nursing leadership, resource “super user” RNs, and other staff RNs. Several 1-hour educational inservice classes were offered. Once the study was progressing, charts, e-mail messages, reminder notes, and attending and reporting study progress at staff meetings were used to sustain staff interest and stimulate memory.

Staff anecdotal impressions of the study ranged widely from thinking that the process was too timeconsuming and lacked meaning, to discovering that the outcome label and indicators really helped describe what the nurse assesses when taking care of a cardiac intensive care patient.

CONCLUSIONS

Through being more familiar with NOC, the staff is determining which outcomes comprise core nursing-sensitive outcomes that reflect the type of nursing care given in an ICU. Two new outcomes regarding the ventilator weaning process were developed. These have been submitted to the University of Iowa for consideration.