Abstract
PURPOSE
To measure and provide evidence supporting the use of NOC as a nursing standardized language.
METHODS
Initially, the group used nursing resources and concept analyses to determine physiologic outcomes important to nursing care and demonstrate contributions of nurses to patient care. After refinement by the NOC team, outcome and indicators were approved and content validity surveys sent to members of the American Association of Nephrology Nurses. A modified Fehring's Diagnostic Content Validity Model was used to determine validity. Respondents used a 5-point Likert-type scale. Each indicator was rated and a weight assigned, and a mean for each indicator was determined. Results of the importance and contribution scores were interpreted using ≥.80 to indicate a “critical” indicator, and ≥.60 to indicate “important” indicators.
FINDINGS
There were 59 total responses with 45 valid cases. The nurses had worked an average of 21.4 years. Twenty-five of the nurses were involved in implementing standardized language, including care-planning systems. The majority, 95%, held master's degrees in nursing and 82.2% were certified. All results were analyzed for both contribution and importance using the established method to determine critical and important indicators in both categories.
Hydration: 13 indicators analyzed.
Contribution: No critical indicators; 11 were rated important (range: 60–77). Importance: 8 indicators rated critical. The 4 highest were shortness of breath not present (.90), blood pressure within normal limits (.89), peripheral edema not present (.88), and adventitious breath sounds not present (.88). Five were rated important (range: 69–78).
Urinary Incontinence: 19 indicators analyzed.
Contribution: No critical indicators; 9 were rated important (range: 61–74). Importance: 5 indicators were rated critical, the 3 highest being recognizes urge to void (.88), absence of urinary tract infection (.86), and absence of postvoid residual (.85) (range: 67–88).
Dialysis Access Integrity: 15 indicators analyzed.
Contribution: 3 were rated critical: drainage at site not present (.83), hematoma at site not present (.82), and bleeding at site not present (.81). There were 11 important indicators (range: 60–78). Importance: 7 were rated critical, the 3 highest being bruit (.97), thrill (.95), and drainage at site not present (.95). Seven were rated as important (range: 64–77).
Systemic Toxin Clearance–Dialysis: 14 indicators analyzed.
Contribution: No critical indicators and 12 important indicators (range: 60–78). Importance: 5 were rated critical, the top 3 being adheres to dialysis schedule (.95), urea reduction ratio (.95), and blood potassium within normal limits (.88). Nine were rated important (range: 63–77).
DISCUSSION
Based on these results, the indicators are representative of the outcomes. Analyses of the indicators supported an overall level of agreement. The highest averages were in two outcomes related to patients undergoing dialysis, which may be because the nurses cared for a specific target group.
CONCLUSIONS
The importance of indicators was rated more highly than the nursing contribution. Most of the indicators were judged quite or very important. The outcomes are nursing sensitive, and nursing is more influential than other disciplines for most of the outcomes.
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