Effects of Using NANDA,NIC,and NOC on Health Outcomes of Schoolchildren: A Pilot Study

PURPOSE

To investigate the effects of using NANDA, NIC, and NOC (NNN) on nurses' power and the children's health outcomes.

METHODS

A quasiexperimental study with a twogroup design was used to examine differences in effects between nurses and children when school nursing software (SNAP) was used with and without NNN. The sample was 12 nurses in 12 schools of Brooklyn and Staten Island, NY (6 in each group). The schools were matched on five variables (ethnicity, socioeconomic status, attendance rate, reading levels, and total registration); nurses from the matched groups were randomly assigned to groups. In the 12 schools, 236 parents gave permission, 232 children (4th and 5th grades) signed assents, and 220 children (101 control group, 119 intervention group) completed pre/post tests. Four instruments for which there were published data on validity and reliability were used, one to measure nurses' power to participate knowingly in children's health and three to measure children's health outcomes. Seven senior baccalaureate degree nursing students were trained in procedures for data collection.

Pre/post tests were administered to both nurses and children with the control group using SNAP software without NNN and the intervention group using SNAP software with NNN. Study protocols were the same for both groups. After completion of the pretests, nurses participated in 3 days of education to prepare them for the study protocols. Nurses met with children in the study for health promotion activities four to eight times over a 7-month period and used the computer software to document these activities. On completion of the study, nurses and children completed the posttests and nurses met to discuss their perceptions of the study.

FINDINGS

With a highest possible score of 336, the pre/post test scores on power of both groups of nurses were high at 262 for the control group and 290 for the intervention group. Posttest scores of the two groups were not significantly different when the pretest scores were taken into account. For both groups, the power scores increased significantly from pre- to posttest (p= .03). Pretest means of children on the three variables showed no differences between the control and intervention groups. pre- and posttests showed there were only small effects in both directions. These changes were not statistically significant with this small sample size. For the total group of children, there was a significant improvement in perceptions of health behaviors (t= 3.19, p= .002). Ancillary findings were that comprehensive and complex nursing services were documented. The visit logs showed logical relations among the NNN categories for nurses in the intervention group. Nurses in both groups reported that children were enthusiastic about participation in health promotion activities and a number of positive outcomes were met.

DISCUSSION

Nurses in this study scored higher on the power tool than did staff nurses in previously reported studies. This may be related to the ongoing opportunities of nurses in school settings to help children with their health. The increase in nursesapos; power from pre- to posttests may be related to participation in the study or may naturally occur in a 1-year time period. Sample size or not enough use of NNN may account for the lack of significant findings regarding nurses' power. More frequent use of NNN is needed to show improvements in health outcomes, or the research instruments were not sensitive enough to changes in children's health outcomes.

CONCLUSIONS

From these study results, it is clear that nurses in schools can use NNN to communicate the elements of nursing care. Schoolwide data collection and aggregation of the elements of nursing care will facilitate a fuller description of children's health. The health outcomes of children were similar before and after this study, indicating there was no harm to children by use of standardized nursing languages as is often claimed by nurses who object to its use. More frequent meetings with children or more frequent use of NNN may be needed to affect nurses' power and children's health outcomes. An extensive field study with a formal research design may not be feasible to test the effects of using NNN on health outcomes. When only small effects occur, the sample sizes that are needed are too large for nurses to manage along with their usual job responsibilities. Evaluation studies can be designed, however, using NOC-based measurements and selected research instruments to demonstrate improvements in health outcomes.